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Congenital VUR Pathology — RACP Paediatrics MCQ

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ModerateNephrologyCongenital VUR PathologyRACP Paediatrics

A neonate is found to have bilateral grade 4 hydronephrosis on prenatal ultrasound. Postnatal USS confirms bilateral hydronephrosis with normal bladder. VCUG shows grade V bilateral VUR. DMSA shows bilateral renal scarring. What is the most common underlying cause of congenital high-grade VUR?

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Correct answer: D — Congenital anomaly of the vesicoureteric junction (short intramural ureter)

Congenital (primary) VUR results from a congenital anomaly of the vesicoureteric junction with a short intramural ureteric tunnel, allowing retrograde urine flow. High-grade VUR (IV-V) is associated with renal dysplasia (congenital reflux nephropathy). Management includes antibiotic prophylaxis, surveillance, and consideration of surgical correction.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: VUR