Related Experiment Video
Updated: May 5, 2026
Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
Published on: July 18, 2017
Renal ultrasound after first febrile urinary tract infection in hospitalized children: The ROUTINE prospective
Sanjay Mahant1,2,3,4, Keenjal Mistry4, Ann Bayliss5
1The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study investigates the necessity of routine renal ultrasounds for children after their first febrile urinary tract infection (UTI). Findings will guide evidence-based practices for managing pediatric UTIs and genitourinary abnormalities.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Clinical Practice Guidelines
Background:
- Urinary tract infections (UTIs) are a frequent cause of hospitalization in young children.
- Current guidelines recommend universal renal ultrasound after a first febrile UTI, despite limited evidence.
- The necessity and impact of these ultrasounds require further investigation.
Purpose of the Study:
- To determine the incidence of clinically significant genitourinary abnormalities detected by renal ultrasound in children under 24 months following a first febrile UTI.
- To analyze the subsequent healthcare interventions and parent experiences related to these findings.
- To identify predictors of clinically important abnormalities.
Main Methods:
- A multicentre, prospective, observational study involving children under 24 months hospitalized with a first febrile UTI.
- 1-year follow-up with standardized classification of genitourinary abnormalities.
- Embedded qualitative component using semistructured interviews with parents.
Main Results:
- The study aims to estimate the incidence of clinically important abnormalities and potential overdiagnosis.
- Secondary outcomes include recurrent UTIs, vesicoureteral reflux, healthcare interventions, and parent-reported outcomes.
- Predictors of clinically important abnormalities will be assessed using multivariable logistic regression.
Conclusions:
- This research will provide crucial evidence on the utility of universal renal ultrasound after a first febrile UTI in children.
- Findings are expected to inform evidence-based management strategies and shared decision-making.
- The study will contribute to refining clinical practice guidelines for pediatric UTI management.
Background:
Urinary tract infection (UTI) is a common reason for hospitalization in young children. American and Canadian guidelines recommend universal renal ultrasound after a first febrile UTI to identify genitourinary abnormalities that require further management, despite limited supporting evidence. The Renal ultrasOund after first febrile Urinary Tract INfEction (ROUTINE) study aims to (a) determine the incidence of clinically important and insignificant genitourinary abnormalities on renal ultrasound, (b) describe the cascade of healthcare interventions following the detection of abnormalities, (c) explore parents' experiences, and (d) identify clinical factors associated with clinically important abnormalities.
Method:
This multicentre, prospective, observational study with an embedded qualitative component will enroll children <24 months of age hospitalized at 17 children's and community hospitals in Canada and the United States after a first febrile UTI, with 1-year follow-up. The primary outcome is detection of genitourinary abnormalities on renal ultrasound, classified by clinical importance using a standardized system. Secondary outcomes include clinical (recurrent febrile UTI), radiologic (vesicoureteral reflux), healthcare interventions (surgery, antibiotic prophylaxis, imaging, specialist follow-up), and parent-reported outcomes (anxiety, involvement in decision making). Parent experiences will be explored through semistructured interviews. Primary analysis will estimate the incidence of clinically important abnormalities and potential overdiagnosis with 95% confidence intervals (CIs). Secondary analysis will summarize radiologic, clinical, healthcare intervention, and parent-reported outcomes and assess predictors of clinically important abnormalities using multivariable logistic regression.
Discussion:
This multicentre prospective study with longitudinal follow-up will generate evidence on the utility of universal renal ultrasound after the first febrile UTI. Findings will inform evidence-based management, shared decision-making, and clinical practice guidelines.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:24Imaging Studies II: Ultrasonography
01:17Urinary Tract Infection IV: Nursing Management
01:25Urinary Tract Infection II: Pathophysiology
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention