5-year-old girl with chronic renal insufficiency is brought to the physician for a follow-up visit Since birth, she has had multiple
episodes of urinary tract infections, for which she takes trimethoprim-sulfamethoxazole daily for prophylaxis. She has a history of poor
growth and mild hypertension but is otherwise developmentally normal. Her mother lost custody of the girl 3 years ago due to failure
to comply with recommended treatment and prophylaxis of her infections. The girl has since lived with her grandmother. Examination
shows mild bilateral lower-extremity edema but no other abnormalities. Urinalysis shows mild proteinuria but no white blood cells or
bacteria. Renal scintigraphy with dimercaptosuccinic acid shows bilateral focal parenchymal scarring and blunted calyces. Which of
the following is the most likely predisposing factor for this patient’s recurrent infections?
- QA Common variable immunodeficiency
- 0 B. Neurogenic bladder
- 0 C. Posterior urethra I valves
- 0 D. Polycystic kidney disease
- 0 E. Recurrent sexual abuse
- 0 F Unilateral renal agenesis
- 0 G. Vesicoureteral reflux
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