Skip to main content

Advertisement

SpringerLink
Log in

Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux

  • Guidelines
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

An Editorial Commentary to this article was published on 17 January 2024

Abstract

We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7–10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3–5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data used in this manuscript is available in the public domain.

References

  1. Indian Society of Pediatric Nephrology, Vijayakumar M, Kanitkar M, Nammalwar BR, Bagga A (2011) Revised statement on management of urinary tract infections. Indian Pediatr 48:709–717

    Google Scholar 

  2. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E (eds) (2011) Committee on Standards for developing trustworthy clinical practice guidelines. Clinical practice guidelines we can trust (2011) Washington, DC: The National Academies Press. http://www.nationalacademies.org/hmd/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. Accessed on 20 June 2022

  3. Brouwers MC, Kerkvliet K, Spithoff K, AGREE Next Steps Consortium (2016) The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ 352:i1152

  4. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 10:ED000142

  5. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394

    Article  PubMed  Google Scholar 

  6. (2015) GRADEpro GDT: GRADEpro Guideline Development Tool [software], McMaster University. https://www.gradepro.org/. Accessed 24 Jan 2023

  7. Shaikh N, Morone NE, Bost JE, Farrell MH (2008) Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 27:302–308

    Article  PubMed  Google Scholar 

  8. Mårild S, Jodal U (1998) Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 87:549–552

    Article  PubMed  Google Scholar 

  9. Copp HL, Schmidt B (2015) Work up of pediatric urinary tract infection. Urol Clin North Am 42:519–526

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kaufman J, Temple-Smith M, Sanci L (2019) Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open 3:e000487

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chang SL, Shortliffe LD (2006) Pediatric urinary tract infections. Pediatr Clin North Am 53:379–400

    Article  PubMed  Google Scholar 

  12. Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE (2017) Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 357:j1341

    Article  PubMed  PubMed Central  Google Scholar 

  13. Herreros Fernández ML, González Merino N, Tagarro García A, Pérez Seoane B, de la Serna MM, Contreras Abad MT, García-Pose A (2013) A new technique for fast and safe collection of urine in newborns. Arch Dis Child 98:27–29

    Article  PubMed  Google Scholar 

  14. Hildebrand WL, Schreiner RL, Stevens DC, Gosling CG, Sternecker CL (1981) Suprapubic bladder aspiration in infants. Am Fam Physician 23:115–118

    CAS  PubMed  Google Scholar 

  15. Ozkan B, Kaya O, Akdağ R, Unal O, Kaya D (2000) Suprapubic bladder aspiration with or without ultrasound guidance. Clin Pediatr (Phila) 39:625–626

    Article  CAS  PubMed  Google Scholar 

  16. Hockberger RS, Schwartz B, Connor J (1987) Hematuria induced by urethral catheterization. Ann Emerg Med 16:550–552

    Article  CAS  PubMed  Google Scholar 

  17. Boon HA, Lenaerts W, Van Aerde C, Verbakel JY (2021) Outpatient urine collection methods for paediatric urinary tract infections: systematic review of diagnostic accuracy studies. Acta Paediatr 110:3170–3179

    Article  PubMed  Google Scholar 

  18. Diviney J, Jaswon MS (2021) Urine collection methods and dipstick testing in non-toilet-trained children. Pediatr Nephrol 36:1697–1708

    Article  PubMed  Google Scholar 

  19. Herreros ML, Tagarro A, García-Pose A, Sánchez A, Cañete A, Gili P (2015) Accuracy of a new clean-catch technique for diagnosis of urinary tract infection in infants younger than 90 days of age. Paediatr Child Health 20:e30-32

    PubMed  PubMed Central  Google Scholar 

  20. Tosif S, Baker A, Oakley E, Donath S, Babl FE (2012) Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health 48:659–664

    Article  PubMed  Google Scholar 

  21. Vaillancourt S, McGillivray D, Zhang X, Kramer MS (2007) To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. Pediatrics 119:e1288-1293

    Article  PubMed  Google Scholar 

  22. Kaufman J, Knight AJ, Bryant PA, Babl Franz E, Kim D (2020) Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children. Arch Dis Child 105:253–259

    Article  PubMed  Google Scholar 

  23. Wilson ML, Gaido L (2004) Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis 38:1150–1158

    Article  PubMed  Google Scholar 

  24. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610

    Article  Google Scholar 

  25. Brumfitt W (1965) Urinary cell counts and their value. J Clin Pathol 18:550–555

    CAS  PubMed  Google Scholar 

  26. Pappas PG (1991) Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am 75:313–325

    Article  CAS  PubMed  Google Scholar 

  27. Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessman HA, Hoberman A (2016) Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr 170:848–854

    Article  PubMed  Google Scholar 

  28. Coulthard MG (2019) Using urine nitrite sticks to test for urinary tract infection in children aged < 2 years: a meta-analysis. Pediatr Nephrol 34:1283–1288

    Article  PubMed  PubMed Central  Google Scholar 

  29. Turner GM, Coulthard MG (1995) Fever can cause pyuria in children. BMJ 311:924

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Shaikh N, Shope TR, Hoberman A, Vigliotti A, Kurs-Lasky M, Martin JM (2016) Association between uropathogen and pyuria. Pediatrics 138:e20160087

    Article  PubMed  Google Scholar 

  31. Nadeem S, Manuel MM, Oke OK, Patel V, Filkins LM, Badawy MK, Park JY, Hennes HM (2022) Association of pyuria with uropathogens in young children. J Pediatr 245:208-212.e2

    Article  PubMed  Google Scholar 

  32. Kass EH (1962) Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med 56:46–53

    Article  CAS  PubMed  Google Scholar 

  33. Hansson S, Svedhem A, Wennerström M, Jodal U (2007) Urinary tract infection caused by Haemophilus influenzae and Haemophilus parainfluenzae in children. Pediatr Nephrol 22:1321–1325

    Article  PubMed  Google Scholar 

  34. Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O’Brien K, Pickles T, Rumsby K, Sterne JA, Thomas-Jones E, van der Voort J, Waldron CA, Whiting P, Wootton M, Butler CC (2016) The diagnosis of urinary tract infection in young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess 20:1–294

    Article  PubMed  PubMed Central  Google Scholar 

  35. Aronson AS, Gustafson B, Svenningsen NW (1973) Combined suprapubic aspiration and clean-voided urine examination in infants and children. Acta Paediatr Scand 62:396–400

