Materiały źródłowe

• #1 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Vesicoureteral reflux (VUR) is characterized by the abnormal backward flow of urine from the urinary bladder into the upper urinary tract during voiding. […] This condition of retrograde urine flow is often caused by a short intramural ureter and is associated with recurrent urinary tract infections, renal cortical scarring, and renal failure in severe cases, including end-stage kidney disease. […] A short intramural ureter often causes this abnormal backward flow of urine. […] VUR can be asymptomatic, unilateral or bilateral, or associated with nephropathy, which can be severe. […] The clinical significance of VUR was not recognized until 1960, when the condition was associated with recurrent urinary tract infections (UTIs), renal cortical scarring, and permanent kidney damage, particularly in children.

• #2 Vesicoureteral Reflux (VUR) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/vesicoureteral-reflux-vur

  Vesicoureteral reflux (VUR) is most often due to congenital anomalous development of the ureterovesical junction. Incomplete development of the intramural ureteral tunnel causes failure of the normal flap valve mechanism at the ureterovesical junction, thus permitting reflux of bladder urine into the ureter and renal pelvis. […] Reflux of urine from the bladder into the ureter may damage the upper urinary tract by bacterial infection and occasionally by increased hydrostatic pressure. Bacteria in the lower urinary tract can easily be transmitted by reflux to the upper tract, leading to recurrent parenchymal infection with potential scarring. Renal scarring can eventually cause hypertension and sometimes renal dysfunction. […] Vesicoureteral reflux (VUR) is most often due to congenital anomalous development of the ureterovesical junction. […] Reflux of urine from the bladder into the ureter may cause bacterial infection of the upper urinary tract; about 30 to 40% of infants and toddlers with urinary tract infection have VUR.

• #3 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Primary VUR arises from intrinsic UVJ dysfunction, characterized by abnormally short or incompetent segments of the intravesical ureter. […] Secondary VUR, on the other hand, develops subsequent to abnormally high voiding pressure in the bladder. […] The natural resolution of VUR is believed to stem from the elongation of the intramural ureter as the child matures, alongside tissue remodeling of the UVJ and the maturation of bladder function over time. […] Intrarenal reflux refers to the backflow of urine into the renal collecting ducts in individuals with VUR. […] This condition poses a significant risk for pyelonephritis, renal scarring, impaired kidney growth, cortical atrophy, childhood hypertension, and chronic renal failure. […] Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection.

• #4 Clinical presentation, diagnosis, and course of primary vesicoureteral reflux – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-course-of-primary-vesicoureteral-reflux/print

  VUR is the retrograde passage of urine from the bladder into the upper urinary tract. It is divided into two categories: primary and secondary, based on the underlying pathogenesis. […] Primary VUR, the most common form of reflux, is due to incompetent or inadequate closure of the ureterovesical junction, which contains a segment of the ureter within the bladder wall (intravesical ureter). Normally, reflux is prevented during bladder contraction by fully compressing the intravesical ureter and sealing it off with the surrounding bladder muscles. […] In primary VUR, failure of this antireflux mechanism is due to a congenitally short intravesical ureter. The intravesical ureter length may be genetically determined, which may explain the increased incidence in family members of patients with VUR.

• #5 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. […] The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (12 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too „end-on”. […] In people with VUR, failure of this mechanism occurs, with resultant backward (retrograde) flow of urine. […] Insufficient submucosal length of the ureter relative to its diameter causes inadequacy of the valvular mechanism. This is precipitated by a congenital defect or lack of longitudinal muscle of the portion of the ureter within the bladder resulting in an ureterovesicular junction (UVJ) abnormality.

• #6 Vesicoureteral reflux: MedlinePlus Medical Encyclopedia ImageLock

  https://medlineplus.gov/ency/imagepages/19502.htm

  When the ureters enter the bladder, they travel through the wall of the bladder for a distance in such a way that they create a tunnel so that a flap-like valve is created inside the bladder. This valve prevents urine from backing-up into the ureters and kidneys. […] In some children, the valves may be abnormal or the ureters in the bladder may not travel long enough in the bladder wall, which can cause vesicoureteral reflux. Vesicoureteral reflux is a condition that allows urine to go back up into the ureters and kidneys causing repeated urinary tract infections. The reflux of urine exposes the ureters and kidney to infection from bacteria and high-pressure, which is generated by the bladder during urination. If left untreated, urinary infections can cause kidney damage and renal scarring with the loss of potential growth of the kidney and high blood pressure later in life.

• #7 Vesicoureteral Reflux | Abdominal Key

  https://abdominalkey.com/vesicoureteral-reflux-2/

  Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the upper urinary tract. […] Primary reflux is the result of a congenital anomaly of the ureterovesical junction, whereas secondary reflux is the result of bladder outlet obstruction and high intravesical pressures. […] The ratio between the length of the submucosal segment and the diameter of the ureter (normal 4:1 or 5:1) is believed to be an important factor for normal function of the antireflux mechanism. […] Active peristalsis of the ureter also acts to prevent reflux. […] Factors associated with VUR include the following: A short submucosal tunnel, Lateral placement of the ureteral orifice, Abnormal configuration of ureteral orifice (e.g., stadium, horseshoe, and golf hole orifices), Infection, Severe bladder outlet obstruction, Young age, Duplicated collecting systems (particularly from the more laterally placed orifice draining the lower pole).

• #8 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Because of a lower intravesical ureteric length to diameter ratio than expected, it was suggested that an intrinsic event might play a role to impair the so-called active antireflux mechanism. […] Active shortening of the longitudinal muscle layer of the transmural and submucosal ureter areas drive off the urine bolus into the bladder. […] Functional and structural alterations of ureteric ends seem to impair the active valve mechanism of the VUJ, causing VUR. […] The smooth muscle cells, therefore act by transforming the extra-cellular matrix (ECM) through the extracellular production of proteinase and their inhibitors. […] The defective innervation of the distal ureteral endings therefore, could be considered as fundamental for the modification of the active anti-reflux mechanism.

• #9 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Vescico-Ureteral Reflux (VUR) is a common condition in childhood, caused by a congenital anomaly at the Vescico-Ureteral Junction (VUJ) level. It seems that the main cause could be an abnormal embryological development occurred during the early stage of fetal life. […] Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as an high rate of atrophy and muscular degeneration with disorganized muscular fibres. […] The roles played by Cajal cells and Connexin 43 in generating peristaltic waves appears to be fundamental for the physiological VUJ function and activity. […] This review will discuss and investigate the importance of the modified configuration of Sarcoglycan (SG) sub complex (particularly the deficiency of the -SG and the increased expression of the -SG), the role played by Cajal Cells, the intravescical tunnel length to ureteral diameter ratio as possible causes of the functional alterations in the refluxing ureteral ends leading towards the VUJ incompetence.

• #10 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Because of a lower intravesical ureteric length to diameter ratio than expected, it was suggested that an intrinsic event might play a role to impair the so-called active antireflux mechanism. […] Active shortening of the longitudinal muscle layer of the transmural and submucosal ureter areas drive off the urine bolus into the bladder. […] Functional and structural alterations of ureteric ends seem to impair the active valve mechanism of the VUJ, causing VUR. […] The smooth muscle cells, therefore act by transforming the extra-cellular matrix (ECM) through the extracellular production of proteinase and their inhibitors. […] The defective innervation of the distal ureteral endings therefore, could be considered as fundamental for the modification of the active anti-reflux mechanism.

• #11 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Because of a lower intravesical ureteric length to diameter ratio than expected, it was suggested that an intrinsic event might play a role to impair the so-called active antireflux mechanism. […] Active shortening of the longitudinal muscle layer of the transmural and submucosal ureter areas drive off the urine bolus into the bladder. […] Functional and structural alterations of ureteric ends seem to impair the active valve mechanism of the VUJ, causing VUR. […] The smooth muscle cells, therefore act by transforming the extra-cellular matrix (ECM) through the extracellular production of proteinase and their inhibitors. […] The defective innervation of the distal ureteral endings therefore, could be considered as fundamental for the modification of the active anti-reflux mechanism.

• #12 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Because of a lower intravesical ureteric length to diameter ratio than expected, it was suggested that an intrinsic event might play a role to impair the so-called active antireflux mechanism. […] Active shortening of the longitudinal muscle layer of the transmural and submucosal ureter areas drive off the urine bolus into the bladder. […] Functional and structural alterations of ureteric ends seem to impair the active valve mechanism of the VUJ, causing VUR. […] The smooth muscle cells, therefore act by transforming the extra-cellular matrix (ECM) through the extracellular production of proteinase and their inhibitors. […] The defective innervation of the distal ureteral endings therefore, could be considered as fundamental for the modification of the active anti-reflux mechanism.

• #13 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Many authors have reported as dysplasia, atrophy and architectural derangement of smooth muscle cells in RUs is essential for the deficient active valve mechanism. […] The regular peristaltic movement is thus essential to drive the urine bolus from the kidney to the bladder towards the normal peristaltic ureters. […] An inverse correlation has been reported between the severity of VUR and the loss of ICCs in refluxing ureteric ends. […] The altered expression of SGs, causing a structural instability to the muscular plasmatic membrane might promote stress damage that develops during smooth muscle fiber contraction in RUs, loss of membrane integrity, smooth muscle cell apoptosis and fiber degeneration. […] Moreover, loss of -SG in RUs might explain the overall microperfusion, ongoing functional and structural alterations of vesicoureteral junction, and subsequent deterioration of the active antireflux mechanism.

• #14 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Many authors have reported as dysplasia, atrophy and architectural derangement of smooth muscle cells in RUs is essential for the deficient active valve mechanism. […] The regular peristaltic movement is thus essential to drive the urine bolus from the kidney to the bladder towards the normal peristaltic ureters. […] An inverse correlation has been reported between the severity of VUR and the loss of ICCs in refluxing ureteric ends. […] The altered expression of SGs, causing a structural instability to the muscular plasmatic membrane might promote stress damage that develops during smooth muscle fiber contraction in RUs, loss of membrane integrity, smooth muscle cell apoptosis and fiber degeneration. […] Moreover, loss of -SG in RUs might explain the overall microperfusion, ongoing functional and structural alterations of vesicoureteral junction, and subsequent deterioration of the active antireflux mechanism.

• #15 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  The pathogenesis of primary VUR still remains unclear. […] It seems that a possible mechanism on its development could be research during the early embryonic phase. […] The most important anomaly seems to occurred at the VUJ level. […] Several studies have shown how the reduction of smooth muscle fascicles and the defective configuration at VUJ level, creates an uncoordinated muscular contraction also accompanied by the loss of c-kit-positive ICCs.

• #16 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Many authors have reported as dysplasia, atrophy and architectural derangement of smooth muscle cells in RUs is essential for the deficient active valve mechanism. […] The regular peristaltic movement is thus essential to drive the urine bolus from the kidney to the bladder towards the normal peristaltic ureters. […] An inverse correlation has been reported between the severity of VUR and the loss of ICCs in refluxing ureteric ends. […] The altered expression of SGs, causing a structural instability to the muscular plasmatic membrane might promote stress damage that develops during smooth muscle fiber contraction in RUs, loss of membrane integrity, smooth muscle cell apoptosis and fiber degeneration. […] Moreover, loss of -SG in RUs might explain the overall microperfusion, ongoing functional and structural alterations of vesicoureteral junction, and subsequent deterioration of the active antireflux mechanism.

• #17 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Many authors have reported as dysplasia, atrophy and architectural derangement of smooth muscle cells in RUs is essential for the deficient active valve mechanism. […] The regular peristaltic movement is thus essential to drive the urine bolus from the kidney to the bladder towards the normal peristaltic ureters. […] An inverse correlation has been reported between the severity of VUR and the loss of ICCs in refluxing ureteric ends. […] The altered expression of SGs, causing a structural instability to the muscular plasmatic membrane might promote stress damage that develops during smooth muscle fiber contraction in RUs, loss of membrane integrity, smooth muscle cell apoptosis and fiber degeneration. […] Moreover, loss of -SG in RUs might explain the overall microperfusion, ongoing functional and structural alterations of vesicoureteral junction, and subsequent deterioration of the active antireflux mechanism.

• #18 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Many authors have reported as dysplasia, atrophy and architectural derangement of smooth muscle cells in RUs is essential for the deficient active valve mechanism. […] The regular peristaltic movement is thus essential to drive the urine bolus from the kidney to the bladder towards the normal peristaltic ureters. […] An inverse correlation has been reported between the severity of VUR and the loss of ICCs in refluxing ureteric ends. […] The altered expression of SGs, causing a structural instability to the muscular plasmatic membrane might promote stress damage that develops during smooth muscle fiber contraction in RUs, loss of membrane integrity, smooth muscle cell apoptosis and fiber degeneration. […] Moreover, loss of -SG in RUs might explain the overall microperfusion, ongoing functional and structural alterations of vesicoureteral junction, and subsequent deterioration of the active antireflux mechanism.

• #19 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Primary VUR arises from intrinsic UVJ dysfunction, characterized by abnormally short or incompetent segments of the intravesical ureter. […] Secondary VUR, on the other hand, develops subsequent to abnormally high voiding pressure in the bladder. […] The natural resolution of VUR is believed to stem from the elongation of the intramural ureter as the child matures, alongside tissue remodeling of the UVJ and the maturation of bladder function over time. […] Intrarenal reflux refers to the backflow of urine into the renal collecting ducts in individuals with VUR. […] This condition poses a significant risk for pyelonephritis, renal scarring, impaired kidney growth, cortical atrophy, childhood hypertension, and chronic renal failure. […] Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection.

• #20 Vesicoureteral Reflux | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31134

  VUR can manifest as either a primary or secondary pathophysiologic process. […] Primary VUR arises from intrinsic UVJ dysfunction, characterized by abnormally short or incompetent segments of the intravesical ureter. […] Secondary VUR, on the other hand, develops subsequent to abnormally high voiding pressure in the bladder. […] A short intramural ureter often causes this abnormal backward flow of urine. […] The natural resolution of VUR is believed to stem from the elongation of the intramural ureter as the child matures, alongside tissue remodeling of the UVJ and the maturation of bladder function over time. […] Intrarenal reflux refers to the backflow of urine into the renal collecting ducts in individuals with VUR. […] This condition poses a significant risk for pyelonephritis, renal scarring, impaired kidney growth, cortical atrophy, childhood hypertension, and chronic renal failure.

• #21 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  In this category the ureters’ valvular mechanism is initially intact and healthy but becomes overwhelmed by increased bladder pressures associated with obstruction, which distorts the ureterovesicular junction. […] Bladder infections may cause reflux due to the elevated pressures associated with inflammation. […] The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. […] Minimizing infections is primarily done by prophylactic antibiotics in newborns and infants who are not potty trained.

• #22 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Renal lesions are associated with higher grades of reflux. Pyelonephritic scarring may, over time, cause serious hypertension due to activation of the renin-angiotensin system. Scarring related to VUR is one of the most common causes of childhood hypertension. […] Bladder outlet obstruction (functional or anatomical), learned voiding abnormalities (eg, nonneurogenic neurogenic bladder, or Hinman syndrome), and gastrointestinal dysfunction may cause VUR. Unphysiologically elevated intravesical pressures are common with all of these abnormalities. […] Acquired voiding dysfunction (eg, Hinman syndrome [nonneurogenic neurogenic bladder]) produces functional bladder outlet obstruction from voluntary contraction of the external sphincter during urination. These children generate high intravesical pressure, develop detrusor instability, and have high postvoid residual urine volumes.

• #23 State of the Art Pediatrics: Vesicoureteral Reflux: Back to Basics | Children’s Mercy Kansas City

  https://www.childrensmercy.org/health-care-providers/refer-or-manage-a-patient/connect-with-childrens-mercy/newsletter-the-link/2024/the-link—november-2024/state-of-the-art-pediatrics-vesicoureteral-reflux-back-to-basics/

  While vesicoureteral reflux (VUR), in and of itself, is not harmful to the kidney, its presence predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney, which can lead to renal scarring, hypertension, and, ultimately, chronic kidney disease (CKD). […] Based upon its pathogenesis, VUR is of two kinds: primary and secondary. In primary VUR, the most common form, reflux is due to inadequate intravesical tunnel length. […] When intravesical tunnel length is short, as it is in primary VUR, the anti-reflux mechanism is faulty and allows for retrograde flow of urine up the collecting system. […] In contrast, secondary VUR is related more to the pressure dynamics of the bladder and its effects on the ureterovesical junction (UVJ). […] Often associated with anatomic (e.g., posterior urethral valves) or functional (e.g., neurogenic bladder) obstruction of the bladder outlet, abnormally high voiding pressures are transmitted to the UVJ and results in failure of its closure during bladder filling and voiding. […] Both the severity and chronicity of the obstruction will impact the grade of reflux.

• #24 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  In this category the ureters’ valvular mechanism is initially intact and healthy but becomes overwhelmed by increased bladder pressures associated with obstruction, which distorts the ureterovesicular junction. […] Bladder infections may cause reflux due to the elevated pressures associated with inflammation. […] The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. […] Minimizing infections is primarily done by prophylactic antibiotics in newborns and infants who are not potty trained.

• #25 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Renal lesions are associated with higher grades of reflux. Pyelonephritic scarring may, over time, cause serious hypertension due to activation of the renin-angiotensin system. Scarring related to VUR is one of the most common causes of childhood hypertension. […] Bladder outlet obstruction (functional or anatomical), learned voiding abnormalities (eg, nonneurogenic neurogenic bladder, or Hinman syndrome), and gastrointestinal dysfunction may cause VUR. Unphysiologically elevated intravesical pressures are common with all of these abnormalities. […] Acquired voiding dysfunction (eg, Hinman syndrome [nonneurogenic neurogenic bladder]) produces functional bladder outlet obstruction from voluntary contraction of the external sphincter during urination. These children generate high intravesical pressure, develop detrusor instability, and have high postvoid residual urine volumes.

• #26 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Renal lesions are associated with higher grades of reflux. Pyelonephritic scarring may, over time, cause serious hypertension due to activation of the renin-angiotensin system. Scarring related to VUR is one of the most common causes of childhood hypertension. […] Bladder outlet obstruction (functional or anatomical), learned voiding abnormalities (eg, nonneurogenic neurogenic bladder, or Hinman syndrome), and gastrointestinal dysfunction may cause VUR. Unphysiologically elevated intravesical pressures are common with all of these abnormalities. […] Acquired voiding dysfunction (eg, Hinman syndrome [nonneurogenic neurogenic bladder]) produces functional bladder outlet obstruction from voluntary contraction of the external sphincter during urination. These children generate high intravesical pressure, develop detrusor instability, and have high postvoid residual urine volumes.

• #27 Vesicoureteral Reflux | SpringerLink

  https://link.springer.com/10.1007/978-981-99-1659-7_76

  Vesicoureteral reflux (VUR) in patients with neurogenic lower urinary tract dysfunction (NLUTD) can develop as a secondary complication of NLUTD, e.g., due to elevated intravesical pressures, or due to bladder wall fibrosis. […] High-grade VUR is regarded as a risk factor for recurrent pyelonephritis and reflux nephropathy pyelonephritis and renal scarring. […] In secondary VUR, treatment consists of treatment of neurogenic detrusor overactivity. […] The treatment of VUR is complex and special, with a variety of options, from active surveillance to surgical treatment. […] This chapter reviewed special aspects on VUR in different NLUTD to help clinicians identify VUR and choose appropriate methods to treat it.

• #28

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Anticholinergics function as a smooth muscle relaxant, which may help control the detrusor muscle overactivity (DOA). DOA is one of the causative factors of secondary VUR, increasing intravesical pressure that causes urine reflux into the ureters. […] The use of anticholinergics and alpha-blockers, although theoretically feasible, is not supported by recent literature, and further study is needed to assess the safety and efficacy of these agents. […] Long-term antibiotic prophylaxis has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] CAP tends to have a greater benefit in patients with high-risk VUR, which are defined in the American Urological Association guideline as patients aged 1 year and VUR with dilatation. […] Probiotics are living microorganisms that are beneficial for human health.

• #29 Vesicoureteral Reflux | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31134

  Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection. […] Renal damage from UTIs associated with VUR may happen at any age and is not limited to children. […] Additionally, elevated intravesical pressure associated with VUR might contribute to renal damage.

• #30 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Primary VUR arises from intrinsic UVJ dysfunction, characterized by abnormally short or incompetent segments of the intravesical ureter. […] Secondary VUR, on the other hand, develops subsequent to abnormally high voiding pressure in the bladder. […] The natural resolution of VUR is believed to stem from the elongation of the intramural ureter as the child matures, alongside tissue remodeling of the UVJ and the maturation of bladder function over time. […] Intrarenal reflux refers to the backflow of urine into the renal collecting ducts in individuals with VUR. […] This condition poses a significant risk for pyelonephritis, renal scarring, impaired kidney growth, cortical atrophy, childhood hypertension, and chronic renal failure. […] Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection.

• #31 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Primary VUR arises from intrinsic UVJ dysfunction, characterized by abnormally short or incompetent segments of the intravesical ureter. […] Secondary VUR, on the other hand, develops subsequent to abnormally high voiding pressure in the bladder. […] The natural resolution of VUR is believed to stem from the elongation of the intramural ureter as the child matures, alongside tissue remodeling of the UVJ and the maturation of bladder function over time. […] Intrarenal reflux refers to the backflow of urine into the renal collecting ducts in individuals with VUR. […] This condition poses a significant risk for pyelonephritis, renal scarring, impaired kidney growth, cortical atrophy, childhood hypertension, and chronic renal failure. […] Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection.

• #32 Vesicoureteral Reflux | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31134

  Reflux alone does not generally damage the kidney, but when coupled with intrarenal reflux, bacteria from the refluxed urine can infect the renal collecting ducts and parenchyma, leading to potential scarring and infection. […] Renal damage from UTIs associated with VUR may happen at any age and is not limited to children. […] Additionally, elevated intravesical pressure associated with VUR might contribute to renal damage.

• #33 Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects

  https://www.mdpi.com/2077-0383/12/6/2380

  From the bladder, either infected or non-infected urine can enter the collecting system of the kidneys, causing inflammation that can lead to renal scarring, proteinuria, hypertension, and impaired renal function. […] The presence of infected urine in kidneys activates a local immune response, which in the case of persistent VUR may lead to chronic inflammation and fibrogenesis, followed by parenchymal healing with scars. […] In the case of non-infected urine reflux, there is no evidence of renal scar development. […] This observation applies to low-grade VUR in the absence of urinary infections. […] Another clinical observation is that patients with low-grade VUR who have an underlying pathological condition that causes abnormally increased detrusor pressure may develop reflux nephropathy in the absence of infections.

• #34 Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects

  https://www.mdpi.com/2077-0383/12/6/2380

  From the bladder, either infected or non-infected urine can enter the collecting system of the kidneys, causing inflammation that can lead to renal scarring, proteinuria, hypertension, and impaired renal function. […] The presence of infected urine in kidneys activates a local immune response, which in the case of persistent VUR may lead to chronic inflammation and fibrogenesis, followed by parenchymal healing with scars. […] In the case of non-infected urine reflux, there is no evidence of renal scar development. […] This observation applies to low-grade VUR in the absence of urinary infections. […] Another clinical observation is that patients with low-grade VUR who have an underlying pathological condition that causes abnormally increased detrusor pressure may develop reflux nephropathy in the absence of infections.

