What is the recommended work-up for a child suspected of having pyelonephritis?

The recommended work-up for a child suspected of having pyelonephritis includes urethral catheterization, urinalysis, and urine culture. This approach is favored because it allows for the accurate collection of urine, which is crucial for diagnosing urinary tract infections (UTIs) and pyelonephritis.

Urethral catheterization ensures that a sterile urine specimen is obtained, minimizing the risk of contamination that can occur with a clean-catch method. This is particularly important in the pediatric population, where accurate diagnosis is essential for appropriate management.

Urinalysis can reveal the presence of leukocytes, nitrites, bacteria, and other indicators of infection, while a urine culture is necessary to identify the specific pathogen causing the infection and to determine its susceptibility to antibiotics. This thorough evaluation is vital in guiding treatment, particularly in cases of more complicated infections like pyelonephritis.

Imaging studies and other laboratory tests, while potentially useful in certain cases, are not routinely part of the initial work-up unless there are atypical features or complications that need further investigation. Similarly, a complete blood count may provide additional information regarding systemic infection but does not replace the need for a focused urinalysis and culture in this scenario.