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7. REFLUX

BACKGROUND

VUR or VRR are defined as non-physiological back-flow of urine from the urinary bladder into the ureter or the renal pelvis. The worst consequence of both primary and secondary VRR is the development of progressive renal failure secondary to recurrent pyelonephritic episodes and subsequent loss of renal parenchyma.

Ten to 15% of patients with reflux suffer from a renin-dependent hypertension as a sequela of focal ischaemia due to parenchymal scarring. The probability of hypertension is highly correlated with the extent and number of parenchymal scars. Reflux is found in 0.5-1 % of normal children without UTIs. While in newborns the incidence of reflux is the same in both sexes, in later life, girls are approximately four times more frequently affected than boys.

In children with recurrent UTI, the incidence of VUR is significantly higher (about 14-29% of kindergarten and school girls and about 30% of boys of the corresponding age).

The main symptoms of VUR are recurrent and occasionally febrile UTIs. Radiological investigations verify uni- or bilateral reflux in 30-50% of cases. A VRR may also make itself apparent in later stages by its consequences, such as hypertension, renal insufficiency or delayed renal growth. Undetected reflux may lead to reflux nephropathy.

Secondary reflux

Predecessor of a secondary reflux is not an inborn primary disturbance of the terminal ureter, but rather an anatomically or functionally obstructive or inflammatory illness of the bladder, or direct damage to a previously intact orifice. It seems that many refluxes, especially of lower grade l-lll, are secondary refluxes and may disappear with the maturation of the bladder function.

CLASSIFICATION

The International Reflux Study Committee introduced a uniform system for the description of reflux, based on the earlier classification by Heikel and Parkkulainen, in 1985. Furthermore, a standardized performance of a voiding cystourethrogram was described to allow comparative studies.