Peds Vesicoureteral Reflux

Question 1

H&P for suspected/confirmed VUR (repeat at 12 month intervals)

Answer 1

-Gestational history
-Prenatal testing results
-BBD history (if age appropriate)
-Height, weight, blood pressure
-Creatinine if bilateral renal cortical abnormalities (or for baseline)
-Urinalysis
-RBUS
-VCUG
-DMSA can be obtained for scarring/function

Question 2

Counseling for initial VUR management

Answer 2

Discuss rationale for treating VUR
Consequences of untreated VUR
Equivalency of certain treatments
Likely adherence
Parental concerns and preferences

Question 3

Goals of treating VUR

Answer 3

Prevent recurrent febrile UTIs
Prevent renal injury
Minimize morbidity

Question 4

Initial VUR treatment

Answer 4

Under 1 yr - CAP if febrile UTI or grade 3+ VUR (may be offered to grade 1-2)
Offer circumcision in boys

Over 1 year
-CAP if BBD, Hx UTI

Question 5

Treatment of bowel/bladder dysfunction as it relates to VUR

Answer 5

Bladder training, biofeedback, anticholinergics, bowel regimen

Question 6

What is DMSA

Answer 6

Dimercaptusuccinic acid
-short lived radioisotope filtered by kidneys
-Assesses for scarring

Question 7

Management of breakthrough UTI on CAP

Answer 7

Change CAP (optional)
Surgical intervention (recommended)

Question 8

Postop imaging following VUR intervention

Answer 8

RBUS
VCUG if bulking agents

Question 9

Follow up after resolution (natural or surgical)

Answer 9

Annual visit is optional
Revisit workup if febrile UTI