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Vesicoureteric Reflux — RACP Paediatrics MCQ

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ModerateNephrologyVesicoureteric RefluxRACP Paediatrics

A 6-month-old boy presents with a febrile UTI. Renal ultrasound shows left-sided hydronephrosis. MCUG shows grade IV vesicoureteric reflux on the left side. What is the recommended initial management?

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Correct answer: B — Antibiotic prophylaxis with trimethoprim and surveillance imaging

High-grade VUR (grades IV–V) in young children is initially managed conservatively with antibiotic prophylaxis (trimethoprim 2 mg/kg at night) and surveillance imaging. Most grades I–III VUR resolve spontaneously. For persistent high-grade VUR with breakthrough infections or new renal scarring, surgical intervention (ureteric reimplantation or endoscopic injection) is considered.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Vesicoureteric Reflux