Vesicoureteric reflux (VUR): Pathogenesis and clinical findings
Authors: Nicola Adderley Reviewers: Emily Ryznar *Lindsay Long * MD at time of publication
Abnormal function
Abnormal anatomy
Neurogenic bladder (e.g. cerebral palsy, constipation, spinal injury, iatrogenic)
Non-neurogenic bladder (neuropsychological)
Lower urinary tract abnormality (posterior urethral valves, meatal stenosis)
Bladder outlet obstruction
↑ pressure distorts UVJ
Upper urinary tract abnormality (ureters)
UVJ abnormality
Incomplete closure of UVJ during bladder contraction
Abbreviations
• UVJ – ureterovesicular junction • UTI – urinary tract infection
Failure of bladder sphincter to relax during bladder contraction
Vesicoureteric reflux (VUR):
Back flow of urine from the bladder into one or both ureters +/- kidneys
Migration of lower urinary tract bacteria to kidneys
Bacterial invasion of renal parenchyma
Upper UTI (pyelonephritis)
Incomplete emptying of bladder during Abnormal
↑ pressure in bladder
Bladder dilates
Dilated bladder on U/S
urination
Bacteria in bladder are not cleared during urination
voiding habits
↑ bladder capacity
Renal scarring
↓ functional renal tissue
*Chronic kidney disease (↓ GFR,
hypertension, proteinuria)
Flank tenderness
Fever, dysuria, urgency, frequency
Lower UTI (cystitis) Urinary stasis
Cloudy, foul- smelling urine
Urethral stricture
Notes
Urgency, dysuria, frequency
• First febrile UTI in an infant should trigger a work-up for VUR
• High likelihood of spontaneous resolution • *Late complication of severe VUR
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published November 19, 2018 on www.thecalgaryguide.com