    Article  CAS  PubMed  Google Scholar 

  36. Ramage IJ, Chapman JP, Hollman AS, Elabassi M, McColl JH, Beattie TJ (1999) Accuracy of clean-catch urine collection in infancy. J Pediatr 135:765–767

    Article  CAS  PubMed  Google Scholar 

  37. Pylkkänen J, Vilska J, Koskimies O (1979) Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection. Acta Paediatr Scand 68:341–344

    Article  PubMed  Google Scholar 

  38. Koskimies O (1995) Diagnostic accuracy of urinary tract infection and subsequent development of renal scars. J Pediatr 126:157–159

    Article  CAS  PubMed  Google Scholar 

  39. Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow T (2015) Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age. Pediatrics 135:965–971

    Article  PubMed  Google Scholar 

  40. Swerkersson S, Jodal U, Åhrén C, Sixt R, Stokland E, Hansson S (2016) Urinary tract infection in infants: the significance of low bacterial count. Pediatr Nephrol 31:239–245

    Article  PubMed  Google Scholar 

  41. Breinbjerg A, Jørgensen CS, Frøkiær J, Tullus K, Kamperis K, Rittig S (2021) Risk factors for kidney scarring and vesicoureteral reflux in 421 children after their first acute pyelonephritis, and appraisal of international guidelines. Pediatr Nephrol 36:2777–2787

    Article  PubMed  Google Scholar 

  42. Shaikh N, Osio VA, Wessel CB, Jeong JH (2020) Prevalence of asymptomatic bacteriuria in children: a meta-analysis. J Pediatr 217:110–117

    Article  CAS  PubMed  Google Scholar 

  43. Yun KW, Kim HY, Park HK, Kim W, Lim IS (2014) Virulence factors of uropathogenic Escherichia coli of urinary tract infections and asymptomatic bacteriuria in children. J Microbiol Immunol Infect 47:455–461

    Article  CAS  PubMed  Google Scholar 

  44. Doganis D, Siafas K, Mavrikou M, Issaris G, Martirosova A, Perperidis G, Konstantopoulos A, Sinaniotis K (2007) Does early treatment of urinary tract infection prevent renal damage? Pediatrics 120:e922-928

    Article  PubMed  Google Scholar 

  45. Hewitt IK, Zucchetta P, Rigon L, Maschio F, Molinari PP, Tomasi L, Toffolo A, Pavanello L, Crivellaro C, Bellato S, Montini G (2008) Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics 122:486–490

    Article  PubMed  Google Scholar 

  46. Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ (2017) Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 106:149–154

    Article  CAS  PubMed  Google Scholar 

  47. Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC (2014) Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev 7:CD003772

  48. Mårild S, Jodal U, Sandberg T (2009) Ceftibuten versus trimethoprim-sulfamethoxazole for oral treatment of febrile urinary tract infection in children. Pediatr Nephrol 24:521–526

    Article  PubMed  Google Scholar 

  49. Toporovski J, Steffens L, Noack M, Kranz A, Burdeska A, Kissling M (1992) Effectiveness of cefetamet pivoxil in the treatment of pyelonephritis in children. J Int Med Res 20:87–93

    Article  CAS  PubMed  Google Scholar 

  50. Fischbach M, Simeoni U, Mengus L, Jehl F, Monteil H, Geisert J, Janin A (1989) Urinary tract infections with tissue penetration in children: cefotaxime compared with amoxycillin/clavulanate. J Antimicrob Chemother 24 Suppl B:177–183

  51. Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, Kearney DH, Reynolds EA, Ruley J, Janosky JE (1999) Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 104:79–86

    Article  CAS  PubMed  Google Scholar 

  52. Desai S, Aronson PL, Shabanova V et al (2019) Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections. Pediatrics 144:e20183844

    Article  PubMed  Google Scholar 

  53. Lewis-de Los Angeles WW, Thurm C, Hersh AL et al (2017) Trends in intravenous antibiotic duration for urinary tract infections in young infants. Pediatrics 140:e20171021

    Article  PubMed  Google Scholar 

  54. Lessard D-A, Huard-Girard T, Tremblay A, Turcotte J-F (2021) Transition to oral antibiotic therapy for pyelonephritis in children under 60 days of age: an observational retrospective cohort study. Paediatr Child Health 26:27–31

    Article  PubMed  Google Scholar 

  55. Brady PW, Conway PH, Goudie A (2010) Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections. Pediatrics 126:196–203

    Article  PubMed  Google Scholar 

  56. Bachur R (2000) Nonresponders: prolonged fever among infants with urinary tract infections. Pediatrics 105:E59

    Article  CAS  PubMed  Google Scholar 

  57. Autore G, Neglia C, Di Costanzo M, Ceccoli M, Vergine G, La Scola C, Malaventura C, Falcioni A, Iacono A, Crisafi A, Iughetti L, Conte ML, Pierantoni L, Gatti C, Biasucci G, Esposito S (2022) Clinical outcome of discordant empirical therapy and risk factors associated to treatment failure in children hospitalized for urinary tract infections. Children (Basel) 9:128

    PubMed  Google Scholar 

  58. Wang ME, Lee V, Greenhow TL, Beck J, Bendel-Stenzel M, Hames N, McDaniel CE, King EE, Sherry W, Parmar D, Patrizi ST, Srinivas N, Schroeder AR (2020) Clinical response to discordant therapy in third-generation cephalosporin-resistant UTIs. Pediatrics 145:e20191608

    Article  PubMed  Google Scholar 

  59. Eliakim-Raz N, Yahav D, Paul M, Leibovici L (2013) Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection– 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 68:2183–2191

    Article  CAS  PubMed  Google Scholar 

  60. Fox MT, Amoah J, Hsu AJ, Herzke CA, Gerber JS, Tamma PD (2020) Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw Open 3:e203951

    Article  PubMed  PubMed Central  Google Scholar 

  61. Zaoutis T, Bhatnagar S, Black SI, Coffin SE, Coffin SE, Downes KJ, Fisher BT, Fisher BT, Gerber J, Green MD, Lautenbach E, Liston K, Martin J, Muniz G, Myers SR, O’Connor S, Rowley E, Shaikh N, Shope T, Hoberman A (2020) 639. Short course therapy for urinary tract infections (SCOUT) in children. Open Forum Infect Dis 7:S380

  62. Fitzgerald A, Mori R, Lakhanpaul M, Tullus K (2012) Antibiotics for treating lower urinary tract infection in children. Cochrane Database Syst Rev 8:CD006857

  63. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA (2003) Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev 1:CD003966. https://doi.org/10.1002/14651858.CD003966

  64. Wettergren B, Jodal U (1990) Spontaneous clearance of asymptomatic bacteriuria in infants. Acta Paediatr Scand 79:300–304

    Article  CAS  PubMed  Google Scholar 

  65. Hansson S, Caugant D, Jodal U, Svanborg-Edén C (1989) Untreated asymptomatic bacteriuria in girls: I-Stability of urinary isolates. BMJ 298:853–855

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Newcastle Covert Bacteriuria Research Group (1981) Covert bacteriuria in schoolgirls in Newcastle upon Tyne: a 5-year follow-up. Arch Dis Child 56:585–592

    Article  PubMed Central  Google Scholar 

  67. Savage DC, Howie G, Adler K, Wilson MI (1975) Controlled trial of therapy in covert bacteriuria of childhood. Lancet 1:358–361

    Article  CAS  PubMed  Google Scholar 

  68. Lindberg U, Claësson I, Hanson LA, Jodal U (1975) Asymptomatic bacteriuria in schoolgirls. I. Clinical and laboratory findings. Acta Paediatr Scand 64:425–431

    Article  CAS  PubMed  Google Scholar 

  69. Fitzgerald A, Mori R, Lakhanpaul M (2012) Interventions for covert bacteriuria in children. Cochrane Database Syst Rev 2:CD006943

  70. Claësson I, Lindberg U (1977) Asymptomatic bacteriuria in schoolgirls. VII. A follow-up study of the urinary tract in treated and untreated schoolgirls with asymptomatic bacteriuria. Radiology 124:179–183

    Article  PubMed  Google Scholar 

  71. Aggarwal VK, Verrier Jones K, Asscher AW et al (1991) Covert bacteriuria: long term follow up. Arch Dis Child 66:1284–1286

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Verrier Jones K, Asscher AW, Verrier Jones ER et al (1982) Glomerular filtration rate in schoolgirls with covert bacteriuria. Br Med J (Clin Res Ed) 285:1307–1310

    Article  CAS  PubMed  Google Scholar 

  73. ’t Hoen LA, Bogaert G, Radmayr C, Dogan HS, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Bhatt NR, Stein R (2021) Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol 17:200–207

    Article  PubMed  Google Scholar 

  74. Sharifian M, Rees L, Trompeter RS (1998) High incidence of bacteriuria following renal transplantation in children. Nephrol Dial Transplant 13:432–435

    Article  CAS  PubMed  Google Scholar 

  75. Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R (2019) Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 68:e83–e110. https://doi.org/10.1093/cid/ciy1121

    Article  PubMed  Google Scholar 

  76. Coussement J, Scemla A, Abramowicz D, Nagler EV, Webster AC (2018) Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Database Syst Rev 2:CD011357. https://doi.org/10.1002/14651858.CD011357.pub2

  77. Smaill FM, Vazquez JC (2019) Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2019:CD000490. https://doi.org/10.1002/14651858.CD000490.pub4

  78. Meena J, Kumar J (2021) Adjuvant corticosteroids for prevention of kidney scarring in children with acute pyelonephritis: a systematic review and meta-analysis. Arch Dis Child 106:1081–1086

    Article  PubMed  Google Scholar 

  79. Zhang G-Q, Chen J-L, Zhao Y (2016) The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol 31:373–379

    Article  PubMed  Google Scholar 

  80. Shaikh N, Shope TR, Hoberman A et al (2020) Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial. Pediatr Nephrol 35:2113–2120

    Article  PubMed  PubMed Central  Google Scholar 

  81. Rius-Gordillo N, Ferré N, González JD et al (2022) Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial. Pediatr Nephrol 37:2109–2118

    Article  PubMed  PubMed Central  Google Scholar 

  82. Alley M (2016) Urinary tract infections in the pediatric patient. Physician Assist Clin 1:639–660

    Article  Google Scholar 

  83. Thergaonkar RW, Hari P (2019) Current management of urinary tract infection and vesicoureteral reflux. Indian J Pediatr 87:625–632

    Article  PubMed  Google Scholar 

  84. Morello W, La Scola C, Alberici I, Montini G (2016) Acute pyelonephritis in children. Pediatr Nephrol 31:1253–1265

    Article  PubMed  Google Scholar 

  85. Vasanawala SS, Kennedy WA, Ganguly A et al (2009) MR voiding cystography for evaluation of vesicoureteral reflux. AJR Am J Roentgenol 192:W206–W211

    Article  PubMed  Google Scholar 

  86. Riccabona M (2016) Imaging in childhood urinary tract infection. Radiol Med 121:391–401

    Article  PubMed  Google Scholar 

  87. Blumenthal I (2006) Vesicoureteric reflux and urinary tract infection in children. Postgrad Med J 82:31–35. https://doi.org/10.1136/pgmj.2005.036327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Williams G, Hodson EM, Craig JC (2019) Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2:CD001532

  89. Stefanidis CJ, Siomou E (2007) Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol 22:937–947

    Article  PubMed  PubMed Central  Google Scholar 

  90. Johnin K, Kobayashi K, Tsuru T et al (2019) Pediatric voiding cystourethrography: an essential examination for urologists but a terrible experience for children. Int J Urol 26:160–171

    Article  PubMed  Google Scholar 

  91. Rianthavorn P, Tangngamsakul O (2016) Probabilities of dilating vesicoureteral reflux in children with first time simple febrile urinary tract infection, and normal renal and bladder ultrasound. J Urol 196:1541–1545

    Article  PubMed  Google Scholar 

  92. Alberici I, La Manna A, Pennesi M et al (2019) First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. Acta Paediatr 108:544–550

    Article  CAS  PubMed  Google Scholar 

  93. Pauchard J-Y, Chehade H, Kies CZ et al (2017) Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound. Arch Dis Child 102:804–808

    Article  PubMed  Google Scholar 

  94. Kobayashi Y, Mishina H, Michihata N et al (2019) Indication for voiding cystourethrography during first urinary tract infection. Pediatr Int 61:595–600

    Article  PubMed  Google Scholar 

  95. Sinha R, Saha S, Maji B, Tse Y (2018) Antibiotics for performing voiding cystourethrogram: a randomised control trial. Arch Dis Child 103:230–234

    Article  PubMed  Google Scholar 

  96. Frimberger D, Mercado-Deane M-G, Section on Urology, Section on Radiology (2016) Establishing a standard protocol for the voiding cystourethrography. Pediatrics 138:e20162590

  97. Lebowitz RL, Olbing H, Parkkulainen KV et al (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109

    Article  CAS  PubMed  Google Scholar 

  98. Abdelhalim A, Khoury AE (2017) Critical appraisal of the top-down approach for vesicoureteral reflux. Investig Clin Urol 58:S14

    Article  PubMed  PubMed Central  Google Scholar 

  99. Karavanaki K, Koufadaki AM, Soldatou A et al (2019) Fever duration during treated urinary tract infections and development of permanent renal lesions. Arch Dis Child 104:466–470

    Article  PubMed  Google Scholar 

  100. Simrén Y, Valdimarsson S, Stokland E et al (2018) Renal swelling indicates renal damage in infants with their first urinary tract infection. Acta Paediatr 107:2004–2010

    Article  PubMed  Google Scholar 

  101. Lee JW, Park JS, Park KB et al (2017) Prediction of renal cortical defect and scar using neutrophil-to-lymphocyte ratio in children with febrile urinary tract infection. Nuklearmedizin 56:109–114

    Article  PubMed  Google Scholar 

  102. Kawai S, Kanai T, Hyuga T et al (2017) Top-down approach is possible strategy for predicting breakthrough fUTIs and renal scars in infants. Pediatr Int 59:781–785

    Article  CAS  PubMed  Google Scholar 

  103. Supavekin S, Hunnangkul S, Pravitsitthikul N et al (2016) Delayed therapeutic response time predicts renal damage in the first episode of febrile urinary tract infection. J Med Assoc Thai 99:861–867

    PubMed  Google Scholar 

  104. Yılmaz İ, Peru H, Yılmaz FH et al (2018) Association of vesicoureteral reflux and renal scarring in urinary tract infections. Arch Argent Pediatr 116:e542–e547

    PubMed  Google Scholar 

  105. Shaikh N, Craig JC, Rovers MM et al (2014) Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatr 168:893–900

    Article  PubMed  Google Scholar 

  106. Rodríguez Azor B, Ramos Fernández JM, Sánchiz Cárdenas S et al (2017) Renal scarring in children under 36 months hospitalised for acute pyelonephritis. An Pediatr (Barc) 86:76–80

    Article  PubMed  Google Scholar 

  107. Swerkersson S, Jodal U, Sixt R et al (2017) Urinary tract infection in small children: the evolution of renal damage over time. Pediatr Nephrol 32:1907–1913

    Article  PubMed  PubMed Central  Google Scholar 

  108. Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, La Scola C, Maringhini S, Marra G, Materassi M, Morello W, Nicolini G, Pennesi M, Pisanello L, Pugliese F, Scozzola F, Sica F, Toffolo A, Montini G; Italian Society of Pediatric Nephrology (2020) Updated Italian recommendations for the diagnosis, treatment and follow‐up of the first febrile urinary tract infection in young children. Acta Paediatr 109:236–247. https://doi.org/10.1111/apa.14988

  109. Roupakias S, Sinopidis X, Tsikopoulos G et al (2017) Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management. Minerva Urol Nefrol 69:144–152

    PubMed  Google Scholar 

  110. Koçyiğit A, Yüksel S, Bayram R et al (2014) Efficacy of magnetic resonance urography in detecting renal scars in children with vesicoureteral reflux. Pediatr Nephrol 29:1215–1220

    Article  PubMed  Google Scholar 

  111. Freeman C, Flors L, Altes T et al (2016) Non-contrast MRI as an alternative to Tc-99m DMSA scintigraphy in the detection of pediatric renal scarring. J Nucl Med 57(Suppl 2):1789–1789

    Google Scholar 

  112. Keren R, Shaikh N, Pohl H et al (2015) Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 136:e13-21

    Article  PubMed  PubMed Central  Google Scholar 

  113. Conway PH, Cnaan A, Zaoutis T et al (2007) Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 298:179–186

    Article  CAS  PubMed  Google Scholar 

  114. Meena J, Mathew G, Hari P et al (2020) Prevalence of bladder and bowel dysfunction in toilet-trained children with urinary tract infection and/or primary vesicoureteral reflux: a systematic review and meta-analysis. Front Pediatr 8:84

    Article  PubMed  PubMed Central  Google Scholar 

  115. Shaikh N, Haralam MA, Kurs-Lasky M, Hoberman A (2019) Association of renal scarring with number of febrile urinary tract infections in children. JAMA Pediatr 173:949–952

    Article  PubMed  PubMed Central  Google Scholar 

  116. (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics 103:843–852

  117. Williams GJ, Lee A, Craig JC (2019) Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev 4:CD001534

  118. Shaikh N, Rajakumar V, Peterson CG et al (2019) Cost-utility of antimicrobial prophylaxis for treatment of children with vesicoureteral reflux. Front Pediatr 7:530

    Article  PubMed  Google Scholar 

  119. Indian Society of Pediatric Nephrology; Vijayakumar M, Kanitkar M, Bagga A, Nammalwar B (2011) Revised statement on management of urinary tract infections. Indian Pediatr 48:709–717

  120. Pennesi M, Amoroso S, Bassanese G, Pintaldi S, Giacomini G, Barbi E (2020) Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation. Arch Dis Child 105:260–263

    Article  PubMed  Google Scholar 

  121. Zee RS, Herbst KW, Kim C et al (2016) Urinary tract infections in children with prenatal hydronephrosis: a risk assessment from the Society for Fetal Urology Hydronephrosis Registry. J Pediatr Urol 12:261.e1–7

    Article  PubMed  Google Scholar 

  122. Hoberman A, Chao HP, Keller DM et al (1993) Prevalence of urinary tract infection in febrile infants. J Pediatr 123:17–23

    Article  CAS  PubMed  Google Scholar 

  123. Easterbrook B, Capolicchio J-P, Braga LH (2017) Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: an updated systematic review. Can Urol Assoc J 11:S3–S11

    Article  PubMed  PubMed Central  Google Scholar 

  124. Silay MS, Undre S, Nambiar AK et al (2017) Role of antibiotic prophylaxis in antenatal hydronephrosis: a systematic review from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. J Pediatr Urol 13:306–315

    Article  PubMed  Google Scholar 

  125. Rianthavorn P, Phithaklimnuwong S (2020) The role of antibiotic prophylaxis in mild to moderate isolated hydronephrosis detected in antenatal screening. Investig Clin Urol 61:200–206

    Article  PubMed  PubMed Central  Google Scholar 

  126. Varda BK, Finkelstein JB, Wang H-H et al (2018) The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis. J Pediatr Urol 14:539

    Article  PubMed Central  Google Scholar 

  127. RIVUR Trial Investigators, Hoberman A, Greenfield SP et al (2014) Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 370:2367–2376

    Article  Google Scholar 

  128. Hari P, Hari S, Sinha A et al (2015) Antibiotic prophylaxis in the management of vesicoureteric reflux: a randomized double-blind placebo-controlled trial. Pediatr Nephrol 30:479–486

    Article  PubMed  Google Scholar 

  129. Craig JC, Simpson JM, Williams GJ et al (2009) Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 361:1748–1759

    Article  CAS  PubMed  Google Scholar 

  130. Pennesi M, Travan L, Peratoner L et al (2008) Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 121:e1489-1494

    Article  PubMed  Google Scholar 

  131. Roussey-Kesler G, Gadjos V, Idres N et al (2008) Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 179:674–679

    Article  CAS  PubMed  Google Scholar 

  132. Al-Sayyad AJ, Pike JG, Leonard MP (2005) Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux? J Urol 174:1587–1589; discussion 1589

  133. Cooper CS, Chung BI, Kirsch AJ et al (2000) The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol 163:269–272

    Article  CAS  PubMed  Google Scholar 

  134. Thompson RH, Chen JJ, Pugach J et al (2001) Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol 166:1465–1469

    Article  CAS  PubMed  Google Scholar 

  135. Alconcher LF, Meneguzzi MB, Buschiazzo R, Piaggio LA (2009) Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux? J Pediatr Urol 5:383–388

    Article  PubMed  Google Scholar 

  136. Kitchens DM, Herndon A, Joseph DB (2010) Outcome after discontinuing prophylactic antibiotics in children with persistent vesicoureteral reflux. J Urol 184:1594–1597

    Article  PubMed  Google Scholar 

  137. Leslie B, Moore K, Salle JLP et al (2010) Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux initially presenting with febrile urinary tract infection: time to event analysis. J Urol 184:1093–1098

    Article  PubMed  Google Scholar 

  138. Weiss HA, Larke N, Halperin D, Schenker I (2010) Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol 10:2

    Article  PubMed  PubMed Central  Google Scholar 

  139. El Bcheraoui C, Zhang X, Cooper CS et al (2014) Rates of adverse events associated with male circumcision in U.S. medical settings, 2001 to 2010. JAMA Pediatr 168:625–634

    Article  PubMed  PubMed Central  Google Scholar 

  140. Hung Y-C, Chang DC, Westfal ML et al (2019) A longitudinal population analysis of cumulative risks of circumcision. J Surg Res 233:111–117

    Article  PubMed  Google Scholar 

  141. Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y (2020) Complications of circumcision in Israel: a one year multicenter survey. Isr Med Assoc J 7:368–370

    Google Scholar 

  142. Morris BJ, Moreton S, Krieger JN (2019) Critical evaluation of arguments opposing male circumcision: a systematic review. J Evid Based Med 12:263–290

    Article  PubMed  PubMed Central  Google Scholar 

  143. Morris BJ, Kennedy SE, Wodak AD, Mindel A, Golovsky D, Schrieber L, Lumbers ER, Handelsman DJ, Ziegler JB (2017) Early infant male circumcision: systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediatr 6:89

    Article  PubMed  PubMed Central  Google Scholar 

  144. Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, Tenke P, Sotto A, Lavigne JP (2010) Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis 10:94

    Article  PubMed  PubMed Central  Google Scholar 

  145. Yang S, Chua ME, Bauer S et al (2018) Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society. Pediatr Nephrol 33:2207–2219

    Article  PubMed  Google Scholar 

  146. Farhat W, Bägli DJ, Capolicchio G et al (2000) The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 164:1011–1015

    Article  CAS  PubMed  Google Scholar 

  147. Zeevenhooven J, Koppen IJN, Benninga MA (2017) The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr 20:1–13

    Article  PubMed  PubMed Central  Google Scholar 

  148. Riegler G, Esposito I (2001) Bristol scale stool form. A still valid help in medical practice and clinical research. Tech Coloproctol 5:163–164

    Article  CAS  PubMed  Google Scholar 

  149. Berger MY, Tabbers MM, Kurver MJ et al (2012) Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 161:44–50

    Article  PubMed  Google Scholar 

  150. Chang S-J, Chiang I-N, Hsieh C-H et al (2013) Age- and gender-specific nomograms for single and dual post-void residual urine in healthy children. Neurourol Urodyn 32:1014–1018

    Article  PubMed  Google Scholar 

  151. Guerra L, Leonard M, Castagnetti M (2014) Best practice in the assessment of bladder function in infants. Ther Adv Urol 6:148–164

    Article  PubMed  PubMed Central  Google Scholar 

  152. Hum S, Liu H, Shaikh N (2022) Risk factors for the development of febrile recurrences in children with a history of urinary tract infection. J Pediatr 243:152–157

    Article  PubMed  Google Scholar 

  153. Meena J, Hari P (2019) Vesicoureteral reflux and recurrent urinary tract infections. Asian J Pediatr Nephrol 2:61

    Article  Google Scholar 

  154. Miklovicova D, Cornelissen M, Cransberg K et al (2005) Etiology and epidemiology of end-stage renal disease in Dutch children 1987–2001. Pediatr Nephrol 20:1136–1142

    Article  PubMed  Google Scholar 

  155. Hari P, Singla IK, Mantan M et al (2003) Chronic renal failure in children. Indian Pediatr 40:1035–1042

    PubMed  Google Scholar 

  156. Craig JC, Irwig LM, Knight JF, Roy LP (2000) Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 105:1236–1241

    Article  CAS  PubMed  Google Scholar 

  157. Routh JC, Inman BA, Reinberg Y (2010) Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics 125:1010–1019

    Article  PubMed  Google Scholar 

  158. Holmdahl G, Brandström P, Läckgren G et al (2010) The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol 184:280–285

    Article  PubMed  Google Scholar 

  159. Brandström P, Esbjörner E, Herthelius M et al (2010) The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol 184:286–291

    Article  PubMed  Google Scholar 

  160. Miyakita H, Hayashi Y, Mitsui T et al (2020) Guidelines for the medical management of pediatric vesicoureteral reflux. Int J Urol 27:480–490

