quiz 1


1. What does the DMSA scan show ?

2.What was the soft tissue prevertebral mass?

3.Is there any life threatening problem that this child could develop?

4.What extrarenal tests can be considered in this child?

A 4 year old girl was brought to the hospital with complaints of abdominal pain for which an ultrasonography of the abdomen was done. The kidneys looked slightly abnormal and a prevertebral soft tissue mass was noted. A DMSA scan was done .Image shown below.

To give or not to give prophylactic antibiotics in children with VUR has been a contentious issue of Hamletian proportions. It has been a long standing belief that urinary prophylaxis prevents recurrent UTI and hence further renal damage in VUR.
Guidelines vary in their recommendations.The AAP says YES; NICE says NO..The ISPN recommends that VUR be initially managed with antibiotic prophylaxiis.The prophylaxis should be continued for 1 year in patients with grade 1 and 2 VUR and upto 5 years or until the VUR resolves in patients with higher grades of VU


The RIVUR study, The Randomized Intervention for Children with VUR trial  investigators report in the New England Journal of Medicine the results of a multicentre study in which 607 children (2 to 71 months of age with VUR grade 1 to 4  after a first or second urinary tract infection received either trimethoprim sulfamethaxozole or placebo for 2 years.Fewer recurrent UTI occured in the prophylaxis grouo (39 out of 302 children)  than in the polacebo group (72 out of 305 children) with a RR of 0.55( 95% confidence interval 0.38 to 0.78.However more children in the prophylaxis group had resistant isolates( 63% vs 19% in the placebo group.).Antibiotic prophylaxis was particularly effective in children whose index infection was febrile and in those with bladder and bowel dysfunction,Although the number of scars was limited no significant between group difference in renal scarring was noted at 2 years.

The full text of the RIVUR study is a must read.; and so is the editorial by Julie Ingelfinger and Bruder Stapleton

The RIVUR trial Investigators.Antimicrobial prophylaxis for children with vesicoureteric reflux. N Engl J Med DOI:

10-1056 NEJMoa 1401811.

Antibiotic prophylaxis for vesico ureteric reflux-Answers;yet questions.Julie R Ingelfinger.MD and F Bruder Stapleton MD; NEJM. mAY 4 20140

the rivur study

Antibiotic prophylaxis for VUR-. Do we have an answer?


Journal Scan

june 2014

must read this month

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