Definition (Pediatr Clin North Am 2006;53:413)
• “Abnormal retrograde flow of urine from bladder into ureter and possibly kidney”
Epidemiology (Pediatr Clin North Am 2006;53:413)
• Prevalence ∼1% of nml kids, changes w/ age as VUR may resolve w/ time
• VUR in 20–40% of kids w/ UTIs & in 10–20% of infants w/ antenatal hydronephrosis
Diagnosis (Pediatrics 2011;128:595)
• Febrile infants w/ UTI should undergo renal U/S to assess for anatomic abnormalities
• Voiding cystourethrogram (VCUG) should not be performed for infant w/ 1st febrile UTI, it is indicated if renal U/S shows hydronephrosis, scarring, or other signs of
high-grade VURVCUG) allows grading, anatomic eval; direct radionuclide cystography can be used for f/u eval (↓ rad exposure but poorer anatomic detail)
• Antenatal hydronephrosis; f/u w/ U/S at 1 mo (relative ↓ in urinary flow in 1st mo may result in false neg if sooner) unless severe hydronephrosis noted prenatally
Clinical Manifestations (Pediatrics 2011;128:595; Pediatr Clin North Am 2001;48:1505)
• Clinical consequences: UTI, reflux nephropathy or scarring, though can occur w/o VUR
• Congenital ureteropelvic junction obstruction (UPJO) can p/w hydronephrosis & nml renal function in asymptomatic infant
Natural History and Complications (Pediatr Clin North Am 2001;48:1505; J Urol 2002;168:2594)
• Grades I & II reflux resolves in >80% of pts (10–25% resolution/yr); Grade III reflux resolves in 50% (Grade IV resolved in ∼30%, & Grade V rarely spontaneously resolves)
• Reflux nephropathy can produce renal failure, proteinuria, and hypertension
Management (Pediatrics 2011;128:595)
• AAP guidelines abx ppx no longer indicated for recurrent UTIs as evidence that ppx not effective in pts w/ or w/o VUR (Pediatrics 2008;122:1064; N Engl J Med 2009;361:1748)
• Grade V reflux almost always requires surgical correction; Grade III or IV reflux can be managed medically unless recurrent UTIs and progressive scarring