A 2-year-old girl has her first febrile UTI confirmed with a catheter specimen showing E. coli >10^5 CFU/mL, 100 WBCs/hpf, and positive leucocyte esterase. She has no antenatal history of hydronephrosis. After completing appropriate antibiotic treatment, what imaging investigation is MOST indicated as per current evidence-based guidelines?
- A DMSA scan at 4–6 months after UTI to detect permanent renal scarring
- B Micturating cystourethrogram (MCUG) immediately after treatment to detect vesicoureteric reflux
- C Renal and bladder ultrasound during the acute episode ✓
- D DMSA scan within 5 days of UTI to detect acute pyelonephritis
Explanation
Current guidelines (NICE 2022, IAP) recommend renal and bladder ultrasound as the first-line imaging for a first febrile UTI in a child <3 years to exclude structural anomalies. Routine MCUG is no longer recommended after a first UTI in a child with a normal renal ultrasound; it is reserved for children with recurrent UTIs, atypical presentations, poor response to treatment, or abnormal ultrasound. DMSA scanning for scarring is performed 4–6 months after acute UTI but only in selected cases. Acute DMSA (option D) to detect pyelonephritis changes management in research settings, not routine practice.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.