Profile and pattern of primary vesicoureteral reflux in children seeking care at a tertiary care teaching centre of Southern India

Shivana Gouda, Sonia Bhatt, Dilip Kumar Mishra, Madhu Sudan Agrawal


Background: Previous studies have suggested that the clinical features of vesicoureteral reflux in infants differ from those of older children with regard to the male-to-female ratio and severity of renal parenchymal damage. Aim of the study is to know the profile and pattern of primary vesicoureteral reflux in subjects seeking care at a tertiary care teaching centre of southern India.

Methods: This was a hospital based study, conducted at the Department of Paediatrics, Kasturba Medical College located at Manipal during August 2004 - August 2012 over a period of 8 years. All the children in the age group of 1 month to 18 years with Vesicoureteral Reflux, who presented to the study centre during study period, were included in the study.

Results: Majority (78.5%) presented before 5 years, youngest age at presentation was 1 month and oldest at 14 year 8 months. Among 93 children studied, 65 were males and 28 were females with male to female ratio of 2.3. The commonest presenting complaint was fever (58%), followed by recurrent Urinary tract infection (UTI) (40.8%), dysuria 32 (34.4%) and reports of documented UTI was available in 23 (24.7%) cases. Four children had hypertension at presentation. Thirteen of them had associated posterior urethral valve. Neurogenic bladder was present in 3 children, 2 had associated Anorectal malformation and one had meningomyelocele.

Conclusions: Majority of vesicoureteral reflux cases presented before 5 years of age. There was a preponderance of males. Majority had grade IV and V reflux. The mean age at presentation of vesicoureteral reflux was 3.6 years. The commonest presenting complaint was fever, followed by recurrent UTI.


Children, Kidney, Pattern, Profile, Retrospective studies, Vesico-ureteral reflux

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RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370:2367-76.

Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol. 2006;175(2):716-22.

Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC. Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials. Arch Dis Child. 2003;88(8):688-94.

Belman AB. Vesicoureteral reflux. Pediatr Clin North Am. 1997;44(5):1171-90.

Bollgren I, Winberg J. The periurethral aerobic flora in girls highly susceptible to urinary infections. Acta Paediatr. 1976;65(1):81-7.

Arant Jr BS. Vesicoureteric reflux and renal injury. Am J Kid Dis. 1991;17(5):491-511.

Linshaw M. Asymptomatic bacteriuria and vesicoureteral reflux in children. Kid Int. 1996;50(1):312-29.

Marra G, Barbieri G, Dell'Agnola CA, Caccamo ML, Castellani MR, Assael BM. Congenital renal damage associated with primary vesicoureteral reflux detected prenatally in male infants. J Pediatr. 1994;124(5):726-30.

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):1548-50.

Abeysekara CK, Yasaratna BM, Abeyagunawardena AS. Long-term clinical follow up of children with primary vesicoureteric reflux. Indian Pediatrics. 2006;43(2):150.

Menon P, Rao KL, Bhattacharya A, Mahajan JK, Samujh R. Primary vesicoureteral reflux: progress of disease, somatic growth and renal parameters. Ind Pediatr. 2004;41(10):1025-30.

Macedo CS, Riyuzo MC, Bastos HD. Renal scars in children with primary vesicoureteral reflux. J Pediatr. 2003;79(4):355-62.

Greenfield SP, Ng M, Wan J. Experience with vesicoureteral reflux in children: clinical characteristics. J Urol. 1997;158(2):574-7.

Rushton HG. Urinary tract infections in children: epidemiology, evaluation, and management. Pediatr Clin North Am. 1997;44(5):1133-69.

International Reflux Study in Children. International system of radiographic grading of vesicoureteric reflux. Pediatr Radio 1985; 15: 105-109.

Smellie JM, Jodal U, Lax H, Möbius TT, Hirche H, Olbing H. Outcome at 10 years of severe vesicoureteric reflux managed medically: Report of the International Reflux Study in Children. J Pediatr. 2001;139(5):656-63.

Olbing H, Smellie JM, Jodal U, Lax H. New renal scars in children with severe VUR: a 10-year study of randomized treatment. Pediatr Nephrol. 2003;18(11):1128-31.