Pediatrics: Vesicoureteral Reflux: Difference between revisions

Line 48:

* '''<span style="color:#ff0000">VUR due to fundamental deficiency of the longitudinal muscle of the intravesical ureter resulting in an inadequate valvular mechanism while the remaining factors (bladder and ureter) remain normal or relatively noncontributory'''

** VUR may be a normal variant in the population but becomes clinically relevant only in some because of a predisposition to UTI. This is supported by the observation that VUR without infection is of questionable clinical significance

* '''~~Genetics~~'''

* '''Risk Factors'''

** '''~~66% rate of reflux in the offspring~~'''

**'''Genetics'''

*** Tendency for an autosomal dominant pattern of inheritance; probably many genes are involved

*** Tendency for an '''autosomal dominant pattern of inheritance'''; probably many genes are involved

** '''Prevalence of VUR in ~~siblings to be ≈32~~%'''

***'''Prevalence of VUR in'''

*** Because the renal consequences of VUR are at issue, rather than reflux itself, siblings may be better served by non-invasively (ultrasound) screening for cortical abnormalities first, and screening for VUR if history of compounding factors such as UTI or bowel and bladder dysfunction are manifested.

****'''Offspring: ≈65%'''

**** By taking into account the imaging of the kidneys first, as well as the patient’s age and history of UTI, a rational top-down approach to sibling reflux screening emerges.

**** '''Siblings: ≈30%'''

**** It cannot be assumed that all cortical abnormalities in siblings with VUR are acquired. The lack of prospective studies should temper the notion of mass screening of siblings

***** Screening in siblings

**** In any sibling, however, in whom reflux is diagnosed, the indications for treatment remain the same as for general reflux in the pediatric population.

******Because the renal consequences of VUR are at issue, rather than reflux itself, siblings may be better served by non-invasively (ultrasound) screening for cortical abnormalities first, and screening for VUR if history of compounding factors such as UTI or bowel and bladder dysfunction are manifested.

******* By taking into account the imaging of the kidneys first, as well as the patient’s age and history of UTI, a rational top-down approach to sibling reflux screening emerges.

******* It cannot be assumed that all cortical abnormalities in siblings with VUR are acquired. The lack of prospective studies should temper the notion of mass screening of siblings

******* In any sibling, however, in whom reflux is diagnosed, the indications for treatment remain the same as for general reflux in the pediatric population.

=== Secondary Reflux ===

@@ Line 48: / Line 48: @@
 * '''<span style="color:#ff0000">VUR due to fundamental deficiency of the longitudinal muscle of the intravesical ureter resulting in an inadequate valvular mechanism while the remaining factors (bladder and ureter) remain normal or relatively noncontributory'''
 ** VUR may be a normal variant in the population but becomes clinically relevant only in some because of a predisposition to UTI. This is supported by the observation that VUR without infection is of questionable clinical significance
-* '''Genetics'''
+* '''Risk Factors'''
-** '''66% rate of reflux in the offspring'''
+**'''Genetics'''
-*** Tendency for an autosomal dominant pattern of inheritance; probably many genes are involved
+*** Tendency for an '''autosomal dominant pattern of inheritance'''; probably many genes are involved
-** '''Prevalence of VUR in siblings to be ≈32%'''
+***'''Prevalence of VUR in'''
-*** Because the renal consequences of VUR are at issue, rather than reflux itself, siblings may be better served by non-invasively (ultrasound) screening for cortical abnormalities first, and screening for VUR if history of compounding factors such as UTI or bowel and bladder dysfunction are manifested.
+****'''Offspring: ≈65%'''
-**** By taking into account the imaging of the kidneys first, as well as the patient’s age and history of UTI, a rational top-down approach to sibling reflux screening emerges.
+**** '''Siblings: ≈30%'''
-**** It cannot be assumed that all cortical abnormalities in siblings with VUR are acquired. The lack of prospective studies should temper the notion of mass screening of siblings
+***** Screening in siblings
-**** In any sibling, however, in whom reflux is diagnosed, the indications for treatment remain the same as for general reflux in the pediatric population.
+******Because the renal consequences of VUR are at issue, rather than reflux itself, siblings may be better served by non-invasively (ultrasound) screening for cortical abnormalities first, and screening for VUR if history of compounding factors such as UTI or bowel and bladder dysfunction are manifested.
+******* By taking into account the imaging of the kidneys first, as well as the patient’s age and history of UTI, a rational top-down approach to sibling reflux screening emerges.
+******* It cannot be assumed that all cortical abnormalities in siblings with VUR are acquired. The lack of prospective studies should temper the notion of mass screening of siblings
+******* In any sibling, however, in whom reflux is diagnosed, the indications for treatment remain the same as for general reflux in the pediatric population.
 === Secondary Reflux ===