A 2-year-old girl presents with dysuria, fever, and a urine culture showing >10^5 CFU/mL of E. coli. Renal ultrasound shows a dilated right ureter and renal pelvis. VCUG demonstrates grade III vesicoureteric reflux on the right. What is the MOST appropriate initial management?

• A Immediate ureteral reimplantation surgery
• B Nephrectomy of the affected kidney
• C DMSA scan only; no antibiotic prophylaxis needed for grade III VUR
• D Antibiotic treatment of acute UTI followed by continuous antibiotic prophylaxis and surveillance ✓

Explanation

Grade III vesicoureteric reflux in a 2-year-old is managed conservatively with antibiotic prophylaxis (trimethoprim or nitrofurantoin at low dose) combined with bladder and bowel dysfunction management, surveillance urine cultures, and periodic imaging to monitor resolution. Most grade I–III VUR resolves spontaneously with age. DIMERCAPTOSUCCINIC ACID (DMSA) scan is used to evaluate renal scarring. Surgical reimplantation is reserved for high-grade (grade IV–V) reflux, breakthrough UTIs on prophylaxis, or failure to resolve. Nephrectomy is not indicated in early reflux nephropathy.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.