How is VUR diagnosed and graded?

A VUR diagnosis usually comes after a febrile UTI is confirmed

When a child presents with a febrile urinary tract infection (fUTI), it could indicate vesicoureteral reflux (VUR).

VUR is most often detected as a result of diagnostic investigations of fUTI or of hydronephrotic (distended) kidney. It may also be suspected in children presenting with high blood pressure or kidney insufficiency.

Accurate diagnosis and grading of VUR can help with the implementation of individualized treatment plans. Diagnosis requires a voiding cystourethrogram (VCUG), typically performed by a radiologist equipped for the fluoroscopy and catheterization of children.

As a result of VCUG assessment, any VUR will be graded from I to V based on the dilation of the ureter and presence and degree of distortion of renal structures.

Grades of VUR

Reprinted by permission from Macmillan Publishers Ltd: NATURE REVIEWS UROLOGY Cooper CS. Diagnosis and management of vesicoureteral reflux in children. 2009;6(9):481-489, copyright 2009.

Generally speaking, the more severe the reflux grade, the lower the chance of spontaneous resolution and the higher the chance for scarring of the kidneys.

However, a 2013 study of children with their first UTI and normal RBUS shows that in 24% of patients, VUR would not have been detected.1 The same study shows that 15% of these children had recurrent pyelonephritis and 7% went on to surgical intervention.1

RBUS may not detect VUR after a first UTI1

As indicated above, a reliance on RBUS could result in delayed treatment and may increase the risk for permanent kidney damage.

Consider referring a patient to a pediatric urologist for the following2:

  • Suspected or confirmed febrile urinary tract infections (fUTIs)
  • Individualized management of VUR
  • Assessment and treatment of related or underlying conditions such as bladder or bowel dysfunction

References:

  1. Juliano TM, Stephany HA, Clayton DB, et al. Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2-24 months. J Urol. 2013; 190: 1505-1510.
  2. Peters CA, Skoog SJ, Arant BS Jr, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 2010;184(3):1134-1144.