Stefan was diagnosed with secondary vesicoureteral reflux; such condition usually results from which of the following?
A. Acidic urine
B. Congenital defects
C. Hydronephrosis
D. Infection
Correct Answer: D. Infection
Infection is the most common cause of secondary vesicoureteral reflux. The possibility that UTI may cause reflux has also been investigated. Indeed, a subset of patients has been identified in whom reflux was detectable only during an episode of cystitis.
Option A: Acidic urine is normal and helps to prevent infection. According to the American Association for Clinical Chemistry, the average value for urine pH is 6.0, but it can range from 4.5 to 8.0. Urine under 5.0 is acidic, and urine higher than 8.0 is alkaline, or basic.
Option B: Congenital defects cause primary vesicoureteral reflux. Primary reflux is VUR in an otherwise normally functioning lower urinary tract. Rates of reflux are likely increased in the setting of congenital bladder outlet obstruction and neurogenic bladder. More than 50% of boys with posterior urethral valves have VUR. Similar results were seen in a series of children undergoing urodynamic studies for neurogenic bladder.
Option C: Hydronephrosis may result from vesicoureteral reflux. Recurrent UTI, first febrile urinary tract infection (UTI) with abnormal renal ultrasound (US) are indications of VUR. Other indications are prenatal/postnatal urinary tract dilatation, dysfunctional voiding, bladder outlet obstruction, neurogenic bladder, dysuria, hematuria, trauma.