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Prof. Dr. Ali Avanoğlu
Vesicoureteral Reflux (VUR) • Basics

Is VUR Genetic? Sibling and Child Screening

Vesicoureteral reflux (VUR) shows a familial predisposition: reflux is found in about 25–30% of the siblings of a child with reflux, and in about 30–35% of the children of a mother or father with a history of reflux. Most of this reflux is low-grade and silent; screening is done with ultrasound first, and a VCUG is obtained only for siblings in whom it is considered necessary.

Who this is forFamilies whose child has been diagnosed with reflux and who are concerned about the siblings; prospective parents who were treated for reflux in childhood
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ByProf. Dr. Ali AvanoğluUpdated
This page is part of vesicoureteral reflux.Read the full treatment overview on the hub page
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01 · Is VUR hereditary?02 · Screening siblings: who, and how?03 · A newborn sibling and prenatal follow-up04 · Parents who were treated for reflux in childhood05 · What happens if screening finds reflux?
In brief5 madde
  • Is VUR hereditary?: Yes, there is a familial predisposition, and this has been known for a long time.
  • Screening siblings: who, and how?: The great majority of reflux found in siblings is low-grade, has never caused an infection, and resolves on its own with growth.
  • A newborn sibling and prenatal follow-up: If there is a family history of reflux, the baby's kidneys are already assessed on prenatal ultrasounds; if antenatal hydronephrosis is seen, postnatal follow-up…
  • Parents who were treated for reflux in childhood: This is one of the most common questions from our former patients who have now reached adolescence or adulthood: 'Will it pass to my child?' The answer is that the…
  • What happens if screening finds reflux?: Reflux found through screening is a different kind of patient from reflux found through infection: the child has never been sick, and the kidneys are usually healthy.
01

Is VUR hereditary?

Yes, there is a familial predisposition, and this has been known for a long time. When the siblings of a child with reflux are examined, reflux is found in roughly a quarter to a third of them; in the child of a mother or father who was diagnosed with reflux in childhood, this rate has been reported at about 30–35%. Concordance is even higher in identical twins.

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  • Inheritance is not transmitted through a single gene in a fixed way; multiple genes make small contributions that affect how the ureteric bud meets the bladder, and the outcome varies from family to family, and even between siblings within the same family. Although some candidate genes have been reported, genetic testing is not performed for reflux in routine practice; diagnosis and screening are carried out through imaging.
  • This information is not meant to cause guilt but to promote alertness. A family history of reflux means that a urine culture comes to mind sooner when a sibling develops fever; that is the real benefit.
02

Screening siblings: who, and how?

The great majority of reflux found in siblings is low-grade, has never caused an infection, and resolves on its own with growth. For this reason, current guidelines do not recommend going straight to a VCUG in siblings; the first step is a painless, radiation-free kidney–bladder ultrasound.

  • For all siblings: a kidney–bladder ultrasound, and informing the family about getting a urine culture with fever
  • For a sibling with an abnormal ultrasound: a VCUG, or ceVUS at a suitable center
  • For a sibling who has had a febrile urinary tract infection: a full, age-appropriate evaluation
  • For an older child or adolescent without infection: ultrasound; further testing only if there is a finding
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  • A VCUG comes into consideration only in two situations: if the ultrasound shows a finding such as kidney enlargement, a size difference, thinning of the renal cortex, or a dilated ureter, or if the sibling has previously had a febrile urinary tract infection. Without these conditions, a normal ultrasound together with an awareness of 'get a culture with fever' is sufficient screening for most families.
  • The value of screening changes with age. Screening is more worthwhile in siblings who are before toilet-training age and preschool age; the benefit of looking for silent reflux in an older child or adolescent who has never had an infection is limited, because even if it is present, it has most likely either resolved or caused no harm. You make this decision together with our physicians based on the sibling's age.
03

A newborn sibling and prenatal follow-up

If there is a family history of reflux, the baby's kidneys are already assessed on prenatal ultrasounds; if antenatal hydronephrosis is seen, postnatal follow-up proceeds along the same path. If there is no enlargement, an ultrasound done in the first weeks after birth is sufficient for sibling screening.

