A 1-year-old girl is diagnosed with her first febrile UTI. Urine culture grows E. coli >10^5 CFU/mL. Renal ultrasound shows no abnormality. According to current IAP/NICE guidelines, which imaging study should be performed to evaluate for vesicoureteral reflux and renal scarring after treatment?

• A Voiding cystourethrogram (VCUG/MCU) routinely after the first UTI in all children under 2 years
• B DMSA scan acutely to confirm renal parenchymal involvement, followed by VCUG regardless of result
• C No imaging required after a first uncomplicated UTI with normal renal ultrasound
• D VCUG only if ultrasound is abnormal OR if recurrent UTIs occur; DMSA scan at 4–6 months post-infection ✓

Explanation

Current NICE and IAP guidelines have moved away from routine VCUG after the first uncomplicated UTI with a normal renal ultrasound. VCUG (MCU) is now recommended only if the renal ultrasound is abnormal, if UTI is recurrent (≥2 UTIs), if the organism is atypical (non-E. coli, unusual antibiotic resistance), or if the response to treatment is poor. DMSA scan is performed at 4–6 months after acute UTI (not acutely) to detect permanent renal cortical scarring. The previous approach of universal VCUG after first UTI led to overdiagnosis of low-grade VUR with limited management impact.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.