WHAT SHOULD THE FIRST INVESTIGATION FOLLOWING PYELONEPHRITIS BE: DMSA OR VCUG?
Primary VUR occurs in less than 1% of the general population but up to 50% of children who present with a UTI will have VUR [46]. Therefore, the detection of VUR is an abnormal finding. The primary reason for identifying VUR as a disease entity has been its association with pyelonephritis (PN), which, if recurrent, can lead to acquired cortical defects and subsequent hypertension and/or end stage renal failure. This perception that the triad of UTI-VUR-nephropathy is an intimate link has driven physicians to actively diagnose and treat VUR over the last 3 decades.