Vesicoureteral Reflux and Reflux Nephropathy

  • Robert A. Weiss
  • Adrian Spitzer


Primary vesicoureteral reflux (VUR) is caused by a congenitally short ureteral tunnel through the bladder submucosa, associated with lateral displacement of the ureteral orifice. As a result, the resistance generated by the collapse of the ureteral tunnel when the bladder pressure rises (micturition) is overcome, and the urine flows in a retrograde direction, towards the kidney. VUR is the most common abnormality observed in children with urinary tract infections (UTIs). The condition was found in 30% of schoolgirls with covert bacteriuria (1) and 33% of children with overt infection (2). In contrast to the preponderance of females in the UTI population beyond infancy, the sex distribution of VUR in neonates with prenatal dilatation of the urinary tract is 5:1 male to female (3).


Vesicoureteral Reflux Renal Scarring Acute Pyelonephritis Reflux Nephropathy Ureteral Reimplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McLachlan MSF, Meller S, Verrier-Jones ER, et al.: The urinary tract in schoolgirls with covert bacteriuria. Arch Dis Child 50: 253, 1975. 22.Google Scholar
  2. 2.
    Smellie JM, Normand ICS, Katz G: Children with urinary infection: A comparison of those with and without vesicoureteric reflux. Kidney Int 20: 717, 1981. 23.Google Scholar
  3. 3.
    Steele BT, DeMaria J: A new perspective on the natural history of vesicoureteric reflux. Pediatrics 90: 30, 1992. 24.Google Scholar
  4. 4.
    Hodson CJ, Maling TM, McManamon PJ, Lewis MG: The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol (Suppl 13 ): 1, 1975. 25.Google Scholar
  5. 5.
    Ransely PG, Risdon RA: Reflux and renal scarring. Br J Radiol 51 (Suppl 14), 1978. 26.Google Scholar
  6. 6.
    Rolleston GL, Maling TMJ, Hodson CJ: Intrarenal reflux and the scarred kidney. Arch Dis Child 49: 531, 1974. 27.Google Scholar
  7. 7.
    Tamminen-Mobius T, Koskimies O: Morphology of renal papillae in normal kidneys and its correlation with frequency 28. of scarring in young children with dilating reflux. In: J Brodehl, JHH Ehrich, eds, Paediatric Nephrology. Springer Verlag, Berlin, Heidelberg, New York, Tokyo, p 321, 1984. 29.Google Scholar
  8. 8.
    North American Pediatric Renal Transplant Cooperative Study: 1994 Annual Report, p 9. 30.Google Scholar
  9. 9.
    U.S. Renal Data System: USRDS 1994 Annual Report. NIH, NIDDK, Bethesda, MD, p 129, July 1994.Google Scholar
  10. 10.
    Lebowitz RL, Olbing H, Parkkulainen K, Smellie JM, 31. Tamminen-Mobius T: International system of radiographic grading of vesicoureteral reflux. Pediatr Radiol 15: 399, 1985. 32.Google Scholar
  11. 11.
    Dwoskin JY, Perlmutter AD: Vesicoureteral reflux in children: A computerized review. J Urol 109: 888, 1973.PubMedGoogle Scholar
  12. 12.
    Bellinger MF, Duckett JW: Vesicoureteral reflux: A comparison of surgical and non-surgical management. Contrib Nephrol 39: 81, 1984.PubMedGoogle Scholar
  13. 13.
    Ozen HA, Whitaker RH: Does the severity of presentation 33. in children with vesicoureteral reflux relate to the severity of disease or the need for operation. Br J Urol 60: 110, 1987.PubMedCrossRefGoogle Scholar
  14. 14.
    Smellie JM, Ransely PG, Normand ICS, et al.: Development 34. of new renal tears: a collaborative study. Br Med J 290: 1957, 1985.CrossRefGoogle Scholar
  15. 15.
    Blickman JG, Taylor GA, Lebowitz RL: Voiding 35. cystourethro-graphy: the initial radiologie study in children with urinary tract infection. Radiology 156: 659, 1985. 36.Google Scholar
  16. 16.
    Smellie JM, Edwards, D, Hunter N, Normand ICS, Prescod N: Vesicoureteral reflux and renal scarring. Kidney Int 8:S65, 1975. 37.Google Scholar
  17. 17.
    Arant BS: Medical management of mild and moderate vesicoureteral reflux: followup studies of infants and young children. A preliminary report of the Southwest Pediatric 38. Nephrology Study Group. J Urol 148: 1683, 1992.PubMedGoogle Scholar
  18. 18.
    Goldraich NP, Goldraich IH: Followup of conservatively 39. treated children with high and low grade vesicoureteral reflux: a prospective study. J Urol 148: 1689, 1992.Google Scholar
  19. 19.
    Birmingham Reflux Study Group: Prospective trial of 40. operative vs. non-operative treatment of severe vesicoureteric reflux in children: five years observation. Br Med J 295: 237, 1987. 41.Google Scholar
  20. 20.
    Tamminen-Mobius T, Brunier E, Ebel KD, Lebowitz RL, Olbing H, Seppanen U, Sixt R: Cessation of vesicoureteral 42. reflux for 5 years in infants and children allocated to medical treatment. J Urol 148: 1662, 1992.PubMedGoogle Scholar
  21. Jodal U, Koskimies O, Hanson E, Lohr G, Olbing H, Smellie JM, Tamminen-Mobius T: Infection patterns in children with vesicoureteral reflux randomly allocated to operation or longterm antibacterial prophylaxis. J Ural 148: 1650, 1992.Google Scholar
  22. Winberg J, Anderesen HJ, Bergstrom T, et al.: Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand (Suppl 252 ) 63: 1, 1974.Google Scholar
  23. Feld LG, Greenfield SP, Ogra PL: Urinary tract infections in infants and children. Pediatr Rev 11: 71, 1989.CrossRefGoogle Scholar
  24. Shapiro ED: Short course antimicrobial treatment of urinary tract infections in children: a critical analysis. Pediatr Infect Dis 1: 294, 1982.CrossRefGoogle Scholar
  25. Politano VA, Leadbetter WF: An operative technique for the correction of vesicoureteral reflux. J Ural 79: 932, 1958.Google Scholar
  26. Duckett JW: Vesicoureteral reflux: a conservative analysis. Am J Kidney Dis 3: 139, 1983.Google Scholar
  27. Jansen H, Scholtmeijer R: Results of surgical treatment of severe vesicureteral reflux. Retrospective study of reflux grades 4 and 5. Br J Urol 65: 413, 1990.CrossRefGoogle Scholar
  28. Ehrlich RM: Vesicoureteral reflux: a surgeon’s perspective. Pediatr Clin North Am 29: 827, 1982.Google Scholar
  29. Hjalmas K, Lohr G, Tamminen-Mobius T, Seppanen J, Olbing H, Wikstrom L: Surgical results in the International Reflux Study in Children (Europe). J Urol 148: 1657, 1992.Google Scholar
  30. Duckett JW, Walker RD, Weiss R: Surgical results: International Reflux Study in Children-United States branch. J Urol 148: 1674, 1992.Google Scholar
  31. Weiss RA, Tamminen-Mobius T, Koskimies O, Olbing H, Smellie JM, Hirche H, Lax-Gross H: Characteristics at entry of children with severe primary vesicoureteral reflux recruited for a multicenter, international therapeutic trial comparing medical and surgical management. J Ural 148: 1644, 1992.Google Scholar
  32. Verrier Jones K, Asscher AW: Urinary tract infection and vesicoureteral reflux. In: CM Edelmann, Jr, ed, Pediatric Kidney Disease, 2nd ed. Little, Brown, Boston/Toronto/London, p 1980.Google Scholar
  33. Miller T, Phillips S: Pyelonephritis: the relationship between infection, renal scarring and antimicrobial therapy. Kidney Int 19: 654, 1981.CrossRefGoogle Scholar
  34. Matouschek E: Treatment of vesicoureteric reflux by transurethral Teflon injection. Urology 20: 263, 1981.Google Scholar
