Pediatric vesicoureteral reflux: Slow but steady steps

Vesicoureteral reflux (VUR) is a common urological anomaly that is found in 1% of children. VUR can cause recurrent febrile urinary tract infection (UTI). The recurrent infections can result in renal scarring, which can lead to renal hypertension and end-stage renal disease. Thus, our therapeutic goal is to prevent febrile UTI in the short term and, in the long term, to preserve renal function by inhibiting renal scarring and the associated complications. The exact pathophysiology of VUR and VUR-related complications is not yet known. We do not know why VUR shows great differences in severity depending on the patient. Genetic studies are being conducted on this aspect. VUR is a disease that is included in congenital anomalies of the kidney and urinary tract (CAKUT). In the article “Genetics of vesicoureteral reflux and congenital anomalies of the kidney and urinary tract”, Lee et al. [1] summarized VUR and CAKUT. CAKUT is a genetically heterogeneous group of disorders that are caused by mutations in genes involved in the kidney development process. Among the genes and signaling pathways, those involved in the progression of CAKUT have been evaluated. More than 20 genes and pathways have been identified that act at each step of kidney development. Although it is still too early to apply these genetic findings in clinical practice, advances in sequencing and bioinformatics technologies illustrate the future possibility of early diagnosis, better management, and genetic counseling. Over the past 20 years, changes have taken place concerning how much to evaluate for VUR when febrile UTI occurs. Abdelhalim and Khoury [2] organized about this in their article, and explained the advantages and disadvantages of the top-down approach, which is the most used in Korea. Historically, children with any degree of VUR were thought to be at risk of renal damage and Pediatric vesicoureteral reflux: Slow but steady steps Editorial