Vesicoureteric Reflux Flashcards
What is Vesicoureteric Reflux?
Abnormal backflow of urine from the bladder into the ureter and kidney.
What does Vesicoureteric Reflux predispose children to?
UTI
Why is important to investigate for VUR in children presenting with a UTI?
VUR can cause renal scarring
What is VUR due to?
ureters are displaced laterally, entering the bladder
therefore shortened intramural course of the ureter
vesicoureteric junction cannot function adequately
How can VUR present in the antenatal period?
Hydronephrosis on ultrasound
(dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream)
How can VUR present in childhood?
Recurrent childhood urinary tract infections
What is reflux nephropathy?
Term used to describe chronic pyelonephritis secondary to VUR
What is reflux nephropathy the commonest cause of?
Chronic pyelonephritis
What can renal scarring that occurs in reflux nephropathy result in?
Renal scar may produce increased quantities of renin causing hypertension
How is VUR diagnosed?
Micturating cystourethrogram (MCUG scan)-
What can be seen using a Micturating cystourethrogram (MCUG scan) for VUR?
You can see the radioactive dye refluxing up into the ureters and/or kidneys.
What other scan can be done on someone with VUR and what is it done for?
DMSA scan may also be performed to look for renal scarring
How many grades are there in the staging of VUR?
5 grades
What is grade 1 VUR?
Reflux into the ureter only, no dilatation
What is grade 2 VUR?
Reflux into the renal pelvis on micturition, no dilatation
What is grade 3 VUR?
Reflux into the pelvis causing mild dilatation of the ureter, renal pelvis and calyces
What is grade 4 VUR?
Reflux into the pelvis causing moderate dilatation of the ureter, renal pelvis and calyces
What is grade 5 VUR?
Through to calyces- refer to surgeon
What is the management of Vesicoureteric reflux?
Conservative- most children will grow out of it
What medical management can be given if it causes recurrent UTI’s?
Trimethoprim
How can Grades 1-3 usually be managed?
Grades 1-3 often spontaneously resolve
When might surgery be required for VUR?
If VUR persists, complications arise or grade 4/5 VUR - surgery may be required
When might surgery be required for VUR?
If VUR persists, complications arise or grade 4/5 VUR - surgery may be required
