ABSTRACT
Primary vesicoureteral reflux (VUR) is the most common urological anomaly in children. Urinary tract development in the embryo begins with the formation of the ureteric bud, which is an outgrowth of the mesonephric duct. Growth of the ureteric bud is stimulated by reciprocal signaling between the bud and the metanephrogenic mesenchyme, and results in the formation of the ureter and branching to form the collecting ducts. The association between VUR and renal scarring is now widely recognized. Dimercaptosuccinic acid (DMSA) scans have allowed us to follow sequentially the evolution of a scar from an area of decreased blood flow during the acute inflammatory phase to a parenchymal defect indicative of a mature scar. Prenatal ultrasonography has resulted in a dramatic increase in the number of infants detected with significant asymptomatic uropathology, allowing treatment before the potential devastating consequences of urinary tract infection (UTI) occur.
