Editing AUA: Vesicoureteral Reflux (2017) (section)

=== 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.'''