Editing Pediatrics: Vesicoureteral Reflux (section)

== Pathophysiology of Acquired Scarring ==

* '''<span style="color:#ff0000">Reflux is not a general cause of UTI'''
* '''<span style="color:#ff0000">Reflux facilitates pyelonephritis'''
* '''<span style="color:#ff0000">In the context of normal voiding dynamics, nephropathy from primary VUR requires the colonization of urine with pathogenic bacteria in the face of normal voiding dynamics.'''
** '''<span style="color:#ff0000">In the absence of infection, sterile urinary reflux is insufficient to cause renal damage'''
* '''Risk factors for scarring'''
** '''Age'''
*** '''The greatest risk for post-infectious renal scarring occurs within the first year of life'''
**** The risk of post-pyelonephritic renal scarring is inversely proportional to age
** '''Papillary Anatomy'''
*** '''Papillae with a concave architecture (compound papillae)''' present their ducts at right angles '''[and are at higher risk of postinfectious renal scarring],''' whereas more convex papillae possess ducts that end obliquely, producing a valvular effect that guards against backflow of urine into the medullary collecting ducts