Chronic Pyelonephritis Treatment & Management
- Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
VUR Stages I and II
This is reflux of urine to the ureter or renal pelvis without ureteral dilatation. Medical therapy with antibiotics, such as amoxicillin, trimethoprim/sulfamethoxazole (Bactrim), trimethoprim alone, or nitrofurantoin, is usually sufficient.
Continue antibiotic therapy until puberty or until reflux resolves. The rule in these cases is spontaneous resolution; surgery is not indicated.
VUR Stages III and IV (severe reflux)
Data from the Birmingham Reflux Study show that medical and surgical therapies for reflux are equally effective. Surgery entails the reimplantation of the ureters, with the creation of an adequate submucosal tunnel and detrusor support. The following are indications for surgical therapy:
Failure to comply with medical regimen, with formation of new scars
Breakthrough infections occurring in patients who are compliant
Women of childbearing age who prefer surgical therapy
Reflux persisting after puberty in women - Should be surgically treated to prevent possible complications (eg, pyelonephritis, abortions in pregnancy)
VUR Stage V (severe reflux)
Surgery is recommended in all children older than 1 year with bilateral reflux with or without the presence of renal scarring. Patients aged 1-5 years with unilateral reflux and no scarring may initially be treated with antibiotic prophylaxis.
Progressive renal injury can be reduced by dietary protein restriction, while aggressive blood pressure control aids in slowing progression of renal failure. Angiotensin-converting enzyme (ACE) inhibitors are particularly beneficial in treating hypertension.
Careful follow-up and monitoring of renal function is beneficial. Vigorously treat a UTI or bacteriuria in a patient who is pregnant to prevent renal failure, preeclampsia, and abortions.
Renal ultrasonography is recommended for siblings of patients with VUR. If an abnormality is found, then perform a voiding cystourethrogram (VCUG).
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