A 2-year-old girl has her first febrile UTI confirmed by suprapubic aspiration (E. coli >10^3 CFU/mL). Post-treatment DMSA scan at 6 months shows bilateral upper pole cortical defects. MCUG shows Grade III bilateral VUR. Long-term management decision should be based on the principle that:
- A Antibiotic prophylaxis indefinitely prevents new renal scarring in all grades of VUR
- B DMSA scan defines the need for VUR grading via MCUG
- C Grade III VUR resolves spontaneously in 100% of cases by age 5
- D High-grade VUR (Grade IV-V) unresponsive to prophylaxis should be considered for endoscopic or surgical correction ✓
Explanation
Current evidence (RIVUR and PRIVENT trials) shows low-dose antibiotic prophylaxis reduces febrile UTI recurrence by ~50% in VUR, especially Grade III-IV, but does not prevent all scarring. For Grade IV-V VUR unresponsive to prophylaxis (breakthrough infections, new scarring), surgical correction (ureteric reimplantation) or endoscopic injection (STING/HIT procedure) is indicated. Grade III VUR resolves spontaneously in about 50% by age 5 (not 100%). DMSA scan identifies scars but MCUG is the definitive investigation for VUR grading. The management decision in Grade III bilateral VUR involves prophylaxis initially with surveillance DMSA and MCUG to assess progression.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.