Vesicoureteric Reflux

Question 1

What is Vesicoureteric Reflux?

Answer 1

Abnormal backflow of urine from the bladder into the ureter and kidney.

Question 2

What does Vesicoureteric Reflux predispose children to?

Answer 2

UTI

Question 3

Why is important to investigate for VUR in children presenting with a UTI?

Answer 3

VUR can cause renal scarring

Question 4

What is VUR due to?

Answer 4

ureters are displaced laterally, entering the bladder
therefore shortened intramural course of the ureter
vesicoureteric junction cannot function adequately

Question 5

How can VUR present in the antenatal period?

Answer 5

Hydronephrosis on ultrasound

(dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream)

Question 6

How can VUR present in childhood?

Answer 6

Recurrent childhood urinary tract infections

Question 7

What is reflux nephropathy?

Answer 7

Term used to describe chronic pyelonephritis secondary to VUR

Question 8

What is reflux nephropathy the commonest cause of?

Answer 8

Chronic pyelonephritis

Question 9

What can renal scarring that occurs in reflux nephropathy result in?

Answer 9

Renal scar may produce increased quantities of renin causing hypertension

Question 10

How is VUR diagnosed?

Answer 10

Micturating cystourethrogram (MCUG scan)-

Question 11

What can be seen using a Micturating cystourethrogram (MCUG scan) for VUR?

Answer 11

You can see the radioactive dye refluxing up into the ureters and/or kidneys.

Question 12

What other scan can be done on someone with VUR and what is it done for?

Answer 12

DMSA scan may also be performed to look for renal scarring

Question 13

How many grades are there in the staging of VUR?

Answer 13

5 grades

Question 14

What is grade 1 VUR?

Answer 14

Reflux into the ureter only, no dilatation

Question 15

What is grade 2 VUR?

Answer 15

Reflux into the renal pelvis on micturition, no dilatation

Question 16

What is grade 3 VUR?

Answer 16

Reflux into the pelvis causing mild dilatation of the ureter, renal pelvis and calyces

Question 17

What is grade 4 VUR?

Answer 17

Reflux into the pelvis causing moderate dilatation of the ureter, renal pelvis and calyces

Question 18

What is grade 5 VUR?

Answer 18

Through to calyces- refer to surgeon

Question 19

What is the management of Vesicoureteric reflux?

Answer 19

Conservative- most children will grow out of it

Question 20

What medical management can be given if it causes recurrent UTI’s?

Answer 20

Trimethoprim

Question 21

How can Grades 1-3 usually be managed?

Answer 21

Grades 1-3 often spontaneously resolve

Question 22

When might surgery be required for VUR?

Answer 22

If VUR persists, complications arise or grade 4/5 VUR - surgery may be required

Question 22

When might surgery be required for VUR?

Answer 22

If VUR persists, complications arise or grade 4/5 VUR - surgery may be required