Vesicoureteral Reflux Diagnosis After Hospitalization for Acute Cystitis and Pyelonephritis

Abstract

Children with recurrent fevers in a short period of time need to be worked up to identify the underlying cause. Fevers in children and infants can be from many different sources. Vesicoureteral reflux (VUR) is an anatomical and physiological anomaly in children that can lead to retrograde urine flow from the bladder back into the distal ureters. This retrograde flow can cause distention, scarring, and recurrent infections including urinary tract infections (UTIs) and pyelonephritis. Identification of multiple UTIs in a short period of time should raise suspicion for a more complex pathology such as VUR and requires a more thorough workup. This workup is needed for both diagnosis and treatment. The patient in this report was seen by physicians in the emergency department, pediatric intensive care unit, nephrology, and her pediatrician. If surgery is needed, a urologist would also be involved. This report will discuss the pathophysiology of VUR and associated pathologies, diagnostic approach, medical and surgical treatment modalities, as well as prognosis.

Keywords: pediatric urinary tract infection; pyelonephritis; recurrent urinary tract infection; urosepsis; vesicoureteral reflux; voiding cystourethrogram.

Figure 1. Renal ultrasound showing hydronephrosis in bilateral kidneys

Figure 2. Ultrasound of left ovarian cyst

Figure 3. VCUG reveals dilated ureters and dilated renal calyces distorting the normal renal anatomy.

VCUG - voiding cystourethrogram