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  • Because urine output is low in the newborn's first few days, the ultrasound may fail to show mild enlargement; for this reason, the screening ultrasound is generally planned after the first few days, within the first months. If the baby develops a fever, the threshold for obtaining a urine culture is kept low because of the family history.
  • If reflux is found in infancy, the approach is determined by age: antibiotic prophylaxis may be recommended for high-grade reflux, while monitoring is sufficient for low grade. Information that circumcision reduces infection risk in boy infants is also shared with the family in this discussion.
04

Parents who were treated for reflux in childhood

This is one of the most common questions from our former patients who have now reached adolescence or adulthood: 'Will it pass to my child?' The answer is that the likelihood is higher than in the general population, but most children will either be born without reflux or will have low-grade reflux that resolves on its own.

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  • The practical recommendation is the same as for siblings: kidney assessment during pregnancy, an ultrasound in the first months after birth, and a urine culture with fever. A VCUG is obtained only if there is an ultrasound finding or an infection. The expectant mother's own reflux history is a separate matter; if there is scarring or her kidney function is affected, care is needed during pregnancy follow-up.
  • Thanks to Doç. Dr. Issı's experience in adult urology, the screening of the children of our patients who were treated in childhood, and the mother's follow-up during pregnancy, are carried out by the same team without interruption.
05

What happens if screening finds reflux?

Reflux found through screening is a different kind of patient from reflux found through infection: the child has never been sick, and the kidneys are usually healthy. The approach in this group is gentler; antibiotic prophylaxis is often not needed for low-grade reflux, and an annual ultrasound together with a culture at any fever is enough.

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  • If the reflux is high-grade, or if a kidney size difference on ultrasound or scarring on DMSA is found, the plan is built on the same principles as for children diagnosed through infection: monitoring, antibiotic prophylaxis, or, rarely, corrective treatment, based on age, grade, bilaterality, and bladder function. When the sibling's follow-up and that of the first child diagnosed are carried out by the same team and the same physicians, the burden on the family is also reduced.
  • For most families, the real outcome of screening is not a diagnosis but an awareness: knowing what not to miss when the sibling has a fever.
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Frequently asked questions
Can we get genetic testing for reflux?
Not in routine practice. Predisposition to reflux is transmitted through multiple genes in a variable way; there is currently no gene test used for screening or diagnostic purposes. Family history, ultrasound, and, if necessary, a VCUG are the basic tools of screening.
Does a sibling always need a VCUG?
No. Guidelines recommend ultrasound as the first step in sibling screening; a VCUG is obtained only if there is an ultrasound finding or if the sibling has had a febrile urinary tract infection. In a sibling with no infection and a normal ultrasound, looking for reflux by catheterizing the child offers limited benefit.
I had reflux as a child; should my baby have a VCUG as soon as they're born?
It's not necessary. An ultrasound in the first months after birth is sufficient; a VCUG is considered only if there is an ultrasound finding or an infection. Remembering to get a urine culture when the baby has a fever is more protective than an early VCUG.
If one sibling has reflux, does that mean the other will too?
No. Reflux is not found in roughly three-quarters of siblings; and among those in whom it is found, most have the low-grade, self-resolving type. Predisposition raises the likelihood, but it does not make it certain.
Up to what age is sibling screening worthwhile?
There is no fixed cutoff; but screening is most worthwhile before toilet training and in the preschool years. The benefit of looking for silent reflux in an older child or adolescent who has never had an infection is low; at these ages, ultrasound is considered sufficient, and the decision is made together with the family.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Celik A, Ulman I, Aydin M, et al. (2002). Familial vesicoureteral reflux in asymptomatic siblings. The Turkish journal of pediatrics. PubMed ↗
←Previous • BasicsUnilateral and Bilateral Reflux
Related pagesFull index →
Diagnosis and evaluationKidney–Bladder Ultrasound: What It Shows, and What It Doesn'tWhen vesicoureteral reflux (VUR) is suspected, the first test is always a kidney–bladder ultrasound: radiation-free, painless, and repeatable. But ultrasound has one limitation: it does not show reflux itself. This page explains what ultrasound looks at, which findings matter, and what a normal ultrasound means.Diagnosis and evaluationVCUG (Voiding Cystourethrogram): How It's Done, and PreparationThe VCUG (voiding cystourethrogram) is the main method that both shows and grades vesicoureteral reflux (VUR). A thin catheter is used to fill the bladder with contrast fluid; as the bladder fills and the child voids, it is imaged to see whether urine backs up into the kidney. This page explains how the procedure is done, how to prepare, radiation, and the alternatives.By age and special situationsVