What is the connection between UTI and VURs?

Suspect VUR when there is a febrile UTI

Febrile urinary tract infections (fUTIs) are the key defining symptom of vesicoureteral reflux (VUR).1 In imaging studies conducted to investigate the cause of UTI, VUR is the most common abnormality detected.2

Most cases of VUR in children are found during evaluation for febrile UTI.3

  • Approximately 30% of children are diagnosed with VUR after their first confirmed UTI4
  • The reflux rate is 54% among girls ages 1 to 3 years with a history of febrile UTI5

The risk of UTI recurrence is greater when there is underlying VUR, especially for higher grades of VUR.6

In one study, children with VUR grades II-IV were followed for 2 years and the risk of febrile UTI recurrence was 30%.7

In the presence of VUR, there is a greater probability that the UTI involves the kidneys8

The risk of kidney scarring associated with VUR increases with each UTI and is greater during the first 3 to 5 years of life.9

Although kidney scarring may begin early in life, the consequences can last a lifetime and can include early onset hypertension and end-stage renal disease.3

References:

  1. Läckgren G, Stenberg A. Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment. Ther Adv Urol. 2009;1(3):131-141.
  2. American Academy of Pediatrics Committee on Quality Improvement, Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103(4 pt 1):843-852.
  3. Elder JS. Vesicoureteral reflux. In: Kliegman R, Nelson WE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders; 2011:1834-1838.
  4. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007;298(2):179-186.
  5. Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1987;1(4):713-729.
  6. Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008;122(5):1064-1071.
  7. Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008;121(6):e1489-1494.
  8. Elder JS. Urinary Tract Infections. In: Kliegman R, Nelson WE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders; 2011:1829-1833.
  9. Sherbotie JR, Cornfeld D. Management of urinary tract infections in children. Med Clin North Am. 1991;75(2):327-338.