A 4-year-old girl is brought to the pediatric clinic by her mother due to recurrent episodes of fever, abdominal pain, and painful urination over the past 6 months. The mother reports that the child has had three urinary tract infections (UTIs) confirmed by urine cultures. The most recent episode occurred two weeks ago, with a high fever (102°F), flank pain, and dysuria. The child was treated with antibiotics, and her symptoms resolved temporarily. Past Medical History: Birth history: Full-term, normal delivery No significant past medical history other than recurrent UTIs No known allergies Family History: Mother had a history of recurrent UTIs during childhood and was treated for vesicoureteral reflux (VUR). Physical Examination: Temperature: 37.8°C Heart rate: 90 bpm Blood pressure: 105/65 mmHg Abdomen: Mild tenderness in the suprapubic region and right flank External genitalia: Normal, no erythema or discharge Costovertebral angle tenderness (right side): Present Diagnostic Workup: Urinalysis: Positive for leukocytes, nitrites, and moderate protein Urine culture: Positive for Escherichia coli Serum creatinine: Normal Blood urea nitrogen (BUN): Normal Renal ultrasound: Shows mild right hydronephrosis, but no visible structural abnormalities Voiding cystourethrogram (VCUG): Demonstrates grade III vesicoureteral reflux (retrograde flow of contrast from the bladder to the right ureter and renal pelvis) DMSA renal scan: Shows areas of scarring in the right kidney consistent with previous infections. Question: What is the first-line treatment for managing vesicoureteral reflux in this patient?
A 30-year-old woman with medullary sponge kidney presents with dysuria and fever. She has a history of recurrent urinary tract infections and kidney stones. Her urinalysis shows pyuria and positive nitrites. A urine culture confirms E. coli infection. Which of the following is the most important preventive strategy for reducing complications in this patient?
A 42-year-old man with a history of nephrolithiasis presents with hematuria and mild flank pain. His serum calcium and parathyroid hormone levels are normal. A urinalysis reveals microscopic hematuria but no proteinuria. Non-contrast CT scan shows bilateral nephrocalcinosis. Which of the following imaging studies would best confirm the diagnosis of medullary sponge kidney?
A 35-year-old woman presents with recurrent episodes of flank pain and hematuria. She has a history of multiple kidney stones and frequent urinary tract infections. She denies any family history of kidney disease. A non-contrast CT scan reveals bilateral nephrocalcinosis. Laboratory tests show normal renal function. What is the most likely diagnosis?
A 30-year-old woman diagnosed with medullary sponge kidney after an incidental finding during an ultrasound for another issue is now discussing her condition with her doctor. She wants to understand if there’s a genetic component to this condition. Which of the following is true regarding the genetic aspects of medullary sponge kidney?
A 40-year-old male with a history of medullary sponge kidney has been managing recurrent stones. He is now concerned about his kidney function and potential impacts on his overall health. Which of the following statements about kidney function in medullary sponge kidney is most accurate?
A 35-year-old woman presents with recurrent urinary tract infections (UTIs) and hematuria. Imaging studies reveal multiple small cystic dilations in the renal pyramids, consistent with medullary sponge kidney (MSK). She is curious about the long-term implications of her condition. Which of the following complications is most commonly associated with medullary sponge kidney?
A 5-year-old boy with a history of recurrent UTIs undergoes a renal ultrasound, which shows mild hydronephrosis. A VCUG is performed, and grade III vesicoureteral reflux is diagnosed. His parents are concerned about the potential complications if left untreated.They ask about the long-term risks of this condition. Which of the following is the most significant long-term complication of untreated vesicoureteral reflux?
A 3-year-old girl presents to the pediatric clinic with recurrent febrile urinary tract infections (UTIs). Her mother reports that the child has had three episodes of fever, dysuria, and foul-smelling urine over the past year. Each episode was treated with antibiotics. A voiding cystourethrogram (VCUG) is performed and it reveals retrograde flow of urine from the bladder into the ureters during micturition. What is the most likely diagnosis in this patient?
A 2-year-old girl is diagnosed with Grade III vesicoureteral reflux after recurrent UTIs. She has normal renal function and no evidence of renal scarring on a DMSA scan. What is the most appropriate initial management strategy for this patient?
