Management of Vesicoureteric Reflux: Indian Society of Pediatric Nephrology Guidelines 2023

Management of Primary Vesicoureteric Reflux (VUR) – revised updates from the Indian Society of Pediatric Nephrology Guidelines (ISPN) 2023:

• Surgical reimplantation is recommended for patients with high-grade VUR who experience recurrent febrile urinary tract infections (UTIs) despite being on antibiotic prophylaxis.
• For children with high-grade VUR, surgical intervention may be an alternative if the parents are hesitant towards antibiotic use.
• If surgery is indicated, endoscopic injection of a bulking agent can be considered as an initial therapy. This option should be explained by a physician regarding its minimally invasive nature but lower success rate compared to ureteric reimplantation.
• Children with high-grade VUR and reflux nephropathy require periodic follow-up to detect long-term complications.
• The child's growth, blood pressure, proteinuria, and kidney function should be monitored at each hospital visit.
• Periodic ultrasound scans are recommended to monitor kidney growth in children with persistent high-grade VUR.
• Dimercaptosuccinic acid (DMSA) scintigraphy should be repeated during follow-up – only for children with recurrent UTIs.
• Routine repeat cystography to document reflux resolution is not necessary, but it may be performed 4-8 years after the initial diagnosis if deemed necessary by the treating physician.
• Siblings under 3 years of age––of children with primary VUR, must be screened using an ultrasound scan.

Source:Meena J, Bagga A, Hari P. Indian Pediatrics. 2024 Apr;61(4):363-9.