    Article  PubMed  PubMed Central  Google Scholar 

  161. Netto JMB, Rondon AV, Machado MG et al (2019) Brazilian consensus on vesicoureteral reflux–recommendations for clinical practice. Int Braz J Urol 46:523–537

    Article  PubMed Central  Google Scholar 

  162. Deng T, Liu B, Luo L et al (2018) Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol 36:819–828

    Article  PubMed  Google Scholar 

  163. Gholami B, Gholami S, Khodaei B, Sharifiaghdas F (2022) Comparison of polyacrylate polyalcohol copolymer (PPC) and dextranomer/hyaluronic acid (Dx/HA) for treatment of vesicoureteral reflux. A systematic review and meta-analysis. J Pediatr Urol 18:664–673

    Article  PubMed  Google Scholar 

  164. Nordenström J, Sjöström S, Sillén U, Sixt R, Brandström P (2017) The Swedish infant high-grade reflux trial: UTI and renal damage. J Pediatr Urol 13:146–154

    Article  PubMed  Google Scholar 

  165. Snodgrass WT, Shah A, Yang M, Kwon J, Villanueva C, Traylor J, Pritzker K, Nakonezny PA, Haley RW, Bush NC (2013) Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol 9:856–863

    Article  PubMed  Google Scholar 

  166. Silva JM, Santos Diniz JS, Marino VS, Lima EM, Cardoso LS, Vasconcelos MA, Oliveira EA (2006) Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21:981–988

    Article  PubMed  Google Scholar 

  167. Lama G, Tedesco MA, Graziano L, Calabrese E, Grassia C, Natale F, Pacileo G, Rambaldi PF, Esposito-Salsano M (2003) Reflux nephropathy and hypertension: correlation with the progression of renal damage. Pediatr Nephrol 18:241–245

    Article  PubMed  Google Scholar 

  168. Hamilton AJ, Braddon F, Casula A, Inward C, Lewis M, Mallett T, Maxwell H, O’Brien C, Tse Y, Sinha MD (2016) UK Renal Registry 18th Annual Report: chapter 4 demography of patients receiving renal replacement therapy in paediatric centres in the UK in 2014. Nephron 132(Suppl 1):99–110

    Article  PubMed  Google Scholar 

  169. Round J, Fitzgerald AC, Hulme C, Lakhanpaul M, Tullus K (2012) Urinary tract infections in children and the risk of ESRF. Acta Paediatr 101:278–282

    Article  PubMed  Google Scholar 

  170. Rudzinski JK, Weber B, Wildgoose P, Lorenzo A, Bagli D, Farhat W, Harvey E, Salle JL (2013) Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux? Can Urol Assoc J 7:E467–E469

    Article  PubMed  PubMed Central  Google Scholar 

  171. Lowe LH, Patel MN, Gatti JM, Alon US (2004) Utility of follow-up renal sonography in children with vesicoureteral reflux and normal initial sonogram. Pediatrics 113:548–550

    Article  PubMed  Google Scholar 

  172. Bowen SE, Watt CL, Murawski IJ, Gupta IR, Abraham SN (2013) Interplay between vesicoureteric reflux and kidney infection in the development of reflux nephropathy in mice. Dis Model Mech 6:934–941

    PubMed  PubMed Central  Google Scholar 

  173. Thompson M, Simon SD, Sharma V, Alon US (2005) Timing of follow-up voiding cystourethrogram in children with primary vesicoureteral reflux: development and application of a clinical algorithm. Pediatrics 115:426–434

    Article  PubMed  Google Scholar 

  174. Unver T, Alpay H, Biyikli NK, Ones T (2006) Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux. Pediatr Int 48:287–291

    Article  PubMed  Google Scholar 

  175. Sükan A, Bayazit AK, Kibar M, Noyan A, Soyupak S, Yapar Z, Anarat A (2003) Comparison of direct radionuclide cystography and voiding direct cystography in the detection of vesicoureteral reflux. Ann Nucl Med 17:549–553

    Article  PubMed  Google Scholar 

  176. Conway JJ, King LR, Belman AB, Thorson T (1972) Detection of vesicoureteral reflux with radionuclide cystography. A comparison study with roentgenographic cystography. Am J Roentgenol Radium Ther Nucl Med 115:720–727

    Article  CAS  PubMed  Google Scholar 

  177. Estrada CR Jr, Passerotti CC, Graham DA, Peters CA, Bauer SB, Diamond DA, Cilento BG Jr, Borer JG, Cendron M, Nelson CP, Lee RS, Zhou J, Retik AB, Nguyen HT (2009) Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol 182:1535–1541

    Article  PubMed  Google Scholar 

  178. Schwab CW Jr, Wu HY, Selman H, Smith GH, Snyder HM 3rd, Canning DA (2002) Spontaneous resolution of vesicoureteral reflux: a 15-year perspective. J Urol 168:2594–2599

    Article  PubMed  Google Scholar 

  179. Knudson MJ, Austin JC, McMillan ZM, Hawtrey CE, Cooper CS (2007) Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol 178:1684–1688

    Article  PubMed  Google Scholar 

  180. Wildbrett P, Schwebs M, Abel JR et al (2013) Spontaneous vesicoureteral reflux resolution in children: a ten-year single-centre experience. Afr J Paediatr Surg 10:9–12

    Article  PubMed  Google Scholar 

  181. Skoog SJ, Peters CA, Arant BS et al (2010) Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol 184:1145–1151

    Article  PubMed  Google Scholar 

  182. Nepple KG, Knudson MJ, Austin JC, Cooper CS (2008) Abnormal renal scans and decreased early resolution of low grade vesicoureteral reflux. J Urol 180:1643–1647; discussion 1647

  183. Zerati Filho M, Calado AA, Barroso U Jr, Amaro JL (2007) Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience. Int Braz J Urol 33:204–215

    Article  PubMed  Google Scholar 

  184. Noe HN (1992) The long-term results of prospective sibling reflux screening. J Urol 148:1739–1742

    Article  CAS  PubMed  Google Scholar 

  185. Hunziker M, Colhoun E, Puri P (2014) Renal cortical abnormalities in siblings of index patients with vesicoureteral reflux. Pediatrics 133:e933-937

    Article  PubMed  Google Scholar 

  186. Giannotti G, Menezes M, Hunziker M, Puri P (2011) Sibling vesicoureteral reflux in twins. Pediatr Surg Int 27:513–515

    Article  PubMed  Google Scholar 

  187. Aggarwal VK, Verrier Jones K (1989) Vesicoureteric reflux: screening of first degree relatives. Arch Dis Child 64:1538–1541

