Flashcards in Pediatrics: Vesicoureteral Reflux Deck (63)
What is vesicoureteral reflux?
Retrograde flow of urine from the bladder to the upper urinary tract (problem at the junction of the ureter into the bladder)
What % of newborns have vesicoureteral reflux?
Who is VUR most common in?
-Under 2 years of age (as we get older, risk of reflux is less)
-Femaes: 2x more than males (girls are more prone to UTI too)
What does VUR predispose to?
-In children with UTI, reflux found in 30-45%
What % of infants with antenatal detected hydronephrosis have VUR?
What is something that might increase your suscpicion for an infant to have VUR?
Hydronephrosis detected on a prenatal US
What is the % prevalence among siblings with VUR?
What % of newborns have a parent with a history of reflux?
Is the inheritance pattern of VUR known?
No, the genetic loci and inheritance of is unknown
What is the competence of the ureterovesical junction (UVJ) achieved by?
A long intramural portion of the ureter which lengthens with age
What does the ureterovesical junction do?
Acts as a valve to prevent retrograde passage of urine up the ureter as the bladder fills
What happens to the ureterovesical junction during urination?
It is compressed (it should contract until the bladder is empty)
What happens to the uretervesical junction with UTI?
The area around the UVJ is inflamed and edematous
What does VUR result from?
Incompetent closure of the UVJ
What are the 2 cateogires of VUR?
1. Primary reflux
2. Secondary reflux
What is primary reflux to do?
Failure of the anti-reflux mechanisn
What is secondary reflux to do?
Other anatomic deformities
1. Posterior uretheral valves
2. Neurogenic bladder: It doesn't contract and function properly (there is a lack of coordinated contraction)
3. Duplication of upper urinary tract
What does an increased grade of VUR correspond to?
What does grade 1 VUR involve?
What does grade 2 VUR involve?
Ureter, pelvic, and calyces
Is there dilation of the ureter in grade 2 VUR?
What is seen in grade 3 VUR?
-Mild dilation of the ureter and/or pelvic
-No blunting of fornices
What is seen in grade 4 VUR?
-Moderate dilation of the ureter, pelvis, and calyces
-Maintains papillary impression
What is seen in grade 5 VUR?
Gross dilation and loss of papillary impression (this is very severe)
What 2 things are associated with VUR?
1. Recurrent UTI
2. Acute pyelonephritis
What can acute pyelonephritis lead to in children?
1. Renal scarring
2. End stage renal failure (ESRF)
What are 5 methods of diagnosing VUR?
1. Visualization of urinary backflow and associated scarring
2. Prenatal US
3. Postnatal US
4. Voiding cystourethrogram (VCUG)
5. Dimercaptosuccinic acid (DMSA) renal scan
What is associated with severe degree of reflux?
Visualization of urinary backflow and associated scarring
What tests can raise suspicion for VUR and how?
Pre and post natal US...if you see hydronephrosis, could be a sign of VUR