Vesico-Ureteric Reflux tick Flashcards
What is vesico-ureteric reflux?
Retrograde flow of urine from the bladder into the upper urinary tract
What is the incidence of VUR?
About 1% of infants
Is VUR congenital or acquired?
Usually congenital
What evidence is there for a genetic predisposition for VUR?
1/3 of siblings of children with VUR also have it
What is the likely inheritance pattern of VUR?
Autosomal dominant with variable penetrance
What is the result of VUR having variable penetrance?
Siblings of a patient with known VUR might have it to a mild degree
What should be done regarding siblings in cases of significant VUR?
- Selective imaging of siblings
- Low threshold for investigation of febrile illness
What complication is VUR linked with?
Recurrent UTIs
What can recurrent UTIs in VUR lead to?
- Reduced renal function
- Renal failure
- Hypertension
- Increased incidence of pregancy-related hypertension
What does the likelihood of resolution of VUR over time with medical treatment depend on?
- Grade of VUR
- Age of child
How is the grade of the VUR relevant in the likelihood of spontaenous resolution?
The lower the grade of VUR, the more likely it will resolve spontaneously
What % of cases of grade 1-2 VUR resolve after 5 years?
80-90%
What kind of VUR has the lowest chance of spontaneous resolution?
Bilateral grade IV-V
2What % of cases of bilateral grade IV-V VUR resolve after 5 years?
20%
What are the treatment options in VUR?
- Prophylactic antibiotics
- Surgical intervention
When might prophylactic antibiotics be required in VUR?
When there is recurrent UTI in higher grade VUR
What are the surgical options in the treatment of VUR?
- Anti-reflux surgery
- Unilateral nephrectomy
When might surgical intervention be required for VUR?
- Severe VUR
- Recurrent UTI
- Documented progressive scarring
What are the types of anti-reflux surgery in VUR?
- Open re-implantation
- Deflux procedure
What is the Deflux procedure?
Periureteric injection of bulking agents
What is the limitations of the Deflux procedure?
The success rate is lower than for open re-implantation, and often needs repeating
When might unilateral nephrectomy be considered in VUR?
- Severe hypetension
- Recurrent UTI secondary to poorly functioning refluxing scarred kidney