Editing AUA: Vesicoureteral Reflux (2017) (section)

== Follow-up of the Child with VUR not undergoing surgical intervention ==

* These guidelines apply to all children, irrespective of age
* '''<span style="color:#ff0000">Recommended follow-up:'''
** '''<span style="color:#ff0000">Annual (3):'''
**# '''<span style="color:#ff0000">History + Physical Exam (including monitoring of blood pressure, height, and weight)'''
**# '''<span style="color:#ff0000">Urinalysis''' for proteinuria and bacteriuria; culture and sensitivity if the U/A is suggestive of infection
**# '''<span style="color:#ff0000">Ultrasound''' to monitor renal growth and any parenchymal scarring
** '''<span style="color:#ff0000">If CAP is used, voiding cystography is recommended between 12 and 24 months to determine when CAP can be stopped'''
*** Longer intervals between follow-up studies in recommended in patients in whom evidence supports lower rates of spontaneous resolution (i.e. those with higher grades of VUR [grades III-V], BBD, and older age)
*** '''If an observational approach without CAP is being used, follow-up cystography becomes an option (see below).'''
** '''<span style="color:#ff0000">DMSA imaging [during follow-up] is recommended if:'''
**# '''<span style="color:#ff0000">Concern for new/increased scarring (i.e. febrile UTI, high-grade VUR (grade III-V))'''
**# '''<span style="color:#ff0000">Renal ultrasound is abnormal'''
**# '''<span style="color:#ff0000">An elevation in serum creatinine'''
* '''Optional follow-up:'''
** '''Follow-up cystography may be done after age >1 in patients with VUR grades I–II'''
*** These patients tend to have a high rate of spontaneous resolution and boys have a low risk of recurrent UTI
** The clinical significance and the need for ongoing evaluation of grade I VUR is undefined
** '''A single normal voiding cystogram (i.e. no evidence of VUR) may serve to establish resolution'''