A 3-year-old girl presents with high fever, dysuria, and a positive urine culture showing ≥10⁵ CFU/mL of E. coli. Micturating cystourethrogram (MCU/VCUG) reveals bilateral grade III vesicoureteral reflux. What is the most important long-term risk of untreated VUR with recurrent UTIs?
- A Bladder transitional cell carcinoma
- B Chronic kidney disease from reflux nephropathy (renal scarring) ✓
- C Nephrotic syndrome
- D Development of autoimmune nephritis
Explanation
Vesicoureteral reflux (VUR) allows urinary tract infections to ascend to the renal parenchyma, causing repeated pyelonephritis and progressive renal scarring (reflux nephropathy). Renal scarring leads to impaired renal growth, chronic kidney disease (CKD), hypertension, and in severe bilateral cases, end-stage renal disease. The younger the child at diagnosis and the higher the VUR grade, the greater the risk of scarring. Management includes low-dose antibiotic prophylaxis or early surgical correction (endoscopic injection/ureteric reimplantation) for high-grade or breakthrough infection VUR. DMSA scintigraphy is the gold standard for detecting renal scarring.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.