A 4-year-old girl is brought to the physician because of a 2-day history of fever and crying while passing urine. She was born at term and has been healthy since. She has had several episodes of fever and abdominal pain, which her parents had treated with over-the-counter antibiotics . Her temperature is 39.0°C (102.2°F), pulse is 144/min, and blood pressure is 85/40 mm Hg. Physical examination shows no abnormalities. Her leukocyte count is 14,000/mm3. Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods. Urine culture results are pending. Renal ultrasound reveals dilated calyces with overlying cortical atrophy bilaterally, mostly in the upper and lower poles. Which of the following is the most likely cause of this patient's ultrasound findings?

Question

A 4-year-old girl is brought to the physician because of a 2-day history of fever and crying while passing urine. She was born at term and has been healthy since. She has had several episodes of fever and abdominal pain, which her parents had treated with over-the-counter antibiotics . Her temperature is 39.0°C (102.2°F), pulse is 144/min, and blood pressure is 85/40 mm Hg. Physical examination shows no abnormalities. Her leukocyte count is 14,000/mm3. Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods. Urine culture results are pending. Renal ultrasound reveals dilated calyces with overlying cortical atrophy bilaterally, mostly in the upper and lower poles.  Which of the following is the most likely cause of this patient's ultrasound findings?

Quizplus · Accepted Answer

Eductional Objective: Vesicoureteral reflux is caused by retrograde urine flow from the bladder into the ureter.  The hydrostatic pressure of refluxing urine along with infections due to ascending bacteria causes inflammation.  The compound papillae in the upper and lower poles of the kidney are most susceptible to reflux-induced damage, which appears as dilated calyces with overlying renal cortical scarring.

A 4-Year-Old Girl Is Brought to the Physician Because of a 2-Day