OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis.METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection ( F/S UTI) and renal scarring.RESULTS: Children with VUR had higher 2-year rates of recurrent F/S UTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD. WHAT'S KNOWN ON THIS SUBJECT:Vesicoureteral reflux is recognized as an important risk factor for recurrent urinary tract infection and renal scarring. Less is known about the contribution of other risk factors to these outcomes. WHAT THIS STUDY ADDS:This study found that information about vesicoureteral reflux and bladder and bowel dysfunction can be used to identify children at low, medium, and high risk of recurrent urinary tract infection, information that clinicians could use to select children for specific preventive therapies.

Practice Gap Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria. Objectives After completing this article, readers should be able to: 1. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. 2. Describe screening techniques for initial evaluation of hematuria and proteinuria. 3. Recognize the criteria for diagnosis of proteinuria and hematuria. 4. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. 5. Recognize serious causes of hematuria and proteinuria that warrant immediate referral.

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