Update on childhood urinary tract infections and reflux

Urinary tract infections (UTIs) are a common and potentially serious source of morbidity in infants and children. In the absence of identifiable structural and/or functional abnormality of the urinary tract that would predispose to UTI, such as vesicoureteric reflux (VUR), significant and permanent injury to the renal parenchyma (pyelonephritic scarring) from UTI is uncommon. However, those patients with such predisposing conditions are at risk for adverse long-term outcomes of pyelonephritic scarring such as hypertension and/or impairment of glomerular filtration rate (GFR). Although the acute symptomatology usually responds promptly to proper antibiotic therapy, the treating physician must be concerned with a number of intermediate and long-term health outcomes. Specifically, is bacteriuria associated with renal parenchymal inflammation? If so, will it heal with restoration of normal architecture (and function), or will there be replacement of formerly healthy renal tissue with fibrosis? How can future UTIs, each with their attendant risk of pyelonephritic scarring, be prevented? What combination of initial diagnostic tests and follow-up management are best suited for which patients to minimize such adverse outcomes? The approach to the diagnostic evaluation for structural and functional disturbances in the urinary tract that would predispose to UTI has evolved to answer these questions. This review will focus on the recent advances in the detection and management of uropathology associated with UTI, particularly that of vesicoureteral reflux (VUR).