How best to diagnose urinary tract infection in preschool children in primary care?

Accurate and timely diagnosis of urinary tract infection (UTI) in young children presenting to primary care is important because appropriate treatment may alleviate suffering and help prevent long term sequelae such as renal scarring, poor renal growth, recurrent pyelonephritis, impaired glomerular function, hypertension, end stage renal disease, and pre-eclampsia. 1 2 The prevalence of renal scarring in the general population is unknown, but a systematic review of studies, largely conducted in secondary care, showed 15% of children with an initial episode of UTI had evidence of renal scarring on follow-up dimercaptosuccinic acid (DMSA) scanning, and there was an 8% incidence of UTI recurrence per year. 3Among consultations for illness episodes in children aged under 5 years in the UK, approximately 40% comprise infectious diseases and respiratory episodes, while about 10% of presentations comprise non-specific symptoms.Thus identifying which children have a significant UTI (which often also presents with non-specific symptoms) is a key challenge for primary care clinicians.