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Management of vesicoureteral reflux

INTRODUCTION

Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. It is the most common urologic diagnosis in children, occurring in approximately 1 percent of newborns and in as many as 30 to 45 percent of children with urinary tract infection (UTI) [1-3].

Current management is based upon the long-held belief that VUR is a risk factor for renal scarring because it predisposes patients to recurrent acute pyelonephritis by transporting bacteria from the bladder to the kidney. The development of renal scarring increases the risk of hypertension and chronic kidney disease (CKD).

However, this premise has been increasingly questioned [4]. An alternate viewpoint suggests that primary VUR does not play a causative role in CKD, but is merely a marker for abnormal renal development. This disruption in renal development leads to a decrease in the formation of normal parenchyma (eg, renal hypoplasia and dysplasia) and results in an increased risk of poor renal outcome. (See "Presentation, diagnosis, and clinical course of vesicoureteral reflux", section on 'Decrease renal parenchyma (scarring)' and "Presentation, diagnosis, and clinical course of vesicoureteral reflux", section on 'Role in renal scarring and chronic kidney disease'.)

Although there are inconclusive data comparing the effectiveness of an interventional with an observational approach in improving renal outcome, the common practice over the past 30 to 40 years is to treat children with VUR either with prophylaxis antibiotics (referred to as medical therapy) or surgical correction [5].

The management of VUR will be reviewed here. The manifestations and diagnosis of VUR is discussed elsewhere in the program. (See "Presentation, diagnosis, and clinical course of vesicoureteral reflux".)

                     

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Literature review current through: Mar 2014. | This topic last updated: Sep 4, 2013.
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