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High-Grade VUR Management — RACP Paediatrics MCQ

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ModerateNephrologyHigh-Grade VUR ManagementRACP Paediatrics

A 2-year-old girl has her second febrile UTI. USS shows bilateral hydronephrosis. DMSA scan shows left renal scarring. VCUG shows grade IV bilateral vesicoureteric reflux. What is the recommended management?

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Correct answer: D — Antibiotic prophylaxis and consideration of surgical correction

High-grade VUR (grade IV-V) with recurrent febrile UTIs and renal scarring requires antibiotic prophylaxis (trimethoprim) and urology referral. Surgical options include endoscopic subureteric injection (Deflux) or ureteric reimplantation. The decision balances infection risk, renal damage, and natural resolution rates.

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