NEW CLINICAL GUIDLINES FOR THE DIAGNOSIS, IMAGING AND TREATMENT OF FEBRILE URINARY TRACT INFECTIONS IN CHILDHOOD

Febrile urinary tract injection (FUTI) is a common bacterial disease and significant cause of morbidity, particularly in infancy and small children. The diagnosis is based on the presence of pyuria and bacteriuria in an appropriately collected urine sample. Prompt and adequate antibiotic treatment prevents complications and possible permanent renal damage (scarring). The risk of renal scarring is increased in children with vesicoureteral reflux and voiding dysfunction. A proportion of children with renal scarring are at a risk of subsequent long-term complications like proteinuria, hypertension, pregnancy-related complications and end-stage renal disease. Thus, all children,following diagnosis of FUTI necessitate imaging studies including renal and bladder ultrasonography, voiding cystography and technetium-99m-dimercaptosuccinic acid scintigraphy. Based on current guidelines, the relevance and sequence of imaging strategy following FUTI practiced for decades are currently under intense debate. Based on excellent prognosis in the majority of children, appropriate education of parents is important for follow-up, prompt diagnosis and treatment of recurrent FUTI. In this review, based on new evidence, problems considering diagnosis, imaging and treatment of childhood FUTI will be discussed in detail including newly proposed guidelines as well as their implications in clinical practice.