Revised Indian Society of Pediatric Nephrology Guidelines 2023 on UTIs and Vesicoureteric Reflux

Imaging Following Urinary Tract Infections (UTIs):

• Ultrasound scan is indicated for all patients diagnosed with UTI. The advantages of using this imaging modality are that it is non-invasive, imposes no radiation exposure, provides dynamic images, enables grading of vesicoureteral reflux (VUR), and offers detailed anatomical delineation of the urinary tract. The limitation is that the technique is operator-dependent.
• Micturatingcystourethrography is advised for patients with abnormal ultrasound scans, patients under 2 years with non-E. coli UTI, and those with recurrent UTI. This modality is the gold standard for detecting kidney scars and provides detailed anatomical delineation of the urinary tract. The limitations include – radiation exposure, invasive, the requirement of catheterization, and risk of UTI. 
• Late-phase DMSA scintigraphy is indicated in cases with recurrent UTIs. This technique is the gold standard for detecting kidney scars and provides detailed anatomical delineation of the urinary tract. The limitations are – radiation exposure, invasiveness, and limited accessibility. 

Source: Meena J, Bagga A, Hari P. Indian Pediatrics. 2024 Feb 26:S097475591600597-.