  35. Puri P, O’Donnell B: Correction of experimentally produced vesicoureteric reflux in the piglet by intravesical injection of Teflon. Br Med J 289: 5, 1984.CrossRefGoogle Scholar
  36. Puri P, O’Donnell B: Endoscopie correction of grades IV and V primary vesicoureteric reflux: 6 to 30 months follow-up in 42 ureters. J Pediatr Surg 22: 1087, 1987.CrossRefGoogle Scholar
  37. O’Donnell B, Puri P: Technical refinements in endoscopie correction of vesicoureteral reflux. J Urol 140: 1101, 1988.Google Scholar
  38. Peters CA: Endoscopie management of vesicoureteral reflux. In: RM Ehrlich, ed, Dialogues in Pediatric Urology, vol, 14. William J. Miller, Pearl River, NJ, p 1991.Google Scholar
  39. Kaplan WE, Dalton DP, Firlit CF: The endoscopie correction of reflux by polytetrafluoroethylene injection. J Urol 138: 953, 1987.Google Scholar
  40. Dewan PA, Guiney EJ: Endoscopie correction of primary vesicoureteric reflux in children. Urology 39: 162, 1992.CrossRefGoogle Scholar
  41. Valla JS, Aubert D, Dodat H, et al.: Endoscopie treatment of vesicoureteric reflux in 337 children. Chir Pediatr 30: 37, 1989.Google Scholar
  42. Cohen SJ: Ureterozystoneostomie: Eine Neue Antirefluxtechnik. Akta Ural 6: 1, 1975.Google Scholar
  43. Malizia AA, Reiman HM, Meyers RP, et al.: Migration and granulomatous reaction after periurethral injection of Polytef (Teflon). JAMA 251: 3277, 1984.CrossRefGoogle Scholar
  44. 44.
    Leonard MP, Canning DA, Peters CA, et al.: Endoscopic injection of glutaraldehyde cross-linked bovine collagen for 59. Meyer TW, Anderson S, Rennke HG, Brenner BM: Reverscorrection of vesicoureteric reflux. J Urol 145: 115, 1991.PubMedGoogle Scholar
  45. 45.
    Smith P, Kaplan WE: Evaluation of polydimethylsiloxane as an alternative to endoscopie treatment of vesicoureteric reflux. American Urological Association, North Central Section Meeting, Scottsdale, AZ, November 4–9, 1991.Google Scholar
  46. 46.
    Walker RD, Wilson J, Clark AE: Injectable bioglass as a potential substitute for injectable polytetrafluoroethylene. J Urol 148: 645, 1992. 1977.Google Scholar
  47. 47.
    Smellie JM, Tamminen-Mobius T, Olbing H, Claesson I, Wikstad I, Jodal U, Seppanen U: Five year study of medical or surgical treatment in children with severe reflux: radiological renal findings. Pediatr Nephrol 6: 223, 1992.PubMedCrossRefGoogle Scholar
  48. 48.
    Najmaldin A, Burge DM, Atwell JD: Reflux nephropathy secondary to intrauterine vesicoureteral reflux. J Pediatr Surg 25: 387, 1990.PubMedCrossRefGoogle Scholar
  49. 49.
    Hinchliffe SA, Chan YF, Jones H, Chan N, Kreczy A, van Velzen D: Renal hypoplasia and postnatally acquired cortical loss in children with vesicoureteral reflux. Pediatr Nephrol 4: 439, 1992.CrossRefGoogle Scholar
  50. 50.
    Benador D, Benador N, Slosman DO, Nussle D, Mermillod B, Girardin E: Cortical scintigraphy in the evaluation of renal Pediatr 2124: 17, 1994.Google Scholar
  51. 51.
    Hoberman A, Wald ER, Reynolds EA, Charron M,Penchansky L: Oral vs. intravenous therapy for acute pyelonephritis in children 1–24 months. Pediatr Res 35: 143A, 1994.Google Scholar
  52. 52.
    Still JL, Cottom D: Severe hypertension in childhood. Arch Dis Child 42: 34, 1967.PubMedCrossRefGoogle Scholar
  53. 53.
    Gill DG, da Costa BM, Cameron JS, et al.: Analysis of 100 children with severe and persistent hypertension. Arch Dis Child 59: 951, 1976.CrossRefGoogle Scholar
  54. 54.
