Imaging work-up of urinary tract infection (UTI) is controversial; professional society guidelines vary internationally
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
't Hoen LA et al: Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol. 17(2):200-7, 2021
Buettcher M et al: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr. 180(3):663-74, 2020
Freesmeyer M et al: Real-time DMSA-SPECT/US fusion imaging revealing nonscarring loss of function after pyelonephritis. Clin Nucl Med. 45(6):e274-5, 2020
Lee YJ et al: Relationship between breastfeeding, birth history, and acute pyelonephritis in infants. J Korean Med Sci. 35(8):e32, 2020
Pleniceanu O et al: Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol. ePub, 2020
Simrén Y et al: Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants. J Pediatr Urol. 16(3):320-5, 2020
Sjöström S et al: Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy. Pediatr Nephrol.36(6):1489-97, 2020
Warner J et al: Unenhanced MRI of the abdomen and pelvis in the comprehensive evaluation of acute atraumatic abdominal pain in children. AJR Am J Roentgenol. 215(5):1218-28, 2020
Zhu H et al: Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis. Transl Pediatr. 9(4):487-95, 2020
Bahat H et al: Predictors of grade 3-5 vesicoureteral reflux in infants ≤2 months of age with pyelonephritis. Pediatr Nephrol. 34(5):907-15, 2019
Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
Millner R et al: Urinary tract infections. Pediatr Clin North Am. 66(1):1-13, 2019
Shaikh N et al: Host and bacterial markers that differ in children with cystitis and pyelonephritis. J Pediatr. 209:146-53.e1, 2019
Bosakova A et al: Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: a prospective study. J Pediatr Urol. 14(3):269.e1-7, 2018
Lee JW et al: D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol. 33(4):631-7, 2018
Palmer LS et al: Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial. World J Urol. 36(9):1441-7, 2018
Chung EM et al: Imaging of the pediatric urinary system. Radiol Clin North Am. 55(2):337-57, 2017
Expert Panel on Pediatric Imaging:. et al: ACR Appropriateness Criteria® Urinary Tract Infection-Child. J Am Coll Radiol. 14(5S):S362-71, 2017
Mattoo TK et al: Interobserver variability for interpretation of DMSA scans in the RIVUR trial. J Pediatr Urol. 13(6):616.e1-6, 2017
Arlen AM et al: Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. J Pediatr Urol. 12(5):288.e1-5, 2016
Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis & Management of the Initial Urinary Tract Infection in Febrile Infants & Young Children 2–24 Months of Age. American Academy of Pediatrics. Published December, 2016. Accessed March 2021. https://pediatrics.aappublications.org/content/138/6/e20163026
Zhang GQ et al: The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol. 31(3):373-9, 2016
de Bessa J Jr et al: Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol. 193(5 Suppl):1772-7, 2015
Morello W et al: Acute pyelonephritis in children. Pediatr Nephrol. 31(8):1253-65, 2015
Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
Shaikh N et al: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 1:CD009185, 2015
Sood A et al: Incidence, admission rates, and economic burden of pediatric emergency department visits for urinary tract infection: data from the nationwide emergency department sample, 2006 to 2011. J Pediatr Urol. 11(5):246.e1-8, 2015
Cerwinka WH et al: Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol. 10(2):344-51, 2014
Jacobson D et al: Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 29(5):919-25, 2014
Strohmeier Y et al: Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 7:CD003772, 2014
Yang TH et al: Obesity and a febrile urinary tract infection: dual burden for young children? Urology. 84(2):445-9, 2014
La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
Leroy S et al: Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 131(5):870-9, 2013
Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
Brenner M et al: Comparison of 99mTc-DMSA dual-head SPECT versus high-resolution parallel-hole planar imaging for the detection of renal cortical defects. AJR Am J Roentgenol. 193(2):333-7, 2009
Siomou E et al: Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 124(3):881-7, 2009
Cerwinka WH et al: Magnetic resonance urography in pediatric urology. J Pediatr Urol. 4(1):74-82; quiz 82-3, 2008
Urinary tract infection in children: diagnosis, treatment & long-term management. National Collaborating Centre for Women's & Children's Health. Commissioned by the National Institute for Health & Clinical Excellence. Published August 2007. Updated 2017. Accessed March 2021. https://www.nice.org.uk/guidance/cg54/evidence/full-guideline-pdf-196566877
Gonzalez E et al: Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol. 173(2):571-4; discussion 574-5, 2005
Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
AAP Gateway: Urinary tract infection: clinical practice guideline for the diagnosis & management of the initial UTI in febrile infants & children 2 to 24 months. Published August, 2011. Accessed May 2016. http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330
NICE: NICE guidelines. Published August 2007. Accessed May 2016. https://www.nice.org.uk/guidance/cg54
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Synonyms
Acute lobar nephronia, focal bacterial nephritis
Definitions
Acute infection of renal parenchyma
Overview
Classic imaging appearance: Focal swelling & ↓ perfusion of affected parenchyma visible on nuclear scintigraphy, US, CT, & MR
Associated vesicoureteral reflux (VUR) in ~ 1/3 of cases
Permanent scarring is more likely in children < 2 years old
Imaging work-up of urinary tract infection (UTI) is controversial; professional society guidelines vary internationally
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
't Hoen LA et al: Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol. 17(2):200-7, 2021
Buettcher M et al: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr. 180(3):663-74, 2020
Freesmeyer M et al: Real-time DMSA-SPECT/US fusion imaging revealing nonscarring loss of function after pyelonephritis. Clin Nucl Med. 45(6):e274-5, 2020
Lee YJ et al: Relationship between breastfeeding, birth history, and acute pyelonephritis in infants. J Korean Med Sci. 35(8):e32, 2020
Pleniceanu O et al: Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol. ePub, 2020
Simrén Y et al: Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants. J Pediatr Urol. 16(3):320-5, 2020
Sjöström S et al: Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy. Pediatr Nephrol.36(6):1489-97, 2020
Warner J et al: Unenhanced MRI of the abdomen and pelvis in the comprehensive evaluation of acute atraumatic abdominal pain in children. AJR Am J Roentgenol. 215(5):1218-28, 2020
Zhu H et al: Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis. Transl Pediatr. 9(4):487-95, 2020
Bahat H et al: Predictors of grade 3-5 vesicoureteral reflux in infants ≤2 months of age with pyelonephritis. Pediatr Nephrol. 34(5):907-15, 2019
Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
Millner R et al: Urinary tract infections. Pediatr Clin North Am. 66(1):1-13, 2019
Shaikh N et al: Host and bacterial markers that differ in children with cystitis and pyelonephritis. J Pediatr. 209:146-53.e1, 2019
Bosakova A et al: Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: a prospective study. J Pediatr Urol. 14(3):269.e1-7, 2018
Lee JW et al: D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol. 33(4):631-7, 2018
Palmer LS et al: Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial. World J Urol. 36(9):1441-7, 2018
Chung EM et al: Imaging of the pediatric urinary system. Radiol Clin North Am. 55(2):337-57, 2017
Expert Panel on Pediatric Imaging:. et al: ACR Appropriateness Criteria® Urinary Tract Infection-Child. J Am Coll Radiol. 14(5S):S362-71, 2017
Mattoo TK et al: Interobserver variability for interpretation of DMSA scans in the RIVUR trial. J Pediatr Urol. 13(6):616.e1-6, 2017
Arlen AM et al: Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. J Pediatr Urol. 12(5):288.e1-5, 2016
Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis & Management of the Initial Urinary Tract Infection in Febrile Infants & Young Children 2–24 Months of Age. American Academy of Pediatrics. Published December, 2016. Accessed March 2021. https://pediatrics.aappublications.org/content/138/6/e20163026
Zhang GQ et al: The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol. 31(3):373-9, 2016
de Bessa J Jr et al: Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol. 193(5 Suppl):1772-7, 2015
Morello W et al: Acute pyelonephritis in children. Pediatr Nephrol. 31(8):1253-65, 2015
Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
Shaikh N et al: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 1:CD009185, 2015
Sood A et al: Incidence, admission rates, and economic burden of pediatric emergency department visits for urinary tract infection: data from the nationwide emergency department sample, 2006 to 2011. J Pediatr Urol. 11(5):246.e1-8, 2015
Cerwinka WH et al: Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol. 10(2):344-51, 2014
Jacobson D et al: Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 29(5):919-25, 2014
Strohmeier Y et al: Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 7:CD003772, 2014
Yang TH et al: Obesity and a febrile urinary tract infection: dual burden for young children? Urology. 84(2):445-9, 2014
La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
Leroy S et al: Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 131(5):870-9, 2013
Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
Brenner M et al: Comparison of 99mTc-DMSA dual-head SPECT versus high-resolution parallel-hole planar imaging for the detection of renal cortical defects. AJR Am J Roentgenol. 193(2):333-7, 2009
Siomou E et al: Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 124(3):881-7, 2009
Cerwinka WH et al: Magnetic resonance urography in pediatric urology. J Pediatr Urol. 4(1):74-82; quiz 82-3, 2008
Urinary tract infection in children: diagnosis, treatment & long-term management. National Collaborating Centre for Women's & Children's Health. Commissioned by the National Institute for Health & Clinical Excellence. Published August 2007. Updated 2017. Accessed March 2021. https://www.nice.org.uk/guidance/cg54/evidence/full-guideline-pdf-196566877
Gonzalez E et al: Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol. 173(2):571-4; discussion 574-5, 2005
Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
AAP Gateway: Urinary tract infection: clinical practice guideline for the diagnosis & management of the initial UTI in febrile infants & children 2 to 24 months. Published August, 2011. Accessed May 2016. http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330
NICE: NICE guidelines. Published August 2007. Accessed May 2016. https://www.nice.org.uk/guidance/cg54
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.