Re: Follow up for UTI in 3 yo girl

[Guest guest]

I had a very similar case in a new 4 year old female patient with her

first UTI. I went over some literature including an AFP article

from a few years ago and a few other references I found on MDConsult.

AAP had some guidelines for this in 1999.

In my case, the dad declined any testing.

Hi Folks- I would love you opinion on this, as I am trying to

see if this pt can avoid a VCUG.

Healthy 3 yo girl first UTI, likley from wet bathing suit, just

started swimming lessons. Had lower abdo pain, freq and dysuria. No

back pain no fever. Urine dip , postive for leuk-75, no blood, no

nitrates. Culture grew 50,000-100,000 CFU/ML OF CITROBACTER KOSERI

(DIVERSUS), so not over 100 000.

Child is much better. I ordered a follow up urine culture and

US, results not back yet. Should I also order a VCUG? It seems invasive

and has Radiation. All my references say order a VCUG for bladder

infection for girls under 5 yo. But she only had less than 100 000

CFU..maybe that does nto count as full blown UTI. My peds colleague

says do VCUG. My FP colleague says not for the first UTI but on the

second. What woud you all do? Thx in advance for the replies. I can

always count on this brilliant group.

--

M.D.

www.elainemd.com

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[Guest guest]

Elaine,Since she is 3 yo with first UTI, was afebrile, is now improving with treatment and without other known complications, most would not do a VCUG. About the culture: Citrobacter koseri, can be found everywhere. It's on the skin, especially in the GU-rectal area, because it's a common intestinal inhabitant. It's also in soil, can be found in water. So could be a contaminant especially if this was a bag specimen. A 3 yo girl is a good candidate for a clean catch that you can count on, with assistance.AAP recommends unless you can get a reliable clean catch, get a transurethral or suprapubic urine. Hope this helps Further Outpatient CareThe American Academy of Pediatrics recommends all infants and young children (2 months to 2 years of age) with first UTI have a urinary tract ultrasonography and voiding cysto-urography (VCUG). These tests should be acquired promptly if patients fail to show expected clinical response within 2 days of treatment.All patients should have close follow-up to evaluate response to antibiotics.Repeat urinalysis and/or urine cultures are not needed if the patient’s condition responds to therapy as expected.Hi Folks- I would love you opinion on this, as I am trying to see if this pt can avoid a VCUG.Healthy 3 yo girl first UTI, likley from wet bathing suit, just started swimming lessons. Had lower abdo pain, freq and dysuria. No back pain no fever. Urine dip , postive for leuk-75, no blood, no nitrates. Culture grew 50,000-100,000 CFU/ML OF CITROBACTER KOSERI (DIVERSUS), so not over 100 000.Child is much better. I ordered a follow up urine culture and US, results not back yet. Should I also order a VCUG? It seems invasive and has Radiation. All my references say order a VCUG for bladder infection for girls under 5 yo. But she only had less than 100 000 CFU..maybe that does nto count as full blown UTI. My peds colleague says do VCUG. My FP colleague says not for the first UTI but on the second. What woud you all do? Thx in advance for the replies. I can always count on this brilliant group.-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

[Guest guest]

thanks Kathleen - I am to0  lazy to look this up- If  you have a sick  little one how many hrs  do i wait trying ot  get  bagged specimen- ok that is not a  c lean catch--  knowing I have to  have the pee before I start  antibx? The situation is febrile little munckin., no obvious cause

The ER nurses tell me they will just stick a bag on but the pediatricians reprimand  me if I admit I did that?(I am afraid of  my local pedaitricians I admit pediatrician -fear)  HAD this happen recenlty I mean how long can I waitt?he was well enough to go home for montioring  I did not give him an IV( more fluids--> make him pee) 

I t was toughAdvice?Jean

 

Elaine,Since she is 3 yo with first UTI, was afebrile, is now improving with treatment and without other known  complications, most would not do a VCUG. About the culture:  Citrobacter koseri, can be found everywhere. It's  on the skin, especially in the GU-rectal area, because it's a common intestinal inhabitant.  It's also in soil, can be found in water.  So could be a contaminant  especially if this was a bag specimen.   A 3 yo girl is a good candidate for a clean catch that you can count on, with assistance.

AAP recommends unless you can get a reliable clean catch, get a transurethral or suprapubic urine.  Hope this helps 

Further Outpatient CareThe American Academy of Pediatrics recommends all infants and young children (2 months to 2 years of age) with first UTI have a urinary tract ultrasonography and voiding cysto-urography (VCUG). These tests should be acquired promptly if patients fail to show expected clinical response within 2 days of treatment.

All patients should have close follow-up to evaluate response to antibiotics.Repeat urinalysis and/or urine cultures are not needed if the patient’s condition responds to therapy as expected.

Hi Folks- I would love you opinion on this, as I am trying to see if this pt can avoid a VCUG.

Healthy 3 yo girl first UTI, likley from wet bathing suit, just started swimming lessons. Had lower abdo pain, freq and dysuria. No back pain no fever. Urine dip , postive for leuk-75, no blood, no nitrates. Culture grew   50,000-100,000 CFU/ML OF CITROBACTER KOSERI (DIVERSUS), so not over 100 000.

Child is much better. I ordered a follow up urine culture and US, results not back yet. Should I also order a VCUG? It seems invasive and has Radiation. All my references say order a VCUG for bladder infection for girls under 5 yo. But she only had less than 100 000 CFU..maybe that does nto count as full blown UTI. My peds colleague says do VCUG. My FP colleague says not for the first UTI but on the second. What woud you all do? Thx in advance for the replies. I can always count on this brilliant group.

--  M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. 

If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. 

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD    

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[Guest guest]

I remember in the " old " days - we used to let girls get a 2nd UTI before a workup.

I also remember a urologist saying that he worked up every UTI in kids because the time between the 1st and 2nd full UTI may be years, but if the patient has urinary reflux, they will then have years of kidney scarring before the full workup is done.

..

There are guidelines now, so I usually try to follow them.

 

At the very least, the parents should be counseled that while it is unlikely that reflux is present (which could be dx'd on the VCUG), if it is missed, scarring of the kidneys can result.

If they decline the VCUG fine -- but at least they were aware of the potential problems that may be missed.

 

See bottom of e-mail for interesting abstract on citrobacter in kids.

 

You should have just asked the internet. Saw this webpage with the exact question you asked.

;-)

 

http://www.netwellness.org/question.cfm/62520.htm

 

Does my toddler really need a VCUG?

05/30/2008

Question:

My son had a urinary tract infection about a year ago, when he was about two years and two months old. He had recently been potty trained. He also was constipated for a couple of months because he did not like to poop in the toilet. The doctor recommended an ultrasound and a VCUG. We had the ultrasound done and the results were normal. I did not take him to do the VCUG because it was going to be invasive, too uncomfortable, and too terrifying for my son (who really hates to be in those type of situations), especially since I didn`t think anything anatomical had caused his UTI. He had never had a UTI before that incident, and he has not had one in the past 12 months. However, my doctor is still pushing me to have it done. In addition, a routine urine exam during his third year visit turned out normal. He is now three years and four months old. So, my question is: If my son has not had a UTI in over a year, does he still really need to have a VCUG, or is this a situation in which it not really necessary? Thank you for your time and expertise.

Answer:

There are a few considerations. UTIs can be divided into bladder infections (burning, frequency, incontinence, blood in the urine, malodorous urine) and kidney infections (back pain, fever, abdominal pain, occasionally nausea and vomiting). Repeated kidney infections can cause kidney damage. Boys who are uncircumcised are at greater risk for a bladder infection than boys who are circumcised, and sometimes the urine sample becomes contaminated by the foreskin. The VCUG primarily is intended to identify individuals who have urinary reflux, which predisposes to kidney infection. If the infection was characteristic of a kidney infection, it would be a good idea to get the VCUG. In some centers, the test can be performed with mild sedation. On the other hand, if the infection involved the bladder, then I would not recommend getting a VCUG at this time.

 

Not sure how accurate this website is, but here is another discussion.

http://www.gp-training.net/protocol/paediatrics/uti_children.htm

Urinary tract infection (UTI) in children

4% of boys and 12% of girls will have had a UTI by the age of 16 years: of these 4% will get kidney scars and 50% may develop hypertension at some point in their life and 10% of those scarred will develop renal failure at some point in their lives.

Symptoms include

Dysuria, frequency, haematuria, smelly urine Bed wetting (new/recurrence) Abdominal pain/discomfort Pyrexia of unknown origin General malaise/non specific illness Failure to thrive Not feeding well Vomiting Prolonged jaundice in the new born or none of these

Scarring occurs in children who have vesico-ureteric reflux and urinary tract infection. Scars can happen within three days. If children have not scarred their kidneys by the age of four, there is good evidence that they will not scar after that age (1997) .

A child may have scarred its kidney many years prior to a first recognised UTI. A child may have scarred its kidney many years prior to a first recognised UTI (they may have had a " silent " undetected UTI).

Summed up ......

No reflux, no scar No UTI, no scar Reflux + UTI may produce focal scars

Therefore, when presented with a child (of any age) with an illness of uncertain cause always collect a urine sample.

snip/snip

All children have an abdominal ultrasound: structural information; shows dilatation, obstruction, cysts, stones, bladder etc.

Gross abnormalities only, little information about small scars (It is non-invasive, safe, pleasant and cheap)

All children have a DMSA scan (TC00 dimercaptosuccinic acid)

This is a protein bound radio isotope which is taken up by the proximal tubules. It involves a small injection (Emla used) 1-2 hours before scan Very little co-operation is needed Static and shows up parenchyma (i.e. " meat " of the kidneys)

MCUG (micturating cystogram urethral/supra pubic catheterisation) It is the only way of demonstrating vesico-ureteric reflux This is an additional investigation done in : the very young (<1 year) or those children with a family history of reflux or if abnormal DMSA or ultrasound. IVU seldom done unless specific information required (usually anatomical information). This is because it is poor at showing small scars and radiation dose is higher than radio-isotope studies)

Subsequent management

Under 1 year of age:

If normal MCUG, U/S and DMSA:

Discharge

If abnormal MCUG, U/S or DMSA:

structural: surgical opinion scarring - if refluxing still, continue prophylaxis and urine monitoring every 3 months and when child unwell always monitor BP for life

Reflux alone:

prophylaxis (trimethoprim) is given urine monitored every three months and when child unwell re-investigate at 4 years of age

1-4 years of age

If U/S and DMSA normal:

monitor for UTIs until 4 years of age (specimen of urine checked every 3 months and when child unwell

If DMSU shows scarred kidneys:

MCUG performed monitor urine (every 3 months) and keep on prophylaxis if refluxing when MCUG performed, continue prophylaxis (trimethoprim) and urine monitoring monitor BP for life

If further UTI under 4 years:

MCUG and repeat DMSA (however in practice between the ages of 3.5 and 4 years usually just the DMSA is repeatd and then a MCUG only if DMSA abnormal if no more UTIs by 4 years - discharge

Over 4 years of age (up to 16yrs)

If U/S and DMSA results normal

discharge

If abnormal DMSA (scarred kidneys)

MCUG: if still refluxing prophylaxis (trimethoprim) and urine monitoring monitor BP for life

A child over 4 years of age with recurrent UTIs and normal investigations is not considered to be at risk of scarring For problematic, repeated UTIs

refer

=================================

http://journals.lww.com/pidj/Abstract/1999/10000/Citrobacter_urinary_tract_infections_in_children.10.aspx

The Pediatric Infectious Disease Journal:

October 1999 - Volume 18 - Issue 10 - pp 889-892

Original Studies

Citrobacter urinary tract infections in children

GILL, MICHELLE A. MD, PHD; SCHUTZE, GORDON E. MD

Abstract

Background. Citrobacter species have been described as the etiologic agents in cases of bacteremia, meningitis, diarrhea and brain abscess, but little is known of their role as a cause of urinary tract infections in children. The purpose of this study was to define the role of Citrobacter species in pediatric urinary tract infections.