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  188. Parekh DJ, Pope JC th, Adams MC, Brock 3rd JW (2002) Outcome of sibling vesicoureteral reflux. J Urol 167:283–284

  189. Bredin HC, Winchester P, McGovern JH, Degnan M (1975) Family study of vesicoureteral reflux. J Urol 113:623–625

    Article  CAS  PubMed  Google Scholar 

  190. Connolly LP, Treves ST, Connolly SA, Zurakowski D, Share JC, Bar-Sever Z, Mitchell KD, Bauer SB (1997) Vesicoureteral reflux in children: incidence and severity in siblings. J Urol 157:2287–2290

    Article  CAS  PubMed  Google Scholar 

  191. Dursun F, Erguven M, Denizmen YU, Dursun M, Yılmaz S, Abul MH (2008) Vesicoureteral reflux incidence in siblings of children with reflux: is screening required? Eur J Gen Med 5:90–94

    Google Scholar 

  192. Dwoskin JY (1976) Sibling uropathology. J Urol 115:726–727

    Article  CAS  PubMed  Google Scholar 

  193. Jerkins GR, Noe HN (1982) Familial vesicoureteral reflux: a prospective study. J Urol 128:774–778

    Article  CAS  PubMed  Google Scholar 

  194. Kenda RB, Fettich JJ (1992) Vesicoureteric reflux and renal scars in asymptomatic siblings of children with reflux. Arch Dis Child 67:506–508

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  195. Kuczyńska R, Czerwionka-Szaflarska M (2001) Incidence of vesicoureteral reflux in siblings of children with reflux–our own observations. Med Sci Monit 7:116–120

    PubMed  Google Scholar 

  196. Chertin B, Puri P (2003) Familial vesicoureteral reflux. J Urol 169:1804–1808

    Article  PubMed  Google Scholar 

  197. Sahin A, Ergen A, Balbay D et al (1991) Screening of asymptomatic sibilings of patients with vesicoureteral reflux. Int Urol Nephrol 23:437–440

    Article  CAS  PubMed  Google Scholar 

  198. Scott JE, Swallow V, Coulthard MG, Lambert HJ, Lee RE (1997) Screening of newborn babies for familial ureteric reflux. Lancet 350:396–400

    Article  CAS  PubMed  Google Scholar 

  199. Tombesi M, Ferrari CM, Bertolotti JJ (2005) Renal damage in refluxing and non-refluxing siblings of index children with vesicoureteral reflux. Pediatr Nephrol 20:1201–1202

    Article  PubMed  Google Scholar 

  200. Van den Abbeele AD, Treves ST, Lebowitz RL, Bauer S, Davis RT, Retik A, Colodny A (1987) Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography. Pediatrics 79:147–153

    Article  PubMed  Google Scholar 

  201. Wan J, Greenfield SP, Ng M et al (1996) Sibling reflux: a dual center retrospective study. J Urol 156:677–679

    Article  CAS  PubMed  Google Scholar 

  202. Menezes M, Puri P (2009) Familial vesicoureteral reflux - is screening beneficial? J Urol 182(4 Suppl):1673–1677

    Article  PubMed  Google Scholar 

  203. Ataei N, Madani A, Esfahani ST, Kejbafzadeh A, Ghaderi O, Jalili S, Sharafi B (2004) Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol 19:1127–1131

    Article  PubMed  Google Scholar 

  204. Buonomo C, Treves ST, Jones B, Summerville D, Bauer S, Retik A (1993) Silent renal damage in symptom-free siblings of children with vesicoureteral reflux: assessment with technetium Tc 99m dimercaptosuccinic acid scintigraphy. J Pediatr 122:721–723

    Article  CAS  PubMed  Google Scholar 

  205. Cascio S, Yoneda A, Chertin B, Colhoun E, Puri P (2003) Renal parenchymal damage in sibling vesicoureteric reflux. Acta Paediatr 92:17–20

    Article  CAS  PubMed  Google Scholar 

  206. Celik A, Ulman I, Aydin M, Arikan A, Avanoğlu A, Gökdemir A (2002) Familial vesicoureteral reflux in asymptomatic siblings. Turk J Pediatr 44:240–243

    PubMed  Google Scholar 

  207. Houle A-M, Cheikhelard A, Barrieras D, Rivest MC, Gaudreault V (2004) Impact of early screening for reflux in siblings on the detection of renal damage. BJU Int 94:123–125

    Article  PubMed  Google Scholar 

  208. Noe HN, Bonnin F (2002) Scintigraphic screening for renal damage in siblings of children with asymptomatic primary vesico-ureteric reflux [2] (multiple letters). BJU Int 89:792–793

    Article  CAS  PubMed  Google Scholar 

  209. Yoneda A, Cascio S, Oue T, Chertin B, Puri P (2002) Risk factors for the development of renal parenchymal damage in familial vesicoureteral reflux. J Urol 168:1704–1707

    Article  CAS  PubMed  Google Scholar 

  210. Pirker ME, Colhoun E, Puri P (2006) Renal scarring in familial vesicoureteral reflux: is prevention possible? J Urol 176:1842–1846

    Article  PubMed  Google Scholar 

  211. Kenda RB, Fettich JJ (1992) Visecoureteric reflux and renal scars in asymptomatic siblings of children with reflux. Arch Dis Child 67:506–508

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  212. Puri P, Gosemann JH, Darlow J, Barton DE (2011) Genetics of vesicoureteral reflux. Nat Rev Urol 8:539–552

    Article  CAS  PubMed  Google Scholar 

  213. Visuri S, Jahnukainen T, Taskinen S (2018) Prenatal complicated duplex collecting system and ureterocele-important risk factors for urinary tract infection. J Pediatr Surg 53:813–817

    Article  PubMed  Google Scholar 

  214. Afshar K, Papanikolaou F, Malek R, Bagli D, Pippi-Salle JL, Khoury A (2005) Vesicoureteral reflux and complete ureteral duplication. Conservative or surgical management? J Urol 173:1725–1727

    Article  PubMed  Google Scholar 

  215. Hunziker M, Mohanan N, Menezes M, Puri P (2010) Prevalence of duplex collecting systems in familial vesicoureteral reflux. Pediatr Surg Int 26:115–117

    Article  PubMed  Google Scholar 

  216. Watson AR, Harden PN, Ferris ME, Kerr PG, Mahan JD, Ramzy MF; International Society of Nephrology; International Pediatric Nephrology Association (2011) Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA). Kidney Int 80:704–707

  217. Joslin B, Langman C, Nishi L, Ghossein C (2020) Assessing success in transitioning of young adults from pediatric to adult kidney practice. BMC Nephrol 21:8

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the following external reviewers for inputs and suggestions in improving the initial draft of the manuscripts: Giovanni Montini (Milan, Italy), Joana Dos Santos (Toronto, Canada), Armando Lorenzo (Toronto, Canada), Per Brandström (Gothenburg, Sweden), Sriram Krishnamurthy (Puducherry, India), Shyam Kukreja (New, Delhi), Anil Vasudevan (Bengaluru, India), Om Prakash Mishra (Varanasi, India), Amit Aggarwal (New Delhi, India), and Vinay Agarwal (New, Delhi, India). We also thank our senior experts for their critical inputs: Uma Ali, Mumbai; Kumud Mehta, Mumbai; BR Nammalwar, Chennai; Kishore D. Phadke, Bengaluru; and RN Srivastava, New Delhi.

Working group members:

Indira Agarwal, Vellore

Arvind Bagga, New Delhi (Group Coordinator)

Minu Bajpai, New Delhi

Sushmita Banerjee, Kolkata

Sudha Ekambaram, Chennai (Group Coordinator)

Pankaj Hari, New Delhi (Chair)

Arpana Iyengar, Bengaluru (Group Coordinator)

Manisha Jana, New Delhi

Madhuri Kanitkar, Pune (Group Coordinator)

Suprita Kalra, New Delhi

Priyanka Khandelwal, New Delhi (Evidence review group member)

Rakesh Kumar, New Delhi

Anurag Krishan, New Delhi

Nisha Krishnamurthy, Mumbai

Manish Kumar, New Delhi (Group Coordinator)

Jitendra Meena, New Delhi (Evidence review group member)

Kirtisudha Mishra, New Delhi

Mukta Mantan, New Delhi

Amarjeet Mehta, Jaipur

Alpana Ohri, Mumbai

Brinda Panchal, Mumbai

Priya Pais, Bengaluru (Group Coordinator)

Shweta Priyadarshini, Mumbai

Sumantra Raut, Kolkata

Abhijeet Saha, New Delhi

Sidharth Sethi, Gurugram

Jyoti Sharma, Pune

Aditi Sinha, New Delhi (Evidence review group member)

Rajiv Sinha, Kolkata

Ranjeet W. Thergoankar, Kolkata (Evidence review group member)

Susan Uthup, Thiruvananthapuram

Anand Vasudev, New Delhi

Funding

The authors acknowledge funding support for collaborative research studies and consensus development by the Indian Council of Medical Research, Advanced Centre for Research in Pediatric Kidney Diseases, 5/7/1090/2013-RHN.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Pankaj Hari, Jitendra Meena, Aditi Sinha, Priyanka Khandelwal, Arvind Bagga & Arvind Bagga

  2. Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India

    Manish Kumar

  3. Department of Pediatrics, Command Hospital (EC), Kolkata, India

    Ranjeet W. Thergaonkar

  4. Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India

    Arpana Iyengar & Priya Pais

  5. Department of Pediatric Nephrology, Apollo Children’s Hospital, Chennai, India

    Sudha Ekambaram

  6. Department of Pediatrics, KEM Hospital, Pune, India

    Jyoti Sharma

  7. Maharashtra University of Health Sciences (MUHS), Nashik, India

    Madhuri Kanitkar

Authors
  1. Pankaj Hari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jitendra Meena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manish Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aditi Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ranjeet W. Thergaonkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arpana Iyengar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Priyanka Khandelwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sudha Ekambaram
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Priya Pais
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jyoti Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Madhuri Kanitkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Arvind Bagga
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of Indian Society of Pediatric Nephrology

  • Arvind Bagga
  • , Indira Agarwal
  • , Minu Bajpai
  • , Sushmita Banerjee
  • , Manisha Jana
  • , Suprita Kalra
  • , Rakesh Kumar
  • , Anurag Krishan
  • , Nisha Krishnamurthy
  • , Kirtisudha Mishra
  • , Mukta Mantan
  • , Amarjeet Mehta
  • , Alpana Ohri
  • , Brinda Panchal
  • , Shweta Priyadarshini
  • , Sumantra Raut
  • , Abhijeet Saha
  • , Sidharth Sethi
  • , Rajiv Sinha
  • , Ranjeet W. Thergoankar
  • , Susan Uthup
  •  & Anand Vasudev

Contributions

All authors are involved in the review of literature and preparation of background document; JM, PH, RWT, AS, and PK helped in synthesizing the data, assessing the quality of evidence, and drafting the recommendation using the GRADE approach; JM and PH drafted the manuscript; PH and AB conceived the idea and critically revised the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Pankaj Hari.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Informed consent

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 1059 KB)

Glossary of terms

Acute pyelonephritis

Bacterial infection involving the upper urinary tract (kidney parenchyma)

Bacteriuria

Presence of one or more bacteria per oil immersion field in a freshly voided uncentrifuged sample

Cystitis or lower UTI

Bacterial infection localizing to the bladder

Febrile urinary tract infection

Fever (temperature ≥ 38 °C) with a positive urine culture defined by presence of significant colony count of a single uropathogen

High-grade vesicoureteric reflux

Grade 3 to 5 vesicoureteric reflux on micturating cystourethrography

Kidney scarring

Acquired kidney damage due to acute pyelonephritis

Leukocyturia

Presence of ≥ 10 leukocytes per mm3 in a fresh uncentrifuged sample, or > 5 leukocytes per high power field in a centrifuged sample

Low-grade vesicoureteric reflux

Grade 1 and 2 vesicoureteric reflux on micturating cystourethrography

Primary vesicoureteric reflux

The passage of urine from the bladder back into a ureter and kidney in the absence of obstructive uropathy and neurogenic bladder dysfunction

Recurrent urinary tract infection

Two episodes of urinary tract infection during any time period in childhood

Reflux nephropathy

Abnormalities in the renal cortex associated with primary VUR (congenital dysplasia or acquired scarring)

Renal dysplasia

Congenital abnormalities in the renal cortex due to abnormal metanephric differentiation

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hari, P., Meena, J., Kumar, M. et al. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatr Nephrol 39, 1639–1668 (2024). https://doi.org/10.1007/s00467-023-06173-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-023-06173-9

Keywords

Search

Navigation