genitourinary disorders
Vesicoureteral Reflux and Reflux Nephropathy
Treatment of VUR and Reflux Nephropathy
Usually prophylactic antibiotics Surgical treatment if vesicoureteral reflux (VUR) is moderate or severe Treatment of reflux nephropathy is based on the unproven assumption that decreasing reflux and UTIs prevents renal scarring. Children with very mild VUR require no treatment, but they should be closely observed for symptoms of UTI. Children with moderate reflux are usually given antibiotics. However, medication therapy predisposes to new episodes of acute pyelonephritis, and it is not clear whether prophylactic antibiotics are more effective than close observation. Patients with severe reflux are at higher risk of renal insufficiency and are usually given antibiotic prophylaxis or undergo surgical interventions, including ureteral reimplantation or endoscopic injection of materials behind the ureter to prevent reflux (bladder contraction during voiding compresses the ureter between the bladder and the material). Incidence of new renal scars is similar in patients treated with surgery and with medications. Reflux spontaneously resolves in about 80% of young children within 5 years. 