🔄 Chapter 576 · Vesicoureteral Reflux (VUR)

Nelson Textbook of Pediatrics 22nd Edition | Primary VUR: congenital incompetence of ureterovesical junction (flap-valve mechanism). Grading I-V (International Reflux Study). Associated with UTI, pyelonephritis, renal scarring (reflux nephropathy). Management: observation, antibiotic prophylaxis, endoscopic injection, ureteral reimplantation.

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📋 30 Clinical Scenarios — Vesicoureteral Reflux

📇 High‑Yield Review Cards (VUR)

🩺 Clinical Recognition: Vesicoureteral Reflux

Select a presentation for diagnostic clues and management.

📋 Stepwise Approach to VUR

🔑 Key Principles — Nelson Ch 576
• Anatomy: Short/absent submucosal tunnel → incompetent flap-valve. Primary VUR: autosomal dominant with variable penetrance.
• Grading (I-V): I: ureter only; II: no dilation; III: mild dilation/blunting; IV: grossly dilated ureter; V: massive tortuous ureter, blunted papillae.
• Natural history: Lower grades (I-II) resolve in 80%; grade III ~50%; grade IV-V rarely resolve spontaneously. Resolution by age 6 years typical.
• Renal scarring risk: Highest with high-grade VUR + febrile UTI. Scarring may be congenital or acquired. Reflux nephropathy → hypertension, CKD.
• Management options: Observation + treat infections; continuous antibiotic prophylaxis (TMP-SMX); endoscopic subureteric injection (dextranomer); open ureteral reimplantation.

    ⚡ Reflex Prompts — Clinical Decisions in VUR

    📖 Summary: Vesicoureteral Reflux — Nelson Ch 576