Pediatrics: Vesicoureteral Reflux Flashcards Preview

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Flashcards in Pediatrics: Vesicoureteral Reflux Deck (63)
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1

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)

2

What % of newborns have vesicoureteral reflux?

1%

3

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)

4

What does VUR predispose to?

UTI
-In children with UTI, reflux found in 30-45%

5

What % of infants with antenatal detected hydronephrosis have VUR?

10-30%

6

What is something that might increase your suscpicion for an infant to have VUR?

Hydronephrosis detected on a prenatal US

7

What is the % prevalence among siblings with VUR?

35%

8

What % of newborns have a parent with a history of reflux?

67%

9

Is the inheritance pattern of VUR known?

No, the genetic loci and inheritance of is unknown

10

What is the competence of the ureterovesical junction (UVJ) achieved by?

A long intramural portion of the ureter which lengthens with age

11

What does the ureterovesical junction do?

Acts as a valve to prevent retrograde passage of urine up the ureter as the bladder fills

12

What happens to the ureterovesical junction during urination?

It is compressed (it should contract until the bladder is empty)

13

What happens to the uretervesical junction with UTI?

The area around the UVJ is inflamed and edematous

14

What does VUR result from?

Incompetent closure of the UVJ

15

What are the 2 cateogires of VUR?

1. Primary reflux
2. Secondary reflux

16

What is primary reflux to do?

Failure of the anti-reflux mechanisn

17

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

18

What does an increased grade of VUR correspond to?

Worse reflux

19

What does grade 1 VUR involve?

Ureter only

20

What does grade 2 VUR involve?

Ureter, pelvic, and calyces

21

Is there dilation of the ureter in grade 2 VUR?

No

22

What is seen in grade 3 VUR?

-Mild dilation of the ureter and/or pelvic
-No blunting of fornices

23

What is seen in grade 4 VUR?

-Moderate dilation of the ureter, pelvis, and calyces
-Maintains papillary impression

24

What is seen in grade 5 VUR?

Gross dilation and loss of papillary impression (this is very severe)

25

What 2 things are associated with VUR?

1. Recurrent UTI
2. Acute pyelonephritis

26

What can acute pyelonephritis lead to in children?

1. Renal scarring
2. End stage renal failure (ESRF)

27

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

28

What is associated with severe degree of reflux?

Visualization of urinary backflow and associated scarring

29

What tests can raise suspicion for VUR and how?

Pre and post natal US...if you see hydronephrosis, could be a sign of VUR

30

What is the gold standard for diagnosing VUR?

Voiding cystourethrogram