Clinical presentation, diagnosis, and course of primary vesicoureteral reflux
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
- Saul P Greenfield, MD
Saul P Greenfield, MD
- Clinical Professor of Urology, State University of New York at Buffalo School of Medicine & Biomedical Sciences
- Director of Pediatric Urology, Children’s Hospital of Buffalo
- Section Editors
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. It is the most common urologic finding in children, occurring in approximately 1 percent of newborns, and as many as 30 to 45 percent of young children with a urinary tract infection (UTI) [1-3].
Current management is based upon the premise that VUR predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney. Pyelonephritis itself is a morbid event that requires acute medical care and possible hospitalization in young infants. In addition, the resulting infection may lead to loss of renal parenchyma (renal scarring). Extensive scarring may progress to chronic kidney disease (CKD) (eg, hypertension, decreased renal function, proteinuria, and sometimes end-stage renal disease [ESRD]) [1,4-6]. However, this long-held belief that reflux in most instances may lead to progressive CKD and potentially ESRD has been increasingly questioned. As a result, the clinical impact of VUR and its management remain uncertain and controversial.
The diagnosis, presentation, and clinical course of primary VUR will be reviewed here. The management of primary VUR is discussed elsewhere in the program. (See "Management of vesicoureteral reflux".)
PATHOGENESIS AND DEFINITION
Vesicoureteral reflux (VUR) is divided into two categories: primary and secondary.
Primary VUR — Primary VUR, the most common form of reflux, is due to incompetent or inadequate closure of the ureterovesical junction (UVJ), which contains a segment of the ureter within the bladder wall (intravesical ureter). Normally, reflux is prevented during bladder contraction by fully compressing the intravesical ureter and sealing it off with the surrounding bladder muscles.
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- PATHOGENESIS AND DEFINITION
- Primary VUR
- Secondary VUR
- CLINICAL FINDINGS
- - Prenatal presentation
- Postnatal evaluation
- Our approach
- - Postnatal presentation
- Likelihood of resolution
- RECURRENT URINARY TRACT INFECTION
- RENAL SCARRING AND/OR DYSPLASIA
- Congenital and acquired scarring
- Renal scarring and severity of reflux
- Our viewpoint
- FURTHER EVALUATION
- Screening of family members
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS