Editing AUA: Vesicoureteral Reflux (2017) (section)

== Screening for VUR ==

=== Screening in Siblings of Children with VUR ===
*'''Prevalence of VUR is 27% in siblings of children with VUR'''
* Goal of screening (through VCUG or radionuclide cystogram) for VUR in siblings is to identify clinically unapparent VUR in order to initiate preventative therapy, usually CAP. 
**However, the value of CAP in preventing febrile UTI and renal damage in VUR is unproven. Therefore, recommendations for screening are limited by the uncertainty of any potential benefit gained by identifying VUR. 
**Identification of VUR may be of some benefit by increasing the awareness of parents and health providers to the potentially increased risk of pyelonephritis and renal scarring
* '''Option: Given that the value of identifying and treating VUR is unproven, an observational approach without screening for VUR may be taken for siblings of children with VUR, with prompt treatment of any acute UTI and subsequent evaluation for VUR'''
* '''Option: Ultrasound screening of the kidneys in the sibling of a child with VUR may be performed to identify significant renal scarring and to focus attention on the presence and potential further risk of VUR'''
* '''<span style="color:#ff0000">Screening for VUR in the sibling is recommended if (2):'''
*# '''<span style="color:#ff0000">Evidence of renal cortical abnormalities or renal size asymmetry on US</span>''' [of sibling]
*# '''<span style="color:#ff0000">History of UTI in the sibling''' who has not been tested for VUR</span>
* '''Option: Sibling screening of older children who are toilet trained may be offered, although the value of identification of VUR is undefined.'''

=== Screening in Offspring ===
* Risk of reflux in the offspring of a patient with VUR is 36%
* '''Screening for VUR in the offspring is optional'''

=== Screening in the neonate with a history of prenatal hydronephrosis ===
* Risk of VUR in infants with prenatally detected hydronephrosis is 16%
** '''Grade of hydronephrosis is NOT associated with risk of VUR'''
* '''Indications for VCUG in the neonate with a history of prenatal hydronephrosis:'''
*# '''High-grade (SFU grade ≥3) hydronephrosis'''
*# '''Hydroureter'''
*# '''An abnormal bladder on ultrasound''' (late-term prenatal or postnatal)
*# '''Develop a UTI on observation'''
** There has been no demonstration of any health benefit of screening for and identifying VUR in these infants. It is therefore a recommendation that families be informed of the potential risk and permitted to participate in the decision-making.
* '''Option: For children with prenatally detected low-grade hydronephrosis (SFU grade 1 or 2), an observational approach without screening for VUR, with prompt treatment of any UTI, may be taken, given the unproven value of identifying and treating VUR. VCUG is also considered an option to screen for VUR.'''