Vesicoureteral reflux is it important to find?

Pediatr Nephrol. 2021 Apr;36(4):1011-1017. doi: 10.1007/s00467-020-04573-9. Epub 2020 Apr 22.


Vesico-ureteral reflux (VUR) has long been recognized as associated with urinary tract infections (UTIs), renal scarring, and chronic kidney disease (CKD). The concept of "reflux nephropathy" was born, whereby the VUR was considered the culprit, predisposing to recurrent UTIs and providing a conduit whereby the infection could ascend to the kidneys resulting in scarring and destruction. The more severe grades of reflux were thought to place the young child at particular risk of CKD. The question being asked in this pro/con debate is whether VUR is indeed the culprit responsible for a significant proportion of children with CKD, a number of whom progress to end-stage kidney failure (ESKF), and is thus important to find and treat, or is it an innocent bystander associated with CKD and ESKF but not the cause. We believe the latter and will present convincing evidence supported by large scale prospective randomized controlled trials that VUR is not the ogre it was thought to be and is not important to find following a UTI (with some exceptions).

Keywords: Antibiotic treatment; Febrile urinary tract infection; Post infectious renal scarring; Prophylaxis; Vesico-ureteral reflux.

Publication types

  • Review

MeSH terms

  • Cicatrix / etiology
  • Cicatrix / pathology
  • Humans
  • Infant
  • Prospective Studies
  • Renal Insufficiency, Chronic* / etiology
  • Urinary Tract Infections* / etiology
  • Vesico-Ureteral Reflux* / complications
  • Vesico-Ureteral Reflux* / diagnosis