    Haycock GB: Hypertension associated with unilateral renal disease in childhood. Acta Paediatr Scand 64: 299, 1975PubMedCrossRefGoogle Scholar
  55. Weiss RA, Duckett JW, Spitzer A: Results of randomized clinical trial of medical vs surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). J Urol 148: 1667, 1992.Google Scholar
  56. 56.
    Tamminen-Mobius T: Unpublished observations. Urol 67: 267, 1991.Google Scholar
  57. 57.
    Wolfish NM, Delbrouck NF, Shanon A, Maizinger MA, Stenstrom R, McLaine PN: Prevalence of hypertension in children with primary reflux. J Pediatr 123: 559, 1993.PubMedCrossRefGoogle Scholar
  58. 58.
    Savage JM, Dillon MJ, Shah V, Baratt TM, Williams D: Renin and blood pressure in children with renal scarring and vesicoureteral reflux. Lancet 2: 441, 1978PubMedCrossRefGoogle Scholar
  59. Melbrouck NF, Shanon A, Maizinger MA, Stenstrom R, McLaine PN: glomerular hypertension stabilizes established glomerular injury. Kidney Int 31: 752, 1987.CrossRefGoogle Scholar
  60. 60.
    Koff SA, Lapides J, Piazza DH: Association of urinary tract infection and reflux with uninhibited bladder contractions and voluntary sphincteric obstruction. J Urol 122: 373, 1979.PubMedGoogle Scholar
  61. 61.
    Van Gool JD, Tanagho EA: External sphincter activity and recurrent urinary tract infections in girls. Urology 10: 348, 1977.PubMedCrossRefGoogle Scholar
  62. 62.
    Koff SA, Lapides J, Piazza DH: Association of urinary tract infection and reflux with uninhibited bladder contractions and voluntary sphincter obstruction. J Ural 122: 373, 1979.Google Scholar
  63. 63.
    Koff SA: Relationship between dysfunctional voiding and reflux. J Ural 148: 1703, 1992.Google Scholar
  64. 64.
    Koff SA, Murtagh DS: The uninhibited bladder in children:effect of treatment on recurrence of urinary infection and onvesicoureteral reflux resolution. J Urol 130: 138, 1983.Google Scholar
  65. 65.
    Van Gool JD, Hjalmas K, Tamminen-Mobius T, Olbing H: Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux. J Ural 148: 1699, 1992.Google Scholar
  66. 66.
    Van Gool JD, Kuitjen RH, Donckerwolcke RA, Messer AP,Vijverberg M: Bladder-sphincter dysfunction, urinary infection and vesicoureteral reflux with special reference to cognitive bladder training. In: CJ Hodson, RH Heptinstall, J.Winberg, eds, Reflux Nephropathy Update. Karger, Basel,1983. Contrib Nephrol 39:190, 1984.Google Scholar
  67. 67.
    Hellstrom A-L, Hjialmas K, Jodal U: Rehabilitation of the dysfunctional bladder in children: method and 3-year follow up. J Urol138: 847, 1987.Google Scholar
  68. 68.
    Noe HN: The role of dysfunctional voiding in failure or complication of ureteral reimplantation for primary reflux. J Ural 134: 1172, 1985.Google Scholar
  69. 69.
    Johnson CE, Elder JS, Judge NE, Adeeb FN, Grisoni ER,. Fattlar DC: The accuracy of antenatal ultrasonography in identifying renal abnormalities. Am J Dis Child 146:1181Google Scholar
  70. 70.
    Anderson PAM, Rickwood AMK: Features of primaryvesicoureteric reflux detected by preenatal sonography. Br J. 1992.Google Scholar
  71. 71.
    Lapides J, Diokno AC: Persistence of the infant bladder as a cause for urinary infection in girls. J Ural 103: 243, 1970.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Robert A. Weiss
    • 1
  • Adrian Spitzer
    • 2
  1. 1.New York Medical CollegeValhallaUSA
  2. 2.Division of Pediatric NephrologyAlbert Einstein College of MedicineBronxUSA

Personalised recommendations