<p>Febrile urinary tract infections (fUTIs) are among the most common severe infections in the pediatric population, posing a significant risk to kidney health. The pathophysiology of fUTIs involves the direct bacterial invasion of kidney tissue, which triggers an inflammatory response. While this response is effective in eradicating the infection, it can also cause substantial kidney damage at multiple levels. In this review, we explore the various forms of kidney involvement in fUTIs, along with their clinical, radiological, and biochemical presentations. We also discuss the implications of these events for the long-term prognosis of kidney function. Understanding these manifestations can assist clinicians in making prompt diagnoses and initiating appropriate treatment to minimize complications such as sepsis, kidney scarring, and long-term kidney damage.</p> Graphical Abstract <p></p>