1/ Hi #NephTwitter #Renal #MedTwitter @aspneph radiology webinar this month was Vesicoureteral reflux #VUR and its management.
Let's get going with a poll!
What percentage of children with febrile UTI may end up having VUR?
Let's get going with a poll!
What percentage of children with febrile UTI may end up having VUR?
2/ Answer: up to 30%
This may be an underestimate since many children don't get tested.
[PMID: 9743033] pubmed.ncbi.nlm.nih.gov
This may be an underestimate since many children don't get tested.
[PMID: 9743033] pubmed.ncbi.nlm.nih.gov
3/ Risk factors for VUR:
⚡️Bowel and bladder dysfunction
⚡️Abnormal urinary tract anatomy
⚡️Younger children and infants
⚡️Girls affected >> boys
⚡️Family history: sibling with VUR ➡️ 25% recurrence risk
Read more 👇
PMID: pubmed.ncbi.nlm.nih.gov
⚡️Bowel and bladder dysfunction
⚡️Abnormal urinary tract anatomy
⚡️Younger children and infants
⚡️Girls affected >> boys
⚡️Family history: sibling with VUR ➡️ 25% recurrence risk
Read more 👇
PMID: pubmed.ncbi.nlm.nih.gov
4/ What tests aid Dx of VUR?
A. Renal ultrasound:
🔺Assess anatomy but not diagnostic for VUR
🔺Absence of hydronephrosis does NOT exclude VUR!!
A. Renal ultrasound:
🔺Assess anatomy but not diagnostic for VUR
🔺Absence of hydronephrosis does NOT exclude VUR!!
5/Testing in VUR:
B. Voiding cystourethrogram [VCUG]:
🎯 for VUR.
💎 Timing: 👍 unless has active UTI pubmed.ncbi.nlm.nih.gov
💎Prophylactic Abx: consider in 👶 and with abnormal renal imaging pubmed.ncbi.nlm.nih.gov
B. Voiding cystourethrogram [VCUG]:
🎯 for VUR.
💎 Timing: 👍 unless has active UTI pubmed.ncbi.nlm.nih.gov
💎Prophylactic Abx: consider in 👶 and with abnormal renal imaging pubmed.ncbi.nlm.nih.gov
![5/Testing in VUR:
B. Voiding cystourethrogram [VCUG]:
🎯 for VUR.
💎 Timing: 👍 un...](https://pbs.twimg.com/media/FYDbjI6WQAAu3y1.png)
6/ Webinar Pearls for VCUG:
🔹8 images for adequate study
- early filling, full bladder, R+ L obliques
🔹Cyclical voiding images are important
🔹Urethral 📷 with voiding after Foley removal to diagnose any obstruction
🔹8 images for adequate study
- early filling, full bladder, R+ L obliques
🔹Cyclical voiding images are important
🔹Urethral 📷 with voiding after Foley removal to diagnose any obstruction
7/ 2 tests in place of VCUG:
1) Contrast enhanced voiding ultrasound [CeVUS]:
✅:
🔸No radiation
🔸Void in upright position
❌:
🔺Urethral catheterization
🔺May miss grade 1 VUR
👉: pubmed.ncbi.nlm.nih.gov
1) Contrast enhanced voiding ultrasound [CeVUS]:
✅:
🔸No radiation
🔸Void in upright position
❌:
🔺Urethral catheterization
🔺May miss grade 1 VUR
👉: pubmed.ncbi.nlm.nih.gov
![7/ 2 tests in place of VCUG:
1) Contrast enhanced voiding ultrasound [CeVUS]:
✅:
🔸No ra...](https://pbs.twimg.com/media/FYDWiMgX0AENVfU.png)
8/ Another test in place of VCUG is:
2) Radionuclide cystogram (RNC):
Pros: Reduced radiation exposure
Cons: Less anatomic detail, not get precise grading
⚡️Used for follow-up evaluation of reflux rather than new diagnosis
2) Radionuclide cystogram (RNC):
Pros: Reduced radiation exposure
Cons: Less anatomic detail, not get precise grading
⚡️Used for follow-up evaluation of reflux rather than new diagnosis
9/ Functional nuclear imaging can be used in VUR; 2 tests are available
A. DMSA Scan
🔳Technetium-99m DMSA is a radioisotope injected IV
⚡️Size, shape and differential function
⚡️Detects renal scarring
A. DMSA Scan
🔳Technetium-99m DMSA is a radioisotope injected IV
⚡️Size, shape and differential function
⚡️Detects renal scarring
10/ Another functional study :
B. MAG3:
🔺 👀 for UPJ or UVJ obstruction
🔺 Cannot detect VUR
🔺gives differential function
B. MAG3:
🔺 👀 for UPJ or UVJ obstruction
🔺 Cannot detect VUR
🔺gives differential function
11/ Lets get into how to treat reflux! What is the role of antibiotic prophylaxis in VUR?
13/ Non-surgical treatment of VUR includes
- Waitful watching for spontaneous resolution
- Address bowel and bladder dysfunction
- Waitful watching for spontaneous resolution
- Address bowel and bladder dysfunction
14/ Surgical Rx of VUR includes
🔹Deflux: sub-ureteric transurethral injection of a copolymer
🔹Ureteral re-implantation [open or robotic]
Read more about surgical techniques in detail here! PMID: 16716788
🔹Deflux: sub-ureteric transurethral injection of a copolymer
🔹Ureteral re-implantation [open or robotic]
Read more about surgical techniques in detail here! PMID: 16716788
15/ To wrap this tweetorial- what determines the prognosis for VUR?
16/ Answer: Degree of renal scarring
⚡️Scars ⬆️⬆️ risk of hypertension and CKD
⚡️ Long term follow up is key!!
⚡️ Monitor for HTN, renal function and proteinuria
⚡️Scars ⬆️⬆️ risk of hypertension and CKD
⚡️ Long term follow up is key!!
⚡️ Monitor for HTN, renal function and proteinuria
17/ For a case-based clinical discussion on vesicoureteric reflux with a radiologist and an expert, login to @ASPNeph website, June 2022 webinar #Membereducation
18/ Special thanks to #ASPNFOAM group for helping me write my first tweetorial! @drM_sudha @nefron1310 @Swasthithinks
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