Current Status of Screening Children for Urinary Tract Infections

There is ample evidence that significant bacteriuria is frequent enough and procedures for mass screening are sufficiently developed to enable this country to mount a large scale program directed to the early detection of urinary tract infections. Information is now available on the epidemiology of bacteriuria, the frequency of associated structural abnormalities and methods to provide effective management. It is also clear that most female children with urinary tract infection generally will have a good prognosis. Few will develop endstage renal failure, but symptomatic infection is commonly associated with considerable morbidity. Unfortunately, it is not as yet possible to predict which child is at high risk of developing serious complications without searching for structural or neurologic abnormalities or by following individual patterns of recurrence. The ultimate impact on health and longevity is unknown even using data from the most structured programs. There is also the danger that mass programs may lead to false hope and eventual disillusionment if they are limited to detect infection and do not provide for further diagnostic, therapeutic and long-term follow-up of patients. For these reasons, urinary tract infection detection programs must be designed in relation to the realities of the current medical care system, the goals should be clearly defined and the expected result be stated honestly. AIMS OF THE PROGRAM There are two major reasons for screening children for urinary tract infection. One is to prevent the considerable morbidity from symptomatic infection and its complications so common in females throughout life. The other is to detect the population (often with anatomical abnormalities) at risk of developing pyelonephritis and subsequent renal damage.