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TAS Nephrology > Vesico-Ureteric Reflux tick > Flashcards

Vesico-Ureteric Reflux tick Flashcards

1
Q

What is vesico-ureteric reflux?

A

Retrograde flow of urine from the bladder into the upper urinary tract

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2
Q

What is the incidence of VUR?

A

About 1% of infants

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3
Q

Is VUR congenital or acquired?

A

Usually congenital

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4
Q

What evidence is there for a genetic predisposition for VUR?

A

1/3 of siblings of children with VUR also have it

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5
Q

What is the likely inheritance pattern of VUR?

A

Autosomal dominant with variable penetrance

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6
Q

What is the result of VUR having variable penetrance?

A

Siblings of a patient with known VUR might have it to a mild degree

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7
Q

What should be done regarding siblings in cases of significant VUR?

A
  • Selective imaging of siblings
  • Low threshold for investigation of febrile illness
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8
Q

What complication is VUR linked with?

A

Recurrent UTIs

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9
Q

What can recurrent UTIs in VUR lead to?

A
  • Reduced renal function
  • Renal failure
  • Hypertension
  • Increased incidence of pregancy-related hypertension
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10
Q

What does the likelihood of resolution of VUR over time with medical treatment depend on?

A
  • Grade of VUR
  • Age of child
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11
Q

How is the grade of the VUR relevant in the likelihood of spontaenous resolution?

A

The lower the grade of VUR, the more likely it will resolve spontaneously

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12
Q

What % of cases of grade 1-2 VUR resolve after 5 years?

A

80-90%

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13
Q

What kind of VUR has the lowest chance of spontaneous resolution?

A

Bilateral grade IV-V

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14
Q

2What % of cases of bilateral grade IV-V VUR resolve after 5 years?

A

20%

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15
Q

What are the treatment options in VUR?

A
  • Prophylactic antibiotics
  • Surgical intervention
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16
Q

When might prophylactic antibiotics be required in VUR?

A

When there is recurrent UTI in higher grade VUR

17
Q

What are the surgical options in the treatment of VUR?

A
  • Anti-reflux surgery
  • Unilateral nephrectomy
18
Q

When might surgical intervention be required for VUR?

A
  • Severe VUR
  • Recurrent UTI
  • Documented progressive scarring
19
Q

What are the types of anti-reflux surgery in VUR?

A
  • Open re-implantation
  • Deflux procedure
20
Q

What is the Deflux procedure?

A

Periureteric injection of bulking agents

21
Q

What is the limitations of the Deflux procedure?

A

The success rate is lower than for open re-implantation, and often needs repeating

22
Q

When might unilateral nephrectomy be considered in VUR?

A
  • Severe hypetension
  • Recurrent UTI secondary to poorly functioning refluxing scarred kidney

TAS Nephrology (16 decks)

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