Is ultrasonography mandatory in all children at their first febrile urinary tract infection?



This study investigated whether performing kidney ultrasound (KUS) only in children presenting either a pathogen other than E. coli at their first febrile urinary tract infection (fUTI) or experiencing fUTI recurrence would increase missed diagnoses of kidney anomalies.


Patients aged 2–36 months with fUTI who underwent KUS evaluation from 2 January 2013 to 31 June 2018 were enrolled. Cystourethrography was performed after pathological KUS or recurring fUTIs. Thereafter, we retrospectively assessed the detection rate of kidney anomalies through performing KUS only in patients with atypical pathogen at first fUTI or with recurring fUTIs.


In 263 patients included, the isolated pathogen was E. coli in 223 cases (84.8%) and atypical in 40 cases (15.2%). KUS detected kidney anomalies in 14/223 (6.3%) of fUTIs caused by E. coli and in 11/40 (27.5%) of fUTIs caused by an atypical pathogen (OR 5.5, 95%CI 2.5–14.5). Cystourethrography was performed in 40 patients and vesicoureteral reflux (VUR) found in 20 cases. None of the high grade VUR diagnoses or other kidney anomalies would have been lost through a different diagnostic protocol that required the presence of an atypical pathogen at the first fUTI or a fUTI recurrence to perform the KUS.


A diagnostic protocol that requires presence of an atypical pathogen at the first fUTI or a second episode of fUTI to perform the KUS would allow a reduction in the number of negative ultrasounds with a negligible risk of missed diagnoses of kidney anomalies.

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Congenital anomalies of the kidney and urinary tract


Febrile urinary tract infection


Kidney ultrasound


Italian Society of Paediatric Nephrology


Voiding cystourethrography


Vesicoureteral reflux


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Author information




Dr Amoroso, Drs Conversano, and Drs Busetti conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Drs Giangreco, Dr Pesce, Pennesi G., and Drs Cattaruzzi designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. Dr Pennesi M. and Prof Barbi conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Stefano Amoroso.

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Pennesi, M., Amoroso, S., Pennesi, G. et al. Is ultrasonography mandatory in all children at their first febrile urinary tract infection?. Pediatr Nephrol (2021).

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  • Children
  • Febrile urinary tract infections
  • Recurrence
  • Kidney ultrasound
  • VCUG