Vesicoureteric reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and kidney. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI), being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI

Pathophysiology of VUR

• ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
• therefore shortened intramural course of the ureter
• vesicoureteric junction cannot, therefore, function adequately

Possible presentations

• antenatal period: hydronephrosis on ultrasound
• recurrent childhood urinary tract infections
• reflux nephropathy
  • term used to describe chronic pyelonephritis secondary to VUR
  • commonest cause of chronic pyelonephritis
  • renal scar may produce increased quantities of renin causing hypertension

Investigation

• VUR is normally diagnosed following a micturating cystourethrogram
• a DMSA scan may also be performed to look for renal scarring

Grading:

Management