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Vesicoureteric Reflux

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Description: Vesicoureteric reflux is a condition where urine flows backward from the bladder into the ureters and sometimes the kidneys.
Type: Vesicoureteric reflux (VUR) is a condition in which urine flows backward from the bladder into the ureters and sometimes into the kidneys.

Type of genetic transmission: VUR can be inherited in an autosomal dominant pattern, meaning a child has a 50% chance of inheriting the condition if one parent carries the gene mutation associated with it. Some forms may also have polygenic or multifactorial inheritance patterns, but autosomal dominant inheritance is the most commonly recognized.
Signs And Symptoms: Most children with vesicoureteral reflux are asymptomatic. Vesicoureteral reflux may be diagnosed as a result of further evaluation of dilation of the kidney or ureters draining urine from the kidney while in utero as well as when a sibling has VUR (though routine testing in either circumstance is controversial). Reflux also increases risk of acute bladder and kidney infections, so testing for reflux may be performed after a child has one or more infections.
In infants, the signs and symptoms of a urinary tract infection may include only fever and lethargy, with poor appetite and sometimes foul-smelling urine, while older children typically present with discomfort or pain with urination and frequent urination.
Prognosis: The prognosis for vesicoureteric reflux (VUR) primarily depends on the severity of the condition and the patient's response to treatment. Mild to moderate cases often resolve on their own as children grow older. Severe cases, however, may require medical intervention, such as long-term antibiotics to prevent infections, or surgery to correct the reflux. Early diagnosis and management are crucial in preventing potential complications like kidney damage or recurrent urinary tract infections. Regular follow-up with a healthcare provider is essential to monitor the condition and ensure appropriate treatment.
Onset: Vesicoureteral reflux (VUR) is a condition that can be present from birth (congenital). It often becomes evident in infancy or early childhood, typically when a child is diagnosed after a urinary tract infection. However, in some cases, it may not be detected until later in childhood or even adulthood.
Prevalence: Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes up to the kidneys. The prevalence is estimated to be around 1-2% in children, but it can be higher in those with urinary tract infections (UTIs), with studies suggesting up to 30-50% of children with recurrent UTIs may have VUR.
Epidemiology: The prevalence of VUR is difficult to ascertain at any one time, it differs depending on the population looked at. The prevalence of VUR in healthy children has been estimated 0.4-1.8% However in children with UTI the prevalence is up to 30%. Probably the prevalence in healthy population is significantly higher than the traditional estimates, up to 10% of the population. Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. This susceptibility decreases with age as the length of the ureters increases as the children grow.
Four times as many girls as boys are diagnosed with VUR during childhood. Boys most commonly present during their first year, and girls present more cumulatively throughout childhood.
Intractability: Vesicoureteric reflux (VUR) is not inherently intractable. Many cases, especially mild to moderate ones, can be managed with medical treatment, including antibiotic prophylaxis to prevent infections. Severe cases may require surgical intervention to correct the reflux and prevent kidney damage. Thus, with appropriate treatment, VUR can often be effectively managed or resolved.
Disease Severity: Vesicoureteric reflux (VUR) severity is typically classified into five grades:
1. Grade I: Reflux into a non-dilated ureter.
2. Grade II: Reflux into the renal pelvis and calyces without dilation.
3. Grade III: Reflux with mild to moderate dilation and minimal blunting of the fornices.
4. Grade IV: Reflux with moderate dilation and tortuosity of the ureter and calyces.
5. Grade V: Severe dilation and tortuosity of the ureter and calyces, with significant blunting of the renal fornices and papillary impressions.
Healthcare Professionals: Disease Ontology ID - DOID:9620
Pathophysiology: Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes up to the kidneys. It can lead to urinary tract infections and potential kidney damage.

**Pathophysiology:**
1. **Anatomical factors**: Typically, a malfunction in the vesicoureteral junction, where the ureter meets the bladder, is responsible. The ureter does not enter the bladder at the correct angle, or the length of the ureteral tunnel through the bladder wall is too short, impairing the valve function that normally prevents backward flow.

2. **Primary VUR**: This often results from congenital defects in the ureterovesical junction and is the most commonly occurring type in children. It is often familial, indicating a genetic predisposition.

3. **Secondary VUR**: This occurs due to high pressure within the bladder or other obstructive uropathies, such as a neurogenic bladder or posterior urethral valves. It may develop due to bladder dysfunction or damage that disrupts the normal flow of urine.

In both primary and secondary VUR, the incorrect flow increases the risk of kidney infections (pyelonephritis), which can lead to renal scarring and eventually, if untreated or severe, to renal insufficiency.
Carrier Status: Vesicoureteric reflux (VUR) is not a condition associated with carrier status, as it is not inherited in a simple dominant or recessive manner. Instead, VUR is typically related to congenital anomalies of the urinary tract or may develop as an acquired condition. Genetic factors can contribute to susceptibility, but there is no single carrier status associated with VUR.
Mechanism: Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and often up to the kidneys. This retrograde urine flow can lead to urinary tract infections and kidney damage if left untreated.

### Mechanism
The primary mechanism involves a malfunction of the valve-like function at the ureterovesical junction (UVJ), which normally prevents urine from flowing backward. In VUR, this valve either doesn't close properly, or the anatomical angle of the ureter as it enters the bladder is not steep enough, allowing urine to reflux.

### Molecular Mechanisms
1. **Genetic Factors:** VUR can be familial, suggesting a genetic predisposition. Mutations or polymorphisms in certain genes (e.g., ROBO2) have been implicated in the development of VUR.
2. **Extracellular Matrix (ECM) Components:** Abnormalities in the ECM proteins that support the structure of the UVJ can lead to valve incompetency. Proteins such as type IV collagen and laminin play roles in maintaining the integrity and function of the ureterovesical junction.
3. **Cell Adhesion Molecules:** These molecules are crucial for the formation and maintenance of the tight junctions within the urinary tract. Deficiencies or dysfunctions in these molecules can compromise the valve mechanism at the UVJ.
4. **Embryonic Development:** Defects during the development of the urinary system, particularly in the ureter, can result in an abnormal insertion into the bladder. This can prevent the anti-reflux mechanism from developing properly.
5. **Signaling Pathways:** Disruptions in signaling pathways that regulate tissue growth and development, such as the WNT signaling pathway, can lead to developmental anomalies contributing to VUR.

Understanding these molecular mechanisms helps in identifying potential therapeutic targets and in predicting the risk of VUR in affected families.
Treatment: 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. However, in children who are older, physicians and parents should focus on bowel and bladder management. Children who hold their bladder or who are constipated have a greater number of infections than children who void on a regular schedule. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. Medical management is recommended in children with Grade I-III VUR as most cases will resolve spontaneously. A trial of medical treatment is indicated in patients with Grade IV VUR especially in younger patients or those with unilateral disease. Of the patients with Grade V VUR only infants are trialled on a medical approach before surgery is indicated, in older patients surgery is the only option.
Compassionate Use Treatment: Compassionate use treatment for vesicoureteric reflux (VUR) may involve treatments not yet approved for general use but considered potentially beneficial on a case-by-case basis. Examples include:

1. **Biologics and Anti-inflammatory Agents**: Experimental use of certain biologic agents aimed at reducing inflammation in the urinary tract.
2. **Stem Cell Therapy**: Investigational use of stem cells to repair or regenerate defective valves between the bladder and ureters.
3. **Gene Therapy**: Experimental treatments targeting genetic abnormalities that could be causing VUR.

Off-label treatments are those approved for other conditions but used for VUR based on emerging evidence. Examples include:

1. **Anticholinergics**: Typically used for overactive bladder, but potentially beneficial off-label to manage VUR by reducing bladder pressure.
2. **Botulinum Toxin (Botox)**: Originally approved for spasticity and other conditions, off-label use may help in reducing bladder spasm and pressure, thereby reducing reflux episodes.

Experimental treatments for VUR are of significant interest in ongoing clinical trials and may include:

1. **Innovative Surgical Techniques**: New minimally invasive surgical methods under evaluation to correct the reflux.
2. **Advanced Imaging and Diagnostic Tools**: Being tested to improve the early detection and precise characterization of VUR severity.
3. **Pharmacological Agents**: New drugs specifically targeting the underlying mechanisms of VUR.

These treatments are usually considered when standard interventions have failed, and they are commonly discussed in the context of specialized healthcare settings.
Lifestyle Recommendations: Lifestyle recommendations for managing vesicoureteral reflux (VUR) may include:

1. **Hydration**: Drink plenty of water to help flush out bacteria and reduce the risk of urinary tract infections (UTIs).
2. **Bladder Management**: Practice regular and complete bladder emptying. Timed voiding schedules can be helpful.
3. **Hygiene**: Maintain good personal hygiene, including wiping from front to back to reduce the risk of bacterial spread.
4. **Diet**: Consume a balanced diet rich in fiber to prevent constipation, which can exacerbate VUR.
5. **Avoid Irritants**: Limit the intake of bladder irritants such as caffeine, artificial sweeteners, and spicy foods.
6. **Medical Follow-Up**: Regular check-ups with a healthcare provider to monitor kidney function and growth, and to adjust treatments as necessary.
7. **Activity**: Engage in normal activities and exercise, but avoid activities that might increase abdominal pressure excessively if advised by a healthcare professional.

These lifestyle changes can help manage symptoms and prevent complications associated with VUR.
Medication: Vesicoureteral reflux (VUR) is commonly managed with antibiotic prophylaxis to prevent urinary tract infections (UTIs). Low-dose antibiotics such as trimethoprim-sulfamethoxazole or nitrofurantoin may be prescribed. The choice and duration depend on the severity of VUR and the patient's age. In some cases, surgical interventions or endoscopic treatments may be necessary. Nano-specific treatments are not typically associated with VUR management.
Repurposable Drugs: Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys. Drug repurposing involves using existing drugs for new therapeutic purposes. While specific repurposable drugs for VUR are not well established, some medications used in related conditions or with mechanisms that might theoretically benefit VUR include:

1. **Antibiotics (e.g., Trimethoprim/Sulfamethoxazole, Nitrofurantoin)** - Often used to prevent urinary tract infections in individuals with VUR.
2. **Anticholinergics (e.g., Oxybutynin)** - Though more commonly used for bladder dysfunction, they might help in selected cases to manage bladder overactivity, potentially reducing reflux episodes.
3. **Angiotensin-Converting Enzyme Inhibitors (e.g., Enalapril)** - Used in some cases to manage hypertension and kidney protection in VUR patients with renal scarring.

Further research is needed to validate the efficacy and safety of these or other repurposed drugs specifically for treating VUR.
Metabolites: For vesicoureteric reflux (VUR), there aren't specific metabolites directly associated with the condition. VUR is a urinary tract disorder where urine flows backward from the bladder to the kidneys. Diagnosis and monitoring usually involve imaging studies like voiding cystourethrography (VCUG) or ultrasound rather than metabolic markers. If you're looking into broader aspects such as complications or related conditions, some metabolic markers might be relevant in detecting kidney function changes or infection, but none are specific to VUR itself.
Nutraceuticals: There is no strong evidence to suggest that nutraceuticals have a direct effect on treating vesicoureteral reflux (VUR). This condition, characterized by the backflow of urine from the bladder into the ureters and kidneys, is typically managed through approaches like medical surveillance, antibiotics to prevent infections, or surgical intervention in more severe cases. Nutritional supplements might offer general immune support but are not a recognized treatment for VUR. Always consult healthcare professionals for management and treatment options specific to VUR.
Peptides: For vesicoureteric reflux (VUR), peptides are not typically the primary focus of treatment or research. VUR is a condition where urine flows backward from the bladder to the kidneys, often leading to recurrent urinary tract infections and renal damage. Treatment typically involves watchful waiting, antibiotic prophylaxis, or surgical intervention, such as ureteral reimplantation, depending on the severity.

If you are interested in the use of nanotechnology (nan) in relation to VUR, it is an emerging field with potential applications in targeted drug delivery, diagnostic imaging, and antimicrobial treatments, although it is not yet standard practice in clinical management of VUR.