Understanding primary vesicoureteric reflux and associated nephropathies

Summary 

Vesicoureteric reflux (VUR) is the retrograde passage of urine from the bladder into the upper tract. It is ‘primary’ when outflow obstruction or neurogenic bladder is excluded. Primary VUR occurs in about 1% of young children and is often familial, with several genetic loci probably involved. ‘Reflux nephropathy’ takes the form of both congenital malformation and the renal sequelae of postnatal infection. In a subset of affected individuals, these renal parenchymal diseases are associated with systemic hypertension and end-stage renal failure. In randomized trials of primary VUR children presenting with urinary infection, prophylactic antibiotics are equivalent to antireflux surgery when subsequent renal lesions and renal excretory function are used as endpoints. There is uncertainty about whether either protocol is superior to observation with appropriate treatment of urinary infection. Although primary VUR can be diagnosed by family screening or after investigation of prenatally detected renal pelvic dilatation, trials are required to establish optimal management of these individuals.

Keywords: Kidney, Vesicoureteric reflux, Renal failure, Surgery, Urinary tract infection