Another look at diagnostic pathways in children with urinary tract infection.

This is a discussion paper on better ways of tackling a common problem : looking for the cause of a child's first recognised urinary infection. We describe practical choices and programmes adopted jointly in our departments over the past two years. We would be the first to accept that they may not suit all places. The following factors made us take another look at our diag? nostic pathways: (a) in the past few years new light has been shed on our understanding of reflux and reflux nephropathy; (6) it has become increasingly apparent thai: an intravenous urogram is no diagnostic panacea in very small children; (c) there are no longer (if indeed there ever were) bottomless funds to pay for expensive investigations for all children with a single urinary tract infection; and (d) the concept that only serious conditions threatening life or the kidney need to be diagnosed on a screening programme. The first three factors are self explanatory. The fourth might not be universally acceptable. We believe, however, that for the sake of avoiding overinvestigation and containing costs, we can afford to miss the diagnosis of certain relatively minor conditions during the first investigation of a child with infection. This is on the understanding that if the child has a further infection, more conventional investigations will be performed that will pick up even the least worrying conditions.