Management of Primary Vesicoureteral Reflux in Children
Publication Date: September 1, 2010
Last Updated: March 14, 2022
Recommendations
Initial Evaluation of the Child with VUR
General Evaluation
VUR and UTI may detrimentally affect the overall health and renal function in affected children. Therefore, on initial presentation the child with VUR should undergo a careful general medical evaluation including measurement of height, weight and blood pressure, as well as serum creatinine if bilateral renal cortical abnormalities are found. (Standard, )
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Urinalysis for proteinuria and bacteriuria is recommended. If the urinalysis indicates infection, urine culture and sensitivity are recommended. (Recommendation, )
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A baseline serum creatinine may be obtained to establish an estimate of glomerular filtration rate (GFR) for future reference. (, )
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Imaging Procedures
Because VUR and UTI may affect renal structure and function, performing renal ultrasound to assess the upper urinary tract is recommended. (Recommendation, )
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DMSA renal imaging can be obtained to assess the status of the kidneys for scarring and function. (Option, )
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Assessment of Voiding Patterns
Symptoms indicative of BBD should be sought in the initial evaluation (including urinary frequency and urgency, prolonged voiding intervals, daytime wetting, perineal/penile pain, holding maneuvers [posturing to prevent wetting] and constipation/encopresis). (Standard, )
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APN, acute pyelonephritis; BBD, bladder and bowel dysfunction; BT-UTI, breakthrough UTI; CAP, continuous antibiotic prophylaxis; DMSA, dimercaptosuccinic acid; UTI, urinary tract infection; VCUG, voiding cystourethrogram; VUR, vesicoureteral reflux
Overview
Title
Management of Primary Vesicoureteral Reflux in Children
Authoring Organization
American Urological Association