Vesicoureteral Reflux in Children

Abstract

Vesicoureteral reflux (VUR) is the most common congenital anomaly of the urinary tract in children. Primary VUR is diagnosed mostly after a urinary tract infection (UTI). It is also diagnosed during postnatal evaluation of antenatally diagnosed hydronephrosis or other congenital anomalies of the kidney and urinary tract (CAKUT). High-grade VUR (≥ grade 3) is a risk factor for acute pyelonephritis-associated acquired reflux nephropathy. Other important risk factors for reflux nephropathy include recurrent UTIs and a delay in initiation of antibiotic treatment. Not all children with a first febrile UTI need a voiding cystourethrogram (VCUG), but it should be considered in those with abnormal ultrasound findings, recurrent UTIs, and/or an atypical causative pathogen. The management of VUR depends on multiple factors and may include surveillance only or antimicrobial prophylaxis; very few patients with VUR need surgical correction. Patients with reflux nephropathy should be monitored for hypertension and those with significant bilateral scarring should be monitored for proteinuria and chronic kidney disease.