Prevalence of VUR in children

VUR is a common childhood congenital urinary anomaly

Vesicoureteral reflux (VUR), commonly referred to as urinary reflux, is the most common congenital urinary anomaly to occur during childhood.1It is defined as the abnormal retrograde flow of urine from the bladder into the upper urinary tract through an incompetent ureterovesical junction.2

The prevalence of reflux varies with several demographic factors of the patient population. Reflux may occur as an isolated entity or with other associated anomalies of the genitourinary tract.2

Urinary reflux usually presents during the first few years of life.3 Up to 1.8% of all children are affected by VUR.4

What puts a child at risk for VUR?

History of urinary tract Infections (UTIs)

  • Less than 1% in children without urologic symptoms or history of infection2
  • 20-50% in children with a history of symptomatic urinary tract infection2
  • About 40% of children with a UTI under 24 months have VUR3

Sibling or child of a person with VUR

  • Siblings of individuals diagnosed with VUR have about a 35% probability of developing VUR5
  • The children of individuals diagnosed with VUR have up to a 50% chance of developing VUR5,6

Age, gender, ethnicity
The prototypical patient with VUR is a Caucasian girl younger than 4 years of age with a history of UTIs3,4

  • Average VUR diagnosis occurs between 2-3 years old5
  • 80% of children evaluated for a UTI and diagnosed with VUR are girls5
  • Light skinned children are at greater risk for VUR, compared with black children and children of Mediterranean origin2

Due to the epidemiology of UTIs in children, boys and girls may present with VUR at different ages.2 UTIs are more common in uncircumcised boys than girls during the neonatal period, therefore many boys will be diagnosed with reflux in the neonatal period.2 However, after the first year of life, the incidence of UTIs is much higher in girls than boys. Therefore, more school-aged children diagnosed with VUR are girls.2

Associated anomalies2

  • Posterior urethral valves
  • Duplicated collecting system
  • Prune belly (Eagle-Barrett) syndrome
  • Bladder exstrophy
  • Severe voiding dysfunction
  • Neurogenic bladder
  • Ureterocele

For distended kidney, VUR is often identified prenatally or younger than one year old and is most often associated with boys4

References:

  1. Ninoa F, Ilaria M, Noviello C et al. Genetics of vesicoureteral reflux. Curr Genomics. 2016;17(1):70-79. DOI: 10.2174/1389202916666151014223507
  2. Baskin LS, Kogan BA, Stock JA. Handbook of Pediatric Urology Third Edition. Philadelphia, PA: Wolters Kluwer; 2019.
  3. Chand DH, Rhoades T, Poe SA, Kraus S, Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urol. 2003;170(4 pt 2):1548-1550.DOI: 10.1097/01.ju.0000084299.55552.6c
  4. Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol. 2000;30:587-93.DOI: 10.1007/s002470000263
  5. Elder JS. Vesicoureteral reflux. In: Kliegman R, Nelson WE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders; 2011:1834-1838.
  6. Skoog SJ, Peters CA, Arant BS, et al. Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010;184:1145-1151.DOI: 10.1016/j.juro.2010.05.066
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