A 7-year-old boy, UTI - nida

[ArchivalUser]

A 7-year-old boy is brought to the pediatrician by his mother for evaluation of his fever. She states that he has been looking ill for 2 days, and has complained of some nausea. His temperature on the morning of presentation was 38.8°C (101.8°F), taken orally. On further questioning, the boy reports urinary frequency and burning on urination. Physical exam is remarkable for a temperature of 38.3°C (101.2° F), mild abdominal tenderness, and bilateral costovertebral angle tenderness. A urine dipstick showed the following results:Urine microscopy revealed four red blood cells (RBCs) and nine white blood cells (WBCs) per high-powered field and WBC casts. Gram stain showed gram-negative rods. After treatment of the patient™s urinary tract infection, what is the next best step in management of this patient?

A. Annual urinalysis to check for asymptomatic infection
B. Child protective services referral for possible sexual abuse
C. Renal needle biopsy
D. Serum immunoglobulin A level
E. Voiding cystourethrogram (VCUG)

[ArchivalUser]

E.

[ArchivalUser]

E.

[ArchivalUser]

E -> to look for valves, reflux or diverticulum

[ArchivalUser]

E (Voiding cystourethrogram (VCUG)) is correct.

Pyelonephritis in males is most likely due to vesicoureteral (VU) reflux, which is evaluated best with VCUG. VU Reflux is graded 1“4 based on such a study. Grades 1 and 2 are minimal and tend to get better with time, grade 3 is associated with blunting of calyces and some ureteral dilitation, and grade 4 involves more dilitation and tortuosity of the ureters and more calyceal blunting than grade 3. Loss of renal cortex may also be seen with grade 4 reflux.