• #35 Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects

  https://www.mdpi.com/2077-0383/12/6/2380

  From the bladder, either infected or non-infected urine can enter the collecting system of the kidneys, causing inflammation that can lead to renal scarring, proteinuria, hypertension, and impaired renal function. […] The presence of infected urine in kidneys activates a local immune response, which in the case of persistent VUR may lead to chronic inflammation and fibrogenesis, followed by parenchymal healing with scars. […] In the case of non-infected urine reflux, there is no evidence of renal scar development. […] This observation applies to low-grade VUR in the absence of urinary infections. […] Another clinical observation is that patients with low-grade VUR who have an underlying pathological condition that causes abnormally increased detrusor pressure may develop reflux nephropathy in the absence of infections.

• #36 Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects

  https://www.mdpi.com/2077-0383/12/6/2380

  From the bladder, either infected or non-infected urine can enter the collecting system of the kidneys, causing inflammation that can lead to renal scarring, proteinuria, hypertension, and impaired renal function. […] The presence of infected urine in kidneys activates a local immune response, which in the case of persistent VUR may lead to chronic inflammation and fibrogenesis, followed by parenchymal healing with scars. […] In the case of non-infected urine reflux, there is no evidence of renal scar development. […] This observation applies to low-grade VUR in the absence of urinary infections. […] Another clinical observation is that patients with low-grade VUR who have an underlying pathological condition that causes abnormally increased detrusor pressure may develop reflux nephropathy in the absence of infections.

• #37 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Two types of urine may enter the renal papillae: infected urine or sterile urine. Intrarenal reflux of infected urine appears to be primarily responsible for the renal damage. The presence of bacterial endotoxins (lipopolysaccharides) activates the host’s immune response and a release of oxygen free radicals. The release of oxygen free radicals and proteolytic enzymes results in fibrosis and scarring of the affected renal parenchyma during the healing phase. […] Initial scar formation at the infected polar region distorts local anatomy of the neighboring papillae and converts simple papillae into compound papillae. Compound papillae, in turn, perpetuate further intrarenal reflux and additional renal scarring. Thus, a potentially vicious cycle of events may occur after initial intrarenal introduction of infected urine.

• #38 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Two types of urine may enter the renal papillae: infected urine or sterile urine. Intrarenal reflux of infected urine appears to be primarily responsible for the renal damage. The presence of bacterial endotoxins (lipopolysaccharides) activates the host’s immune response and a release of oxygen free radicals. The release of oxygen free radicals and proteolytic enzymes results in fibrosis and scarring of the affected renal parenchyma during the healing phase. […] Initial scar formation at the infected polar region distorts local anatomy of the neighboring papillae and converts simple papillae into compound papillae. Compound papillae, in turn, perpetuate further intrarenal reflux and additional renal scarring. Thus, a potentially vicious cycle of events may occur after initial intrarenal introduction of infected urine.

• #39 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Two types of urine may enter the renal papillae: infected urine or sterile urine. Intrarenal reflux of infected urine appears to be primarily responsible for the renal damage. The presence of bacterial endotoxins (lipopolysaccharides) activates the host’s immune response and a release of oxygen free radicals. The release of oxygen free radicals and proteolytic enzymes results in fibrosis and scarring of the affected renal parenchyma during the healing phase. […] Initial scar formation at the infected polar region distorts local anatomy of the neighboring papillae and converts simple papillae into compound papillae. Compound papillae, in turn, perpetuate further intrarenal reflux and additional renal scarring. Thus, a potentially vicious cycle of events may occur after initial intrarenal introduction of infected urine.

• #40 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Renal lesions are associated with higher grades of reflux. Pyelonephritic scarring may, over time, cause serious hypertension due to activation of the renin-angiotensin system. Scarring related to VUR is one of the most common causes of childhood hypertension. […] Bladder outlet obstruction (functional or anatomical), learned voiding abnormalities (eg, nonneurogenic neurogenic bladder, or Hinman syndrome), and gastrointestinal dysfunction may cause VUR. Unphysiologically elevated intravesical pressures are common with all of these abnormalities. […] Acquired voiding dysfunction (eg, Hinman syndrome [nonneurogenic neurogenic bladder]) produces functional bladder outlet obstruction from voluntary contraction of the external sphincter during urination. These children generate high intravesical pressure, develop detrusor instability, and have high postvoid residual urine volumes.

• #41 SciELO Brazil – Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt? Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?

  https://www.scielo.br/j/ibju/a/cp63sgTCvQpvyc6TrkzVqtt/

  Long term consequences for patients with renal scars are well known and include hypertension, proteinuria, compromising somatic growth and renal failure. […] Baileys paper earlier mentioned and reinforced in Ishikura et al. publications, conclude that VUR alone might not be responsible for kidneys deterioration. […] Their reports showed that the presence of hypoplasia/ dysplasia in refluxing units has a stronger association with the reduction of the glomerular filtration rate (GFR) other than VUR alone. […] Different from others here mentioned, Ishikura includes also patients with secondary VUR, for example males with posterior urethral valve. […] Another author that demonstrated the straight relation between urinary protein, VUR and CKD was Spibus et al. in 2017, showing a downgrade on GFR in patients with high-grade VUR and high volume of urinary albumin excretion.

• #42 Vesicoureteral Reflux | Pediatric Urology Book

  https://pediatricurologybook.com/zh/book/chapters/03-16_vesicoureteral-reflux/

  Multiple studies demonstrate a direct correlation between prevalence of renal scarring and grade of reflux. […] Renal scars have also been demonstrated to be a negative predictor of VUR resolution independent of reflux grade. […] Children with renal scars are more likely to develop further UTIs and additional scars than children without renal scars. […] These data strongly suggest that children with scarring are at increased risk for further development of additional scars and long-term clinical sequelae.

• #43 Vesicoureteral Reflux | Pediatric Urology Book

  https://pediatricurologybook.com/zh/book/chapters/03-16_vesicoureteral-reflux/

  Multiple studies demonstrate a direct correlation between prevalence of renal scarring and grade of reflux. […] Renal scars have also been demonstrated to be a negative predictor of VUR resolution independent of reflux grade. […] Children with renal scars are more likely to develop further UTIs and additional scars than children without renal scars. […] These data strongly suggest that children with scarring are at increased risk for further development of additional scars and long-term clinical sequelae.

• #44 Vesicoureteral reflux – WikiLectures

  https://www.wikilectures.eu/w/Vesicoureteral_reflux

  Reflux probably also has a genetic basis – if it is in one child, the probability that it will be in others is about 25%. […] the main mechanism of ureteral occlusion is its oblique passage through the bladder wall and the pressure of the detrusor and trigon […] in children this orifice often matures late, lower levels of reflux often disappear spontaneously, […] reflux alone is probably not dangerous for scarring, it damages the kidney when a urinary tract infection is present.

• #45 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  Vescico-Ureteral Reflux (VUR) is a common condition in childhood, caused by a congenital anomaly at the Vescico-Ureteral Junction (VUJ) level. It seems that the main cause could be an abnormal embryological development occurred during the early stage of fetal life. […] Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as an high rate of atrophy and muscular degeneration with disorganized muscular fibres. […] The roles played by Cajal cells and Connexin 43 in generating peristaltic waves appears to be fundamental for the physiological VUJ function and activity. […] This review will discuss and investigate the importance of the modified configuration of Sarcoglycan (SG) sub complex (particularly the deficiency of the -SG and the increased expression of the -SG), the role played by Cajal Cells, the intravescical tunnel length to ureteral diameter ratio as possible causes of the functional alterations in the refluxing ureteral ends leading towards the VUJ incompetence.

• #46

  https://journals.lww.com/ajpn/fulltext/2019/02020/vesicoureteral_reflux_and_recurrent_urinary_tract.1.aspx

  Vesicoureteric reflux (VUR) is the retrograde passage of urine into the upper urinary tract, during detrusor contraction at micturition. In the absence of lower urinary tract outlet obstruction and neurogenic bladder, it is considered to be primary. Primary VUR is regarded as a risk factor for urinary tract infections (UTIs) and postinfectious scarring. Several mechanisms are proposed to explain the pathogenesis of primary VUR. The key event in the development of kidney and ureters is the ureteric budding from the Wolffian duct and its reciprocal interaction with the metanephric mesenchyme. Accordingly, cephalad ureteric budding results in laterally displaced ureteric orifice, shorter length of intravesical ureter with loss of valve mechanism preventing reflux. VUR is seen in syndromes associated with genes of the ureteric budding pathway. Loss of ureteral peristalsis and bladder dysfunction are proposed to contribute to the occurrence and persistence of VUR.

• #47 Mini-review on pathogenesis and diagnosis of vesicoureteral reflux in children – MedCrave online

  https://medcraveonline.com/UNOAJ/mini-review-on-pathogenesis-and-diagnosis-of-vesicoureteral-reflux-in-children.html

  Vesicoureteral reflux (VUR) represents nowadays a controversial issue regarding its diagnosis, screening and treatment for its potential renal damage is not clearly understood. […] Primary VUR is essentially related to short intravesical length of the ureter, while secondary reflux is more related to anatomic or neuro functional anomalies of the bladder. […] VUR can be divided into two categories: primary and secondary. I. Primary VUR is related to an incompetent ureterovesical junction (UVJ) with failure of its closure by bladder compression during filling. […] Abnormalities in UVJ constitution as Waldeyers sheath weakness or extracellular matrix composition may lead to VUR. […] When the ureteral bud reaches the UGS too soon, its implantation into the bladder is high and lateral with a short intravesical length, leading to VUR.

• #48 Mini-review on pathogenesis and diagnosis of vesicoureteral reflux in children – MedCrave online

  https://medcraveonline.com/UNOAJ/mini-review-on-pathogenesis-and-diagnosis-of-vesicoureteral-reflux-in-children.html

  Moreover, anomalies concerning ureteral budding may affect the interaction between bud epithelium and the metanephros, making renal anomalies such as hypoplasia, dysplasia or agenesis an associated finding with VUR. […] II. Secondary reflux results from anomaly affecting the integrity of the ureter or the functional dynamics of the bladder. […] Neurofunctional problems of the bladder lead to secondary reflux. […] Management of LUTD in children is not always associated with VUR resolution, showing a borderline incompetent UVJ with probable deterioration by high voiding pressures and UTI.

• #49 Genetics of Vesicoureteral Reflux

  https://www.eurekaselect.com/article/71091

  Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder to the upper urinary tract. […] An ectopic embryonal ureteric budding development is implicated in the pathogenesis of VUR, which is a complex genetic developmental disorder. […] Many genes are involved in the ureteric budding formation and subsequently in the urinary tract and kidney development. […] Previous studies demonstrate an heterogeneous genetic pattern of VUR. […] In fact no single major locus or gene for primary VUR has been identified. […] It is likely that different forms of VUR with different genetic determinantes are present. […] Moreover genetic studies of syndromes with associated VUR have revealed several possible candidate genes involved in the pathogenesis of VUR and related urinary tract malformations.

• #50 Genetics of Vesicoureteral Reflux

  https://www.eurekaselect.com/article/71091

  Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder to the upper urinary tract. […] An ectopic embryonal ureteric budding development is implicated in the pathogenesis of VUR, which is a complex genetic developmental disorder. […] Many genes are involved in the ureteric budding formation and subsequently in the urinary tract and kidney development. […] Previous studies demonstrate an heterogeneous genetic pattern of VUR. […] In fact no single major locus or gene for primary VUR has been identified. […] It is likely that different forms of VUR with different genetic determinantes are present. […] Moreover genetic studies of syndromes with associated VUR have revealed several possible candidate genes involved in the pathogenesis of VUR and related urinary tract malformations.

• #51 Genetics of Vesicoureteral Reflux

  https://www.eurekaselect.com/article/71091

  Mutations in genes essential for urinary tract morphogenesis are linked to numerous congenital syndromes, and in most of those VUR is a feature. […] The different genes and signaling pathways controlling the embryonal urinary tract development are analyzed. […] A better understanding of VUR genetic bases could improve the management of this condition in children.

• #52

  https://omim.org/entry/193000

  Vesicoureteral reflux (VUR) is characterized by the reflux of urine from the bladder into the ureters and sometimes into the kidneys. It is a risk factor for urinary tract infections. Primary VUR results from a developmental defect of the ureterovesical junction (UVJ). In combination with intrarenal reflux, the resulting inflammatory reaction may result in renal injury or scarring, also called reflux nephropathy (RN). Extensive renal scarring impairs renal function and may predispose patients to hypertension, proteinuria, and renal insufficiency (summary by Lu et al., 2007). […] A locus designated VUR1 maps to chromosome 1p13. VUR2 (610878) is caused by mutation in the ROBO2 gene (602431) on chromosome 3p12; VUR3 (613674) is caused by mutation in the SOX17 gene (610928) on chromosome 8q11; VUR4 (614317) maps to chromosome 5; VUR5 (614318) maps to chromosome 13; VUR6 (614319) maps to chromosome 18; VUR7 (615390) maps to chromosome 12; and VUR8 (615963) is caused by mutation in the TNXB gene (600985) on chromosome 6p21. A possible X-linked form has been reported (VURX; 314550).

• #53 Genetics of Vesicoureteral Reflux

  https://www.eurekaselect.com/article/71091

  Mutations in genes essential for urinary tract morphogenesis are linked to numerous congenital syndromes, and in most of those VUR is a feature. […] The different genes and signaling pathways controlling the embryonal urinary tract development are analyzed. […] A better understanding of VUR genetic bases could improve the management of this condition in children.

• #54 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Vesico Ureteral Reflux (VUR) is a common pediatric urological condition characterized by the abnormal flow of urine from the bladder into the ureters and sometimes into the kidneys. […] While the pathophysiology of VUR is multifactorial, the role of the immune system in its development and progression remains an area of ongoing research. […] Understanding the immune expression in children with VUR is crucial in comprehending the diseases pathogenesis and guiding treatment strategies. […] The immune system plays a critical role in defending the body against infections, and its involvement in VUR is multifaceted. […] Immune expression in children with VUR can be analyzed at different levels. […] In VUR, frequent UTIs can stimulate the adaptive immune system, leading to an increased production of antibodies against common pathogens.

• #55 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Vesico Ureteral Reflux (VUR) is a common pediatric urological condition characterized by the abnormal flow of urine from the bladder into the ureters and sometimes into the kidneys. […] While the pathophysiology of VUR is multifactorial, the role of the immune system in its development and progression remains an area of ongoing research. […] Understanding the immune expression in children with VUR is crucial in comprehending the diseases pathogenesis and guiding treatment strategies. […] The immune system plays a critical role in defending the body against infections, and its involvement in VUR is multifaceted. […] Immune expression in children with VUR can be analyzed at different levels. […] In VUR, frequent UTIs can stimulate the adaptive immune system, leading to an increased production of antibodies against common pathogens.

• #56 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #57 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #58 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Vesico Ureteral Reflux (VUR) is a common pediatric urological condition characterized by the abnormal flow of urine from the bladder into the ureters and sometimes into the kidneys. […] While the pathophysiology of VUR is multifactorial, the role of the immune system in its development and progression remains an area of ongoing research. […] Understanding the immune expression in children with VUR is crucial in comprehending the diseases pathogenesis and guiding treatment strategies. […] The immune system plays a critical role in defending the body against infections, and its involvement in VUR is multifaceted. […] Immune expression in children with VUR can be analyzed at different levels. […] In VUR, frequent UTIs can stimulate the adaptive immune system, leading to an increased production of antibodies against common pathogens.

• #59 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #60 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #61 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #62 Factors Affecting Physical Growth in Children with Primary Vesicoureteral Reflux: A Single Center Experience – The Journal of Pediatric Research

  https://jpedres.org/articles/factors-affecting-physical-growth-in-children-with-primary-vesicoureteral-reflux-a-single-center-experience/doi/jpr.galenos.2018.85619

  Primary Vesicoureteral reflux (VUR) is defined as retrograde urine flow from the bladder to the upper urinary system due to an insufficient valvular mechanism in the ureterovesical junction. […] Renal damage and persistent VUR have been reported to alter physical growth in former studies, however, recent data revealed no relevance between renal damage, UTIs, VUR grade and growth. […] Our study highlighted that the presence of renal scarring and UTIs at follow-up may lead to growth alterations in patients with primary VUR. […] The most striking insight in the present study was particularly the negative impact of afebrile UTIs on growth in patients with primary VUR.

• #63 Factors Affecting Physical Growth in Children with Primary Vesicoureteral Reflux: A Single Center Experience – The Journal of Pediatric Research

  https://jpedres.org/articles/factors-affecting-physical-growth-in-children-with-primary-vesicoureteral-reflux-a-single-center-experience/doi/jpr.galenos.2018.85619

  Primary Vesicoureteral reflux (VUR) is defined as retrograde urine flow from the bladder to the upper urinary system due to an insufficient valvular mechanism in the ureterovesical junction. […] Renal damage and persistent VUR have been reported to alter physical growth in former studies, however, recent data revealed no relevance between renal damage, UTIs, VUR grade and growth. […] Our study highlighted that the presence of renal scarring and UTIs at follow-up may lead to growth alterations in patients with primary VUR. […] The most striking insight in the present study was particularly the negative impact of afebrile UTIs on growth in patients with primary VUR.

• #64 Factors Affecting Physical Growth in Children with Primary Vesicoureteral Reflux: A Single Center Experience – The Journal of Pediatric Research

  https://jpedres.org/articles/factors-affecting-physical-growth-in-children-with-primary-vesicoureteral-reflux-a-single-center-experience/doi/jpr.galenos.2018.85619

  Primary Vesicoureteral reflux (VUR) is defined as retrograde urine flow from the bladder to the upper urinary system due to an insufficient valvular mechanism in the ureterovesical junction. […] Renal damage and persistent VUR have been reported to alter physical growth in former studies, however, recent data revealed no relevance between renal damage, UTIs, VUR grade and growth. […] Our study highlighted that the presence of renal scarring and UTIs at follow-up may lead to growth alterations in patients with primary VUR. […] The most striking insight in the present study was particularly the negative impact of afebrile UTIs on growth in patients with primary VUR.

• #65 Physiopathology of vesico-ureteral reflux | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0316-x

  The pathogenesis of primary VUR still remains unclear. […] It seems that a possible mechanism on its development could be research during the early embryonic phase. […] The most important anomaly seems to occurred at the VUJ level. […] Several studies have shown how the reduction of smooth muscle fascicles and the defective configuration at VUJ level, creates an uncoordinated muscular contraction also accompanied by the loss of c-kit-positive ICCs.

• #66 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.2017.58.S1.S46

  Vesicoureteral reflux (VUR) is one of the most common diseases in pediatric urology and classified into primary and secondary VUR. […] Although posterior urethral valve (PUV) is well known as a cause of the secondary VUR, it is controversial that minor urethral deformity recognized in voiding cystourethrography represents mild end of PUV spectrum and contributes to the secondary VUR. […] The most common anomaly is posterior urethral valve (PUV). However, the diagnosis of PUV is sometimes difficult because of its wide spectrum in terms of severity and morphology. […] Another underlying condition that contributes to apparent primary VUR might be mild PUV, which is sometimes difficult to detect in ordinary imaging studies because it does not present with conventional findings, such as overt dilatation of the posterior urethra.

• #67 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.2017.58.S1.S46

  Mild urethral obstructive lesion has long been suggested as a contributing factor in VUR and urinary tract infection (UTI) but has not been systematically investigated. […] The reason why endoscopic incision of the anterior lesion recognized in mild PUV is effective for lowering detrusor pressure as well as symptomatic improvement needs to be answered. […] We hypothesize that urethral kinking, which can be observed in these children (preadolescent boys without prostatic development) with mild PUV may be a key for understanding pathophysiology. […] The broad spectrum of PUV has gradually become more widely recognized. Among patients with primary VUR (i.e., those without an underlying disease), to date there may at least be some patients with mild concomitant PUV.

• #68 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.2017.58.S1.S46

  Mild urethral obstructive lesion has long been suggested as a contributing factor in VUR and urinary tract infection (UTI) but has not been systematically investigated. […] The reason why endoscopic incision of the anterior lesion recognized in mild PUV is effective for lowering detrusor pressure as well as symptomatic improvement needs to be answered. […] We hypothesize that urethral kinking, which can be observed in these children (preadolescent boys without prostatic development) with mild PUV may be a key for understanding pathophysiology. […] The broad spectrum of PUV has gradually become more widely recognized. Among patients with primary VUR (i.e., those without an underlying disease), to date there may at least be some patients with mild concomitant PUV.

• #69 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.2017.58.S1.S46

  Mild urethral obstructive lesion has long been suggested as a contributing factor in VUR and urinary tract infection (UTI) but has not been systematically investigated. […] The reason why endoscopic incision of the anterior lesion recognized in mild PUV is effective for lowering detrusor pressure as well as symptomatic improvement needs to be answered. […] We hypothesize that urethral kinking, which can be observed in these children (preadolescent boys without prostatic development) with mild PUV may be a key for understanding pathophysiology. […] The broad spectrum of PUV has gradually become more widely recognized. Among patients with primary VUR (i.e., those without an underlying disease), to date there may at least be some patients with mild concomitant PUV.

• #70 Vesicoureteral reflux and the extracellular matrix connection.

  https://dukespace.lib.duke.edu/items/e0f4e296-78d7-4d67-9239-3f4c2516dbb0

  Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. […] The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. […] This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.

• #71 Vesicoureteral Reflux | Abdominal Key

  https://abdominalkey.com/vesicoureteral-reflux/

  The cellular and molecular details that characterize normal and refluxing UVJs are still unknown. However, it is likely that in addition to architectural deficiencies of tunnel length, abnormalities in UV smooth muscle and extracellular matrix composition and neural function may contribute to reflux.

• #72 Vesicoureteral reflux and the extracellular matrix connection.

  https://dukespace.lib.duke.edu/items/e0f4e296-78d7-4d67-9239-3f4c2516dbb0

  Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. […] The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. […] This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.

• #73 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

• #74

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Exogenous probiotics are known to have a protective effect against uropathogens and have been used as a modality for preventing UTIs. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients. […] Thus, circumcision can be considered in all male patients with VUR if possible.

• #75 A pilot study on immune expression in children with vesicoureteral reflux

  https://www.pediatricurologycasereports.com/articles/a-pilot-study-on-immune-expression-in-children-with-vesicoureteral-reflux-103236.html

  Over time, this heightened immune response may contribute to kidney damage if left untreated. […] Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. […] However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring. […] Research into the microbiomes role in VUR is ongoing and may provide insights into the conditions pathogenesis. […] The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. […] Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs. […] The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF- suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. […] In conclusion, immune expression in children with vesicoureteral reflux is a complex interplay of innate and adaptive immune responses, inflammation, genetics, and microbial factors. […] Understanding these mechanisms is vital for developing targeted therapies and preventive strategies.

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