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Virtual Pediatric Hospital: Paediapaedia: Vesicoureteral Reflux (VUR) Paediapaedia: Genitourinary Diseases

Vesicoureteral Reflux (VUR)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Urinary tract infection.

Etiology/Pathophysiology:
Is a congenital abnormality caused by immaturity or deficiency of the longitudinal muscle of the submucosal ureter. Reflux is normally prevented by the presence of an antireflux mechanism consisting of a flap-valve mechanism at the ureterovesical junction that is due to the oblique course and length of the ureter in the bladder wall. Renal scarring is the loss of renal parenchyma and calyceal blunting. It is commonly seen in children with reflux and is caused by the reflux of infected urine into the renal collecting system and then intrarenal reflux which allows microorganisms from the infected urine into the renal parenchyma and this leads to pyelonephritis and scarring. Scarring predominantly occurs at the renal poles where compound calyces predominate.

Pathology:
Not applicable

Imaging Findings:
On the VCUG you see reflux of contrast material from the bladder up into the ureters and the collecting systems.

On an IVP thinning of the renal cortex is seen due to scarring.

On ultrasound, thinning of the renal cortex is seen due to scarring. Intermittent hydronephrosis may also be seen as reflux is an intermittent process.

DDX:

References:
See References Chapter.

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