A nurse in a provider's office is caring for a 1-year-old toddler client. Drag words from the choices below to fill in each blank in the following sentence. The child is at risk for developing and .

Answer: pyelonephritis and renal scarring Brief Introduction This toddler is at significant risk for upper urinary tract complications due to the combination of a known structural abnormality and current clinical evidence of infection. Vesicoureteral reflux (VUR) creates a pathway for infected urine to backflow into the kidneys. The presence of a high fever, lethargy, and a urinalysis positive for nitrites and leukocyte esterase suggests that the current infection is likely affecting the renal parenchyma. Rationales: pyelonephritis: The child's systemic symptoms—specifically the fever of 38.4 C (101.1 F), irritability, and lethargy—combined with a history of vesicoureteral reflux, point toward an infection that has ascended to the kidneys. In pediatric patients with VUR, a febrile UTI is clinically considered pyelonephritis until proven otherwise because the reflux allows bacteria to bypass the normal protective mechanisms of the lower urinary tract. renal scarring: This is a direct consequence of recurrent or severe pyelonephritis in young children. When the kidney tissue becomes inflamed due to repeated infections, it can lead to permanent fibrotic changes (scarring). This risk is particularly high in children under age 2 and those with high-grade VUR, potentially leading to long-term issues like hypertension or impaired renal function. nephrotic syndrome: This condition involves damage to the glomeruli resulting in massive protein loss in the urine. It typically presents with severe edema and is not a complication of bacterial urinary tract infections or vesicoureteral reflux. polycystic kidney: This is an inherited genetic disorder where numerous cysts develop within the kidneys. It is a congenital structural disease and is not caused by infections, fevers, or reflux. acute glomerulonephritis: This is an inflammation of the kidney's filtering units, often occurring as an immune response following a streptococcal infection. It manifests with hematuria and hypertension rather than the classic signs of a bacterial UTI like nitrites and leukocyte esterase in the urine.