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Vesicoureteral Reflux and the Adult

  • Chapter
Transition and Lifelong Care in Congenital Urology

Part of the book series: Current Clinical Urology ((CCU))

Abstract

The ongoing morbidity of VUR relates primarily to the development of reflux nephropathy, which may include impaired renal function and growth, hypertension, as well as other renal and systemic effects. However, the likelihood of progression to end-stage renal disease is exceedingly low.

Reflux nephropathy is thought to result from renal scarring, for which younger patients are most at risk, but because of their irreversible nature, are most prevalent in adults.

A link between UTI, VUR and renal scarring exists, but there is variation in scar etiology, which can be congenital (more accurately termed dysplasia) or acquired (mostly from repeat febrile UTI).

Acquired renal scar most commonly develops from febrile UTI. Prompt initiation of antibiotics is the most important, modifiable factor in preventing new scar formation in the immediate setting.

Certain populations are at particular risk for VUR and its sequelae, including pregnant patients, patients with a renal transplant, and patients with neurogenic bladder. In pregnancy, the presence of baseline scar and renal impairment portends the worst prognosis for maternal and fetal morbidity.

Follow-up of patients with a history of VUR should include regular assessment of blood pressure and may additionally include periodic measurement and assessment of creatinine, renal size and split function, patient height, and the presence of proteinuria.

Evaluation for VUR in adults may be considered in those with complicated UTI, immunocompromised patients, patients with pyelonephritis and a personal or family history of VUR, adult women of child-bearing age with a history of pyelonephritis, patients with flank pain upon bladder filling, potential transplant recipients with a history of UTI, and in select patients with hypertension.

Women with a history of or the ongoing presence of VUR should be considered for evaluation of VUR in offspring, due to the genetic risk of the condition.

Ureteral reimplantation has high success rates in children but is more technically challenging in adults.

Endoscopic treatment is very successful and is a reasonable option for eliminating VUR in adults.

Even after surgical correction of childhood VUR, UTI and ongoing renal morbidity may occur.

CAP, while a popular temporizing option in children, is of limited benefit and practicality in adults.

Adjunct therapies for VUR, such as management of bowel bladder dysfunction as well as medical and surgical management of hypertension may be helpful in managing adults with VUR.

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Authors and Affiliations

  1. Cohen Children’s Medical Center, North Shore - Long Island Jewish Health System, New Hyde Park, NY, USA

    Ariella A. Friedman M.D.

  2. Department of Urology, New York Presbyterian Weill-Cornell Medical Center, New York, NY, 10021, USA

    Moneer K. Hanna M.D., F.R.C.S.

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  1. Ariella A. Friedman M.D.
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Correspondence to Ariella A. Friedman M.D. .

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  1. Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA

    Hadley M. Wood

  2. Adolescent and Reconstructive Urology, University College London Hospitals, London, United Kingdom

    Dan Wood

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Friedman, A.A., Hanna, M.K. (2015). Vesicoureteral Reflux and the Adult. In: Wood, H., Wood, D. (eds) Transition and Lifelong Care in Congenital Urology. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-14042-1_16

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