VUR is a common childhood anomaly
Vesicoureteral reflux (VUR) is the most common congenital urinary anomaly to occur during childhood.1 It usually presents during the first few years of life.
What puts a child at risk for VUR?2
Sibling or child of a person with VUR
Age, gender, race
Certain congenital anomalies or conditions of the kidney or pelvis
- Multicystic dysplastic kidney
- Pelviureteric junction
- Distended kidney
- Neuropathic bladder
Siblings of individuals diagnosed with VUR have a 30% probability of developing VUR3
The offspring of women diagnosed with VUR have a 50% chance of developing VUR2
For distended kidney, VUR is often identified prenatally or younger than 1 year old and is most often associated with boys2
Spontaneous resolution of VUR occurs more often in lower grades
VUR may spontaneously resolve over time; though, there is no definitive test to predict in which children. It is more likely to do so in children with lower grades of reflux.2
What is the likelihood of a child outgrowing VUR?
According to the American Urological Association:4
- A child who is between the ages of 2-5 years old with grade III VUR (unilateral) has between a 13.4% (at 1 year) and 51.3% (at 5 years) chance of spontaneous VUR resolution
- A child who is between the ages of 5-10 years old with grade III VUR (bilateral) has between a 2.6% (at 1 year) and 12.5% (at 5 years) chance of spontaneous VUR resolution
- In patients aged 25 to 60 months with bilateral VUR grade III, only 30.5% of cases were resolved at 5 years
Antibiotic prophylaxis may be needed for a significant number of years in nearly half of the patients to protect them from a urinary tract infection (UTI) while their VUR persists. During this time, regular voiding cystourethrograms (VCUGs) are required to assess the condition. Also, the child is still at risk of breakthrough infections despite ongoing antibiotic treatment.
Age and gender matter in VUR resolution
The rate of spontaneous resolution of VUR decreases with increasing patient age. In a retrospective study, VUR resolved significantly slower in children over 13 months compared with children up to the age of 12 months (P<0.03).5
Boys with VUR have a greater likelihood of spontaneous resolution within the first year of life than girls.7 In one study, a resolution rate of 29% was reported in boys younger than 1 year with VUR grades IV and V. The same study reported that in both girls and boys after their first year of life, the annual reported resolution rate was only 9%.7
While high resolution rates have been reported for low grade VUR—one study reported spontaneous resolution rates of 82% for grade I VUR within 5 years8—resolution cannot be expected to occur universally. The longer a child goes without medical intervention, the more likely it is that he or she will suffer long-term consequences associated with VUR.
VUR may not resolve in time to prevent kidney damage
The longer the patient has had VUR, the less likely it is that VUR will resolve on its own, with or without antibiotic treatment.
- Patients who experience VUR arising from febrile UTIs are at high risk for kidney scarring associated with infected urine coming into contact with the kidney.
- In one study, children experiencing a first UTI have a 70% risk of developing acute kidney infection9