Vesicoureteral Reflux (VUR) is a condition in which urine flows backward from the bladder into the ureters and, in more severe cases, into the kidneys. It is a significant cause of recurrent urinary tract infections and kidney damage, particularly in children, and represents an important focus of pediatric nephrology. If left untreated, VUR can lead to recurrent kidney infections, renal scarring, and long-term loss of kidney function.
Under normal circumstances, the junction between the ureter and bladder functions as a one-way valve, allowing urine to flow downward while preventing backflow. In VUR, this valve mechanism is defective, allowing urine to reflux toward the kidneys, especially during bladder filling or voiding. VUR may be primary, due to a congenital abnormality of the ureterovesical junction, or secondary, resulting from increased bladder pressure caused by obstruction or dysfunctional voiding.

Children with VUR are particularly susceptible to recurrent urinary tract infections. Each episode of infection can inflame renal tissue and cause scarring, especially in younger children whose kidneys are still developing. Over time, repeated infections and scarring may lead to hypertension, proteinuria, and chronic kidney disease.

Clinical presentation varies. Some children present with recurrent febrile urinary tract infections, while others are diagnosed following antenatal ultrasound showing hydronephrosis. Older children and adults may have a history of repeated infections, flank pain, or unexplained decline in kidney function. In some cases, VUR is detected incidentally during imaging for unrelated conditions.

Diagnosis involves urine testing to assess infection and kidney function, along with imaging studies to evaluate reflux severity. Ultrasound is used to assess kidney structure, while specialized imaging confirms reflux and grades its severity. Early diagnosis allows timely intervention and prevention of kidney damage.

Management depends on the severity of reflux, age of the patient, frequency of infections, and presence of kidney damage. Mild cases may resolve spontaneously with growth and are managed with careful monitoring and infection prevention strategies. More severe cases require closer nephrology and urology follow-up to protect kidney health. Long-term monitoring is essential to detect complications early and preserve renal function.