Clinical scenario: Recurrent UTI | Hypertension | DMSA scan
A 9-year-old girl has a history of recurrent febrile urinary tract infections since infancy. She is now found to have blood pressure of 145/92 mmHg. Urinalysis shows mild proteinuria without active urinary sediment. Serum creatinine is mildly elevated. A DMSA scan demonstrates focal cortical scarring of the left kidney.
What is the most likely cause of her hypertension?
A. Acute pyelonephritis
B. Reflux nephropathy
C. Minimal change disease
D. Renal vein thrombosis
E. Wilms tumor
Correct answer & Explanation
Correct answer: B. Reflux nephropathy
Explanation:
This child has reflux nephropathy, resulting from vesicoureteral reflux (VUR) with recurrent pyelonephritis leading to permanent renal cortical scarring.
Typical features include:
- History of recurrent febrile UTIs
- Hypertension
- Mild proteinuria
- Progressive CKD
- DMSA scan showing renal cortical scars (gold standard for detecting renal scarring)
Hypertension develops due to activation of the renin–angiotensin system from scarred renal parenchyma.
Why the other options are incorrect:
- A. Acute pyelonephritis – Causes acute illness but not chronic cortical scarring with persistent hypertension.
- C. Minimal change disease – Causes nephrotic syndrome, not renal scarring.
- D. Renal vein thrombosis – Presents with hematuria, flank mass, and acute kidney injury.
- E. Wilms tumor – May cause hypertension but would present with an abdominal mass rather than DMSA-proven cortical scars.
Key point:
A child with recurrent febrile UTIs + hypertension + DMSA cortical scarring has reflux nephropathy, a major cause of secondary hypertension and chronic kidney disease in children.
