Bilateral high grade reflux with recurrent febrile UTI and renal scarring

• 07 Mar 2021 05:44:03 PM
• |Pediatic Urology

Dear All,

Comments(2)

• 

  Lalit Shah

  08 Mar 2021 01:17:47 PM

  Would need bilateral ureteric reimplant with guarded prognosis.

• 

  AMIT KUMAR

  08 Mar 2021 02:29:13 PM

  Hello sir 

  This is case of bilateral grade 4 vur in a 10 month old male. 

  - Firstly secondary vur has to be ruled out. Though usg shows only mild bladder wall thickening, second mcu film shows dilated posterior urethra with cut off, I would first put a puc and observe. 

  - serum creatinine is normal for age, no proteinuria, bp normal, means kidneys are preserved. 

  -though the dmsa scan shows decreased count on posterior films of left kidney, and left kidney appears irregular and scarred, renal scarring in dmsa cannot be commented in case of acute episode, and mandates a repeat dmsa after 6 months. 

  - management might include, catheterisation, starting on prophylactic antibiotics, continuing antibiotics till he develops breakthrough uti or develops progressive scars on repeat dmsa, or progressive worsening of grade of vur on follow-up usg, or proteinuria, growth retardation, hypertension, then he would need surgical correction. Till then he would be kept on follow up with serial usg, rft and dmsa after 6 months. 

  - If parents non compliant or strict follow up is anticipated to be difficult, upfront surgery can be offered.