AUA: Vesicoureteral Reflux (2017): Difference between revisions
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=== History and Physical Exam === | === History and Physical Exam === | ||
* '''History''' | * '''<span style="color:#ff0000">History''' | ||
**'''Assess for symptoms of bladder/bowel dysfunction (BBD) including (6):''' | **'''<span style="color:#ff0000">Assess for symptoms of bladder/bowel dysfunction (BBD) including (6):''' | ||
**# '''Urinary frequency and urgency''' | **# '''<span style="color:#ff0000">Urinary frequency and urgency''' | ||
**# '''Prolonged voiding intervals''' | **# '''<span style="color:#ff0000">Prolonged voiding intervals''' | ||
**# '''Daytime wetting''' | **# '''<span style="color:#ff0000">Daytime wetting''' | ||
**# '''Perineal/penile pain''' | **# '''<span style="color:#ff0000">Perineal/penile pain''' | ||
**# '''Holding maneuvers (posturing to prevent wetting)''' | **# '''<span style="color:#ff0000">Holding maneuvers (posturing to prevent wetting)''' | ||
**# '''Constipation/encopresis''' (soiling of underwear with stool by children who are beyond age of toilet training) | **# '''<span style="color:#ff0000">Constipation/encopresis</span>''' (soiling of underwear with stool by children who are beyond age of toilet training) | ||
*** '''BBD''', dysfunctional voiding, dysfunctional elimination syndrome and dysfunctional lower urinary tract symptoms, refer to a common but poorly characterized '''complex of symptoms typically including urinary incontinence, frequency or infrequent voiding, dysuria, UTI, and constipation''' | *** '''<span style="color:#ff0000">Bladder bowel dysfunction (BBD)</span>''', dysfunctional voiding, dysfunctional elimination syndrome and dysfunctional lower urinary tract symptoms, refer to a common but poorly characterized '''<span style="color:#ff0000">complex of symptoms typically including urinary incontinence, frequency or infrequent voiding, dysuria, UTI, and constipation''' | ||
*** '''Untreated BBD associated with:''' | *** '''Untreated BBD associated with:''' | ||
**** '''Increased incidence of breakthrough UTI in children on continuous antibiotic prophylaxis (CAP)''' | **** '''Increased incidence of breakthrough UTI in children on continuous antibiotic prophylaxis (CAP)''' | ||
**** '''Decreased resolution rates of VUR at initial follow-up in children treated with endoscopic surgery''' | **** '''Decreased resolution rates of VUR at initial follow-up in children treated with endoscopic surgery''' | ||
***** '''BBD does not alter surgical resolution rates in children treated with open surgery''' | ***** '''BBD does not alter surgical resolution rates in children treated with open surgery''' | ||
* '''Physical exam''' | * '''<span style="color:#ff0000">Physical exam''' | ||
**'''General medical evaluation including measurement of''' | **'''<span style="color:#ff0000">General medical evaluation including measurement of''' | ||
***'''Height''' | ***'''<span style="color:#ff0000">Height''' | ||
***'''Weight''' | ***'''<span style="color:#ff0000">Weight''' | ||
***'''Blood pressure''' | ***'''<span style="color:#ff0000">Blood pressure''' | ||
=== Labs === | === Labs === | ||
*'''Serum creatinine''' | *'''<span style="color:#ff0000">Serum creatinine''' | ||
**'''Indications''' | **'''<span style="color:#ff0000">Indications''' | ||
***'''Absolute (1):''' | ***'''<span style="color:#ff0000">Absolute (1):''' | ||
****'''Bilateral renal abnormalities''' | ****'''<span style="color:#ff0000">Bilateral renal abnormalities''' | ||
***'''Relative''' | ***'''Relative''' | ||
****'''Children with VUR but without bilateral renal abnormalities''' to establish an estimate of glomerular filtration rate (GFR) for future reference. | ****'''Children with VUR but without bilateral renal abnormalities''' to establish an estimate of glomerular filtration rate (GFR) for future reference. | ||
* '''Urinalysis''' | * '''<span style="color:#ff0000">Urinalysis''' | ||
**Evaluate for proteinuria and bacteriuria''';''' if the urinalysis indicates infection, a urine culture and sensitivity is recommended | **Evaluate for proteinuria and bacteriuria''';''' if the urinalysis indicates infection, a urine culture and sensitivity is recommended | ||
=== Imaging === | === Imaging === | ||
* '''Recommended (1)''': | * '''<span style="color:#ff0000">Recommended (1)''': | ||
**'''Renal ultrasound''' | **'''<span style="color:#ff0000">Renal ultrasound''' | ||
***VUR and UTI may affect renal structure and function | ***VUR and UTI may affect renal structure and function | ||
* '''Optional (1)''' | * '''<span style="color:#ff0000">Optional (1)''' | ||
**'''DMSA''' (technetium-99m-labeled dimercaptosuccinic acid) | **'''<span style="color:#ff0000">DMSA</span>''' (technetium-99m-labeled dimercaptosuccinic acid) | ||
***'''To assess the status of the kidneys for scarring and function''' | ***'''To assess the status of the kidneys for scarring and function''' | ||
**** '''Children with higher grades of VUR (i.e. grades III to V) are at greater risk of having renal cortical abnormalities.''' | **** '''Children with higher grades of VUR (i.e. grades III to V) are at greater risk of having renal cortical abnormalities.''' | ||
**** DMSA scanning can be useful to identify pre-existing abnormalities. | **** DMSA scanning can be useful to identify pre-existing abnormalities. | ||
== Initial Management of the Child with VUR == | == Initial Management of the Child with VUR == | ||