Related Experiment Videos
Insights
Vesicoureteral reflux (VUR) in children can lead to kidney scarring and damage. Early detection through micturition cystourethrography (MCU) is crucial for preventing long-term complications like hypertension and renal failure.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Vesicoureteral reflux (VUR) is a primary condition affecting the ureterovesical junction, predominantly in children.
- Intrarenal reflux (IRR) during micturition cystourethrography (MCU) can lead to reflux nephropathy (RN), characterized by kidney scarring.
- VUR is associated with serious health issues including hypertension and end-stage renal failure.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and management of VUR and RN.
- To highlight the importance of early detection and prevention strategies in infants and young children.
Main Methods:
- Radiographic MCU for VUR diagnosis.
- Urography for RN diagnosis, assessing focal scars and parenchymal thickness.
- Standardized measurement of parenchymal thickness to predict scarring in children with VUR.
Main Results:
- IRR occurrence depends on papillary morphology, intrapelvic pressure, and urine flow.
- A relationship exists between renal ischemia and IRR, potentially causing a 'vicious circle' leading to RN.
- Standardized parenchymal thickness measurement can identify kidneys at risk for focal scarring.
Conclusions:
- Early detection of VUR in infants and young children is vital for preventing renal scarring.
- Standardized MCU techniques are recommended for accurate VUR diagnosis, even with normal urograms.
- Management of VUR involves medical and surgical options, with a focus on prevention in early childhood.
Abstract:
Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incompetence of the ureterovesical junction, mostly affecting a pediatric population. During micturition cystourethrography (MCU) reflux into the kidney--intrarenal reflux (IRR)--is occasionally seen. In areas with IRR the kidney surface may subsequently be depressed and the papillae retracted (reflux nephropathy (RN]. VUR may lead to hypertension and/or end-stage renal failure. Most commonly, VUR is discovered during evaluation for urinary tract infection, but it may also be present in patients with hypertension, toxemia of pregnancy, chronic renal failure and proteinuria, and it may be found in siblings of patients with VUR. For the time being VUR is demonstrated at radiographic MCU, whereas RN is diagnosed by demonstration of focal scars and of abnormal parenchymal thickness at urography. In children with VUR and no abnormalities of calyces or parenchymal defects standardized measurement of the parenchymal thickness at three sites may identify kidneys which are likely to develop focal scars. Quantitation of focal scarring should be performed in connection with a measure of the overall kidney size. The occurrence of IRR is dependent of the papillary morphology, intrapelvic pressure and urine flow. There may be an important relationship between renal ischemia and IRR in producing a 'vicious circle of deleterious effects' which, combined with parenchymal extravasation, may lead to RN. Treatment of VUR includes medical and surgical management. Since renal scarring may occur in infancy, prevention should focus on infants and young children. Infants and young children with severe VUR may have normal urograms. Therefore a MCU should also be performed, preferably with the recommended standardized technique.