Vesicoureteric Reflux in Children

Vesicoureteric reflux (VUR) is a common finding in pediatric practice that occurs in about 1% of children and is often familial, with several genetical loci probably involved. The majority of low-grade cases have a tendency to resolve spontaneously during childhood. However, VUR has been identified as a risk factor for the development of urinary tract infections (UTI) and is present in a third of young children presenting with this problem. In addition, some children with high-grade VUR have already renal lesions before the advent of any UTI. In a subset of affected individuals, these renal parenchymal lesions are associated with systemic hypertension and chronic renal failure but this risk is considerably smaller than previously assumed. In randomized trials of primary VUR diagnosed after urinary infection, prophylactic antibiotics are equivalent to anti-reflux surgery when subsequent renal lesions and UTIs relapses are used as endpoints. Controlled trials comparing the outcome of renal function in children offered either protocol or immediate treatment at recurrences are desperately lacking. This review article aims to summarize the extensive data regarding this controversial condition, to present rational investigation strategy and to analyze management attitudes in the light of the various lines of practice.