The backward flow of urine from the bladder to the ureters is referred to as vesicoureteral reflux. Signs and symptoms vary, depending on the age of the child. Parents may notice a failure of their infants to thrive as well as anorexia, vomiting, diarrhea and lethargy that may or may not be accompanied by fever.
Older children may complain of a vague abdominal pain and present with symptoms of a urinary tract infection (UTI) such as frequent or urgent micturition, fever, or burning during micturition. Urinalysis, imaging and urodynamic studies are the cornerstones of the diagnosis of this condition. Treatment depends largely on the severity of the VUR and may range from surveillance with antibiotic prophylaxis to other medical therapies and/ or surgery.
Affecting up to 2% of the pediatric population, VUR is the most common urinary tract pathology in children. Furthermore, it is present in up to 4 out of every 10 pediatric UTI cases. There are several studies that establish the recurrence of VUR within families, thereby suggesting that there is a genetic component to the condition.
These studies highlight the increased risk of acquiring VUR among siblings when one is or has been affected. The chances of a sibling developing VUR has been reported to be somewhere between 1 in 4 to 1 in 2, but exact risk assessment is not easy, owing to the spontaneous resolution of VUR that may occur as a child grows.
Age and Sex Demographics
The prevalence of VUR is higher among younger infants and this prevalence progressively decreases in older age groups. In other words, the prevalence of this condition is inversely proportional to the age due to the relatively high incidence of spontaneous resolution. In one study, it was shown that approximately 70% of infants under the age of 12 months who presented with UTI had VUR. By the age of 4 years, 12 years, and post adolescence, the percentage of patients presenting with a UTI who also had VUR dropped to 25%, 15% and 5.2%, respectively.
Owing to the anatomical differences between males and females, UTIs are more common in the latter population. As a result of the increased rates of UTIs in females and the subsequent screening in these patients, the diagnosis of VUR is made more often in females. Despite this, boys are more likely than girls to have VUR, with a male: female ratio of approximately 2:1. Furthermore, and unfortunately so, young males are at a greater risk of having more severe grades of VUR, which is also diagnosed at a younger age in comparison to their female counterparts. The good news, however, is that VUR in boys is more likely to undergo spontaneous resolution.
Geographic and Racial Demographics
The global incidence of VUR per region is not thoroughly described in contemporary literature. However, it is believed to be fairly similar between North America and Europe. With regards to racial differences, VUR is more prevalent in the Caucasian pediatric population when compared to others.
Reviewed by Liji Thomas, MD.