Methods. The project consisted of a retrospective chart review of microbiologic and medical records of patients younger than 18 years of age with urine cultures positive for Citrobacter species during a 3-year period.

Results. Thirty-four patients with 37 infections were included in the review. |The average patient age was 6.9 years (range, 1 month to 18 years) and 71% were female. Fifty-six percent of the patients had urinary tract/renal anomalies or neurologic impairment and 26% represented nosocomial infections.

Thirty-seven percent of patients were asymptomatic at the time of diagnosis, whereas 63% complained of at least one of the following findings: gastrointestinal symptoms; dysuria; fever; incontinence; penile/vaginal discharge; frequency; flank pain; and hematuria.

Twenty-six of the isolates were Citrobacter freundii and 11 were Citrobacter koseri. Blood cultures were obtained in 9 patients and all were negative for Citrobacter isolates.

Conclusions. Although it is uncommon Citrobacter can cause urinary tract infections in the pediatric population, which occur more frequently in children with underlying medical conditions. It appears that treatment similar to that of other Gram-negative enteric organisms is the most prudent approach to these children until more information can be gathered.

Locke, MD

[Guest guest]

You know, I've been thinking your pediatrician up there, is perhaps a jerk? Based on your observations and notes in the past. Enough about him.Now about your kid.As you know, it depends on the age of the munchkin. The same old rubric applies: A 6 minute old human is a different creature than a 6 hour old human, is different from a 6 day old infant, is different from a 6 week old, is different from a 6 month old...6 year old.... 16 year old. After that they start to level out a bit and then it's beyond my jurisdiction sometime around 21. Like, the newborns are a separate kind of being, you know? I'm old school. Nobody can fault you or me for working up a baby under two months old, who has fever of unknown source or is vomiting with or without fever or who plain just doesn't look right. Collect all fluids for exam and culture. Consider images because it could be NEC even in a full term baby, or pneumonia. CBCs, blood cultures, spinal taps, urine cultures, even images, are all cheap; lives are not cheap. And if herpes even crosses your mind fleetingly, treat immediately and continue investigations while that drip is running. There is some new evidence coming in, opinions falter and change here and there with what appears to be the new evidence based treatment. But still I follow Patton's Rule as above until the evidence strongly suggests this results in more harm than good. But I'm thinking your kid is older than two months? Toddlers and almost toddlers who can't always tell you what hurts or where what hurts, are trickier. So much depends on age, how sick the kid looks, how reliable or capable the parents are. This is where algorithms, cookbooks and minute clinics are not working well. A good looking, smiling toddler with fever can really have the meninge, go down so fast that there is nothing you can do or could have done to keep that child from trying to go to heaven. It does happen. However, what ever the toddler has, is more likely to be the current viral thing going around than meninge. On waiting for the child to pee. Sigh. I always thank a nurse for putting a bag on the child. It's always good to have some idea of the amount of urine out put. And I'm always so happy that the kid is getting some attention in the ER before I get there. Would I use it for a culture? No. That said. If the UA is leuk or nitrite negative, that actually means something to most of us, right? unless the urine is very dilute. Still not a guarantee despite the negative predictability. So what to do while waiting for the kid to produce some urine? I'm a big believer in serial observations while we hydrate the wee wee out of the kid and the wait time accumulates. ERs may not like it, but they are usually very gracious to kids. Clean up the wee wee spots, put on some topical while holding a cup in position to catch any urine that may decide to come out with the stimulation, put on a fresh bag. Hydrate, oral or IV. If the kid can't keep the oral hydration down, well that's important information. Then after a suitable time to allow the topical to work, cath the kid. Then you're good to wait. Have quality time and a cup of tea with the parents, they will appreciate it, finish those pesky discharge dictations,make phone calls. The urine will come out. I have never, ever, regretted the time spent. Supra pubic taps are the standard with proper technique, but if there is not enough fluid in the tank, you will come up dry no matter how good the technique. So cath, wait and hydrate works for me. Hamster wheels do not like this. But I like sleeping well at night. It becomes for me, a matter of what am I treating if I treat with abx even though I don't anything to impugn? Of course this too depends on age. A 6 year old is so different from a 6 month old...Golly, long post. Saturday night logorrhea. If I've left any gaps or questions, please let's talk. Please forgive. I teach medical decision making to med students. Hence verbosity and style.Time to watch Dr. Who with the family.God speed to all of you getting through this night and sweet dreams to those who get to sleep tonight. K thanks Kathleen - I am to0 lazy to look this up- If you have a sick little one how many hrs do i wait trying ot get bagged specimen- ok that is not a c lean catch-- knowing I have to have the pee before I start antibx? The situation is febrile little munckin., no obvious cause The ER nurses tell me they will just stick a bag on but the pediatricians reprimand me if I admit I did that?(I am afraid of my local pedaitricians I admit pediatrician -fear) HAD this happen recenlty I mean how long can I waitt?he was well enough to go home for montioring I did not give him an IV( more fluids--> make him pee) I t was toughAdvice?JeanOn Sat, Jun 5, 2010 at 2:08 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote: Elaine,Since she is 3 yo with first UTI, was afebrile, is now improving with treatment and without other known complications, most would not do a VCUG. About the culture: Citrobacter koseri, can be found everywhere. It's on the skin, especially in the GU-rectal area, because it's a common intestinal inhabitant. It's also in soil, can be found in water. So could be a contaminant especially if this was a bag specimen. A 3 yo girl is a good candidate for a clean catch that you can count on, with assistance.AAP recommends unless you can get a reliable clean catch, get a transurethral or suprapubic urine. Hope this helps Further Outpatient CareThe American Academy of Pediatrics recommends all infants and young children (2 months to 2 years of age) with first UTI have a urinary tract ultrasonography and voiding cysto-urography (VCUG). These tests should be acquired promptly if patients fail to show expected clinical response within 2 days of treatment.All patients should have close follow-up to evaluate response to antibiotics.Repeat urinalysis and/or urine cultures are not needed if the patient’s condition responds to therapy as expected.Hi Folks- I would love you opinion on this, as I am trying to see if this pt can avoid a VCUG.Healthy 3 yo girl first UTI, likley from wet bathing suit, just started swimming lessons. Had lower abdo pain, freq and dysuria. No back pain no fever. Urine dip , postive for leuk-75, no blood, no nitrates. Culture grew 50,000-100,000 CFU/ML OF CITROBACTER KOSERI (DIVERSUS), so not over 100 000.Child is much better. I ordered a follow up urine culture and US, results not back yet. Should I also order a VCUG? It seems invasive and has Radiation. All my references say order a VCUG for bladder infection for girls under 5 yo. But she only had less than 100 000 CFU..maybe that does nto count as full blown UTI. My peds colleague says do VCUG. My FP colleague says not for the first UTI but on the second. What woud you all do? Thx in advance for the replies. I can always count on this brilliant group.-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

[Guest guest]

Traditionally, a positive culture is 100k CFU's and this is a weird organism in

a child, since most are E coli. Was this a good sample, or did she have a real

UTI. I would not work this up further.

________________________________________

From:

[ ] On Behalf Of

[elaine2md@...]

Sent: Saturday, June 05, 2010 9:46 AM

To: practiceimprovement1

Subject: Follow up for UTI in 3 yo girl

Hi Folks- I would love you opinion on this, as I am trying to see if this pt can

avoid a VCUG.

Healthy 3 yo girl first UTI, likley from wet bathing suit, just started swimming

lessons. Had lower abdo pain, freq and dysuria. No back pain no fever. Urine dip

, postive for leuk-75, no blood, no nitrates. Culture grew 50,000-100,000

CFU/ML OF CITROBACTER KOSERI (DIVERSUS), so not over 100 000.

Child is much better. I ordered a follow up urine culture and US, results not

back yet. Should I also order a VCUG? It seems invasive and has Radiation. All

my references say order a VCUG for bladder infection for girls under 5 yo. But

she only had less than 100 000 CFU..maybe that does nto count as full blown UTI.

My peds colleague says do VCUG. My FP colleague says not for the first UTI but

on the second. What woud you all do? Thx in advance for the replies. I can

always count on this brilliant group.

--

M.D.

www.elainemd.com<http://www.elainemd.com>

Office:

Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly

confidential medical, Personal and Health Information (PHI) and/or legal

information. The information is intended only for the use of the individual or

entity named above.

If you are not the intended recipient of this material, you may not use,

publish, discuss, disseminate or otherwise distribute it. If you are not the

intended recipient, or if you have received this transmission in error, please

notify the sender immediately and confidentially destroy the information that

email in error.

[Guest guest]

If pmh neg would get sono to be sure no maj abnormalities and if

recuurs then standard workup. As long as parents reliable if not full

speed ahead with workup.

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> Elaine,Since she is 3 yo with first UTI, was afebrile, is now improving

with treatment and without other known  complications, most would not do a VCUG.

> About the culture:  Citrobacter koseri, can be found everywhere. It's  on the

skin, especially in the GU-rectal area, because it's a common intestinal

inhabitant.  It's also in soil, can be found in water.  So could be a

contaminant  especially if this was a bag specimen.   A 3 yo girl is a good

candidate for a clean catch that you can count on, with assistance.

> AAP recommends unless you can get a reliable clean catch, get a transurethral

or suprapubic urine.

> Hope this helps

> Further Outpatient CareThe American Academy of Pediatrics recommends all

infants and young children (2 months to 2 years of age) with first UTI have a

urinary tract ultrasonography and voiding cysto-urography (VCUG). These tests

should be acquired promptly if patients fail to show expected clinical response

within 2 days of treatment.All patients should have close follow-up to evaluate

response to antibiotics.Repeat urinalysis and/or urine cultures are not needed

if the patient’s condition responds to therapy as expected.On Jun 5, 2010, at

11:46 AM, wrote:

>

> Hi Folks- I would love you opinion on this, as I am trying to see if this pt

can avoid a VCUG.Healthy 3 yo girl first UTI, likley from wet bathing suit, just

started swimming lessons. Had lower abdo pain, freq and dysuria. No back pain no

fever. Urine dip , postive for leuk-75, no blood, no nitrates. Culture grew  

50,000-100,000 CFU/ML OF CITROBACTER KOSERI (DIVERSUS), so not over 100

000.Child is much better. I ordered a follow up urine culture and US, results

not back yet. Should I also order a VCUG? It seems invasive and has Radiation.

All my references say order a VCUG for bladder infection for girls under 5 yo.

But she only had less than 100 000 CFU..maybe that does nto count as full blown

UTI. My peds colleague says do VCUG. My FP colleague says not for the first UTI

but on the second. What woud you all do? Thx in advance for the replies. I can

always count on this brilliant group.

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

confidential medical, Personal and Health Information (PHI) and/or legal

information. The information is intended only for the use of the individual or

entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

publish, discuss, disseminate or otherwise distribute it. If you are not the

intended recipient, or if you have received this transmission in error, please

notify the sender immediately and confidentially destroy the information that

email in error.

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Elaine,A tour de force of information on UTIs in children!Good stuff. Bravo.The key to imaging, extracted from your message:We suggest routine imaging (RUS and VCUG) for:Girls younger than three years of age with a first UTI (children older than three years are more reliably able to verbalize urinary symptoms)Boys of any age with a first UTIChildren of any age with a febrile UTIChildren with recurrent UTI (if they have not been imaged previously)First UTI in a child of any age with a family history of renal disease, abnormal voiding pattern, poor growth, hypertension (calculator 1 and calculator 2), or abnormalities of the urinary tractK