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First uncomplicated acute upper UTI in a child aged 3 years or over — MSRA MCQ

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ModerateUrinary Tract InfectionsFirst uncomplicated acute upper UTI in a child aged 3 years or overMSRA

A 4-year-old girl is reviewed after her first confirmed urinary tract infection. She initially presented with fever of 39.1°C, dysuria and abdominal pain. A clean-catch urine culture grew Escherichia coli. She was treated with oral antibiotics and became afebrile with resolution of symptoms within 36 hours. She has normal urine flow, no palpable abdominal or bladder mass, normal renal function and no history of antenatally detected renal abnormality. She was not seriously unwell and has had no previous UTI. What is the most appropriate imaging plan?

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Correct answer: C — Arrange no routine urinary tract imaging

This child has had a first acute upper UTI: bacteriuria with fever of at least 38°C. However, she is aged over 3 years, has responded promptly to suitable treatment, and has no atypical features or recurrent infection. NICE therefore recommends no routine imaging after a first UTI in children aged 3 years or over who respond well within 48 hours. A renal tract ultrasound during the acute illness is indicated for atypical UTI, such as non-E. coli infection, poor urine flow, raised creatinine, septicaemia, serious illness or failure to respond within 48 hours. Ultrasound within 6 weeks is indicated in this age group following recurrent UTI, not after an uncomplicated first infection. A DMSA scan at 4 to 6 months is used for children aged 3 years or over with recurrent UTI, whereas MCUG is not routinely performed and is reserved for selected circumstances. The key discriminator is the combination of age, first episode, E. coli pathogen and rapid clinical response.

Reference: Urinary tract infection in under 16s: diagnosis and management (NG224) – Recommendations (27 July 2022) — https://www.nice.org.uk/guidance/ng224/chapter/Recommendations