Vesicoureteral Reflux (VUR)
• (VUR) is the retrograde flow of urine from the bladder up to the ureter or even up to the kidney.• It is may be familial
30% to 40% of siblings of a child with VUR also have VUR
Effect of VUR:
• It cause:• hydrodynamic pressure on the kidney during voiding
• predispose to UTI due to incomplete emptying of the bladder and ureter.
• This will facilitate the bacterial transport to the kidney causing pyelonephritis.
• pyelonephritis can result in renal injury or scarring termed Reflux nephropathy, which if it severe will cause end-stage renal disease.
Classification:
• Primary VUR: due to congenital incompetence of the ureterovesical (UV) junction.• Secondary VUR:
• distal bladder obstruction
• duplications of the ureter
• neurogenic bladder
• cystitis
• acquired bladder obstruction e.g. foreign body or vesical stones.
Grading:
By contrast voiding cystourethrogram (VCUG)
G I G II G III G IV G V
• Incidence of renal scarring with VUR
• GI and GII 15%• G IV or V 65%
• Grade I or II VUR is likely to resolve without surgical intervention
• G IV or GV < 50% resolve spontaneously.
• VUR is often identified during radiologic evaluation after a UTI .
• The younger the patient with UTI, the more likely to have VUR.• There are no clinical signs can differentiate children with UTI who have VUR from those without VUR.
Clinical manifestations:
• Long-term prophylactic AB (trimethoprim-sulfamethoxazole or nitrofurantoin)
Indications:• Mild to moderate VUR (controversial).
• High-grade VUR and/or recurrent symptomatic UTI
• Patient younger than one year of age.
2. Surgical correction: In sever VUS
Treatment:
• Hypertension
• Chronic kidney disease (CKD).Complications of VUR: