Reflux nephropathy, urinary tract infection, and voiding disorders

Urinary tract infection (UTI), vesicoureteral reflux (VUR), and certain voiding disorders result in renal damage. In the past few years, the increasing use of 99mTc-dimercaptosuccinic acid renal scans, urodynamic testing, and antenatal sonography have helped shed light on the interrelationship of these disorders. Renal parenchymal involvement during acute febrile UTI and subsequent renal scarring are quite commonly observed in the absence of VUR, suggesting that the presence of reflux is not a prerequisite for renal damage. In infants with gross VUR, renal damage is often present at birth even before the development of any UTI. High intravesical pressures during bladder filling and voiding are commonly observed in infants with gross VUR, reflecting an underlying voiding dysfunction. High voiding detrusor pressures are also commonly observed in infants presenting with symptomatic UTI who do not have VUR. Children with dysfunctional voiding states are at risk for development of VUR and UTI. Renal damage in these children may occur in the absence of one or the other. This review elucidates how voiding dysfunction predisposes children to bacterial colonization of the bladder, the development or perpetuation of VUR, and renal damage.