Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal 3 > Pediatrics: Vesicoureteral Reflux > Flashcards

Pediatrics: Vesicoureteral Reflux Flashcards

1
Q

What is vesicoureteral reflux?

A

Retrograde flow of urine from the bladder to the upper urinary tract (problem at the junction of the ureter into the bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What % of newborns have vesicoureteral reflux?

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who is VUR most common in?

A
  • Under 2 years of age (as we get older, risk of reflux is less)
  • Femaes: 2x more than males (girls are more prone to UTI too)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does VUR predispose to?

A

UTI

-In children with UTI, reflux found in 30-45%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of infants with antenatal detected hydronephrosis have VUR?

A

10-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is something that might increase your suscpicion for an infant to have VUR?

A

Hydronephrosis detected on a prenatal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the % prevalence among siblings with VUR?

A

35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What % of newborns have a parent with a history of reflux?

A

67%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the inheritance pattern of VUR known?

A

No, the genetic loci and inheritance of is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the competence of the ureterovesical junction (UVJ) achieved by?

A

A long intramural portion of the ureter which lengthens with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the ureterovesical junction do?

A

Acts as a valve to prevent retrograde passage of urine up the ureter as the bladder fills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens to the ureterovesical junction during urination?

A

It is compressed (it should contract until the bladder is empty)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to the uretervesical junction with UTI?

A

The area around the UVJ is inflamed and edematous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does VUR result from?

A

Incompetent closure of the UVJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 cateogires of VUR?

A
  1. Primary reflux

2. Secondary reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is primary reflux to do?

A

Failure of the anti-reflux mechanisn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is secondary reflux to do?

A

Other anatomic deformities

  1. Posterior uretheral valves
  2. Neurogenic bladder: It doesn’t contract and function properly (there is a lack of coordinated contraction)
  3. Duplication of upper urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does an increased grade of VUR correspond to?

A

Worse reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does grade 1 VUR involve?

A

Ureter only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does grade 2 VUR involve?

A

Ureter, pelvic, and calyces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is there dilation of the ureter in grade 2 VUR?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is seen in grade 3 VUR?

A
  • Mild dilation of the ureter and/or pelvic

- No blunting of fornices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is seen in grade 4 VUR?

A
  • Moderate dilation of the ureter, pelvis, and calyces

- Maintains papillary impression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is seen in grade 5 VUR?

A

Gross dilation and loss of papillary impression (this is very severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What 2 things are associated with VUR?

A
  1. Recurrent UTI

2. Acute pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can acute pyelonephritis lead to in children?

A
  1. Renal scarring

2. End stage renal failure (ESRF)

27
Q

What are 5 methods of diagnosing VUR?

A
  1. Visualization of urinary backflow and associated scarring
  2. Prenatal US
  3. Postnatal US
  4. Voiding cystourethrogram (VCUG)
  5. Dimercaptosuccinic acid (DMSA) renal scan
28
Q

What is associated with severe degree of reflux?

A

Visualization of urinary backflow and associated scarring

29
Q

What tests can raise suspicion for VUR and how?

A

Pre and post natal US…if you see hydronephrosis, could be a sign of VUR

30
Q

What is the gold standard for diagnosing VUR?

A

Voiding cystourethrogram

31
Q

Once diagnosis of VUR is made, what test can be done for follow up depending on severity?

A

DMSA (nuclear scan)

32
Q

What can a VCUG do for you?

A
  1. You can see the anatomy of the renal tract

2. You can grade the severity of the reflux

33
Q

What are the complications of VUR?

A
  1. Renal scarring

2. Complications during pregnancy

34
Q

What are some problems that renal scarring can cause?

A
  1. Proteinuria
  2. HTN
  3. Renal failure
35
Q

What % of patients with VUR have spontaneous resolution at 2 years?

A

51%

36
Q

What are the associated factors with spontaneous resolution?

A
  1. Age of diagnosis under 1 year of age
  2. Lower grades of VUR
  3. Prenatal hydronephrosis
  4. Unilateral involvement
37
Q

What is the rate of spontaneous resolution in grade 1 VUR?

A

72%

38
Q

What is the rate of spontaneous resolution in grade 2 VUR?

A

61%

39
Q

What is the rate of spontaneous resolution in grade 3 VUR?

A

49%

40
Q

What is the rate of spontaneous resolution in grade 4 VUR?

A

32%

41
Q

What is the rate of spontaneous resolution in grade 5 VUR?

A

It’s rare

42
Q

What are treatment considerations with VUR?

A
  1. Prompt treatment of UTI

2. UTI prophylaxis when appropriate

43
Q

What must be part of the initial evaluation with VUR?

A
  1. Renal status: Urinalysis, serum creatinine, renal US
  2. Growth parameters: Worry that the child won’t grow on target for age and gender
  3. BP
44
Q

Why is VUR considered a RF for recurrent pyelonephritis and possible renal scarring?

A

Because conclusive evidence demonstrating whether or not directed therapeutic interventions towards VUR affect long-term renal outcome is lacking

45
Q

What is the decision of observation, medical, or surgical intervention based on?

A
  1. Risk of reflux to the patient
  2. Likelihood of spontaneous resolution
  3. Parental-patient preferences
46
Q

Which grades of VUR are at greatest risk and require treatment?

A

3-5

47
Q

What are the 2 categories for treatment of grade 3-5 VUR?

A
  1. Antibiotic prophylaxis
  2. Surgery
    * Between these 2 there is no statistical difference in outcome
48
Q

What are the 3 circumstances when surgical treatment of VUR is required?

A
  1. Grade V reflux with scarring
  2. Grade V reflux in children over 6 years of age
  3. Children who fail medical therapy
49
Q

What grades of VUR are lower risk and treated case by case?

A

1-2

50
Q

How are grades 1-2 VUR treated?

A

Medical monitorying versus antibiotic

51
Q

What 2 drugs are given as antibiotic prophylaxis for VUR?

A
  1. TMP-SMX (Bactrim)
  2. Nitrofurantoin
    * One daily dose at half the therapeutic dose
52
Q

Does Bactrim require refridgeration?

A

NO

53
Q

What happens in an open surgical repair and what is the success rate?

A
  • You reimplant the ureter (flipping ureter and sew it back in….it’s very invasive)
  • Greater than 95%
54
Q

What is the endoscopic correction of VUR called?

A

Subureteric transurethral injection (STING procedure)

55
Q

How does STING work?

A

You inject bulking agents (dextranomer/hyaluronic acid (Dx/HA or DEFLUX)) via cystoscopy into bladder wall beneath the ureteral orifice to elongate the intramural section of the ureter

56
Q

What are the rates of successful correction and long-term outcomes for STING?

A
  1. Rate of successful correction isn’t as high as with the open procedure
  2. Long-term outcome of the endoscopic approach is uncertain
57
Q

What are complications associated with STING?

A

There is a low risk of complications… the risk of ureteral obstruction after ET of VUR is less than 0.5%

58
Q

What are 3 reasons antibiotic prophylaxis for VUR is desirable?

A
  1. Prevents UTI
  2. Minimize risk of pyelonephritis
  3. Noninvasive
59
Q

What are 6 reasons antibiotic prophylaxis for VUR is undesirable?

A
  1. Long-term: Until VUR resolves (years)
  2. Inconvenient
  3. Side Effects: Nausea, vomiting, skin rash, rare anapylaxis, and systemic effects
  4. Compliance
  5. Antibiotic resistance
  6. Breakthrough infections
60
Q

Why are surgical considerations desirable?

A

They prevent renal damage (one this is established, it can’t be reversed)

61
Q

Why are surgical considerations undesirable?

A

The value of surgical correction in a self-limiting condition…?

62
Q

What are 4 follow up considerations for patients with VUR?

A
  1. Growth parameters
  2. Blood pressure
  3. Urine culture with any UTI symptoms
  4. Annual renal US
63
Q

When do you discontinue medical therapy?

A

There is no conclusive evidence, but reasonable:

  1. Resolution on VCUG to grade 1
  2. Infection free for 6-9 months
  3. Toilet trained

Renal 3 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions