Vesicoureteral reflux is defined as a retrograde (or backflow) of urine into the ureters. The diagnosis for VUR rarely occurs after 5 years of age. The etiology of VUR is categorized into two types, primary and secondary reflux. Primary reflux is caused by an inadequate valvular mechanism at the ureterovesical junction and is not associated with any obstruction or neurogenic bladder. The inadequate valve in primary reflux is caused by the shortened submucosal tunnel that shortens bladder filling. Secondary reflux occurs secondary to obstruction (50% of cases in infants are caused by posterior urethral valves) or neurogenic bladder. Important risk factors associated with VUR include: age, urinary tract infection (UTI), and reflux.
The following effects of unrepaired reflux have been identified: urine concentration ability is inversely proportional to the grade of reflux; renal scarring; lower-weight percentiles (in physical growth); hypertension; proteinuria; and those with bilateral scarring and an increased risk of developing end stage renal failure (as high as 30%). In the majority of children, the problem will disappear spontaneously without surgical intervention if infection is controlled. Management of reflux includes antibacterial therapy for infection control.
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