Urinary tract infections (UTI) are a common and important clinical problem in childhood. Upper urinary tract infections (ie, acute pyelonephritis) may lead to renal scarring, hypertension, and end-stage renal disease. Although children with pyelonephritis tend to present with fever, it is often difficult on clinical grounds to distinguish cystitis from pyelonephritis, particularly in young children (those younger than two years) . As a result, we have defined UTI broadly here without attempting to distinguish cystitis from pyelonephritis. Acute cystitis in older children is discussed separately. (See "Acute cystitis in children older than two years and adolescents".)
The clinical features and diagnosis of UTI in children will be discussed here. The epidemiology, risk factors, and management of UTI in children and UTI in newborns (younger than one month of age) are discussed separately. (See "Epidemiology and risk factors for urinary tract infections in children" and "Acute management, imaging, and prognosis of urinary tract infections in infants and children older than one month" and "Long-term management and prevention of urinary tract infections in children" and "Urinary tract infections in newborns".)
Urinary tract infections (UTI) may present with nonspecific symptoms and signs, particularly in infants and young children.
Younger children — In a meta-analysis of the diagnostic accuracy of the symptoms and signs of UTI in children younger than two years, the following symptoms and signs were the most helpful in identifying children with UTI (table 1) :
- History of UTI (likelihood ratio [LR] 2.3)
- Temperature >40ºC (LR 3.2)
- Suprapubic tenderness (summary LR 4.4)
- Lack of circumcision (summary LR 2.8)