Dr. Anil Takvani
Dr. Anil Takvani
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Bilateral high grade reflux with recurrent febrile UTI and renal scarring

Dear All,


10 months male child, appearing sick,  presented with history of recurrent febrile UTI since last 6 to 7 months. On previous febrile episodes child was not evaluated for presence of UTI. He is on antibiotics as per culture sensitivity.  Since last 10 days afebrile.  Height normal,  weight is less in compare to age.  BP normal,  urine protein absent. 
S. Creatinine: 0.48 mG%
I am attaching recent USG,  VCUG and DMSA renal scan for review. 
How will you manage this child from this point...
Thanks 

Bilateral high grade reflux with recurrent febrile UTI and renal scarring Bilateral high grade reflux with recurrent febrile UTI and renal scarring Bilateral high grade reflux with recurrent febrile UTI and renal scarring Bilateral high grade reflux with recurrent febrile UTI and renal scarring

Comments(2)

  • Lalit Shah
    Lalit Shah
    08 Mar 2021 01:17:47 PM

    Would need bilateral ureteric reimplant with guarded prognosis.

  • AMIT KUMAR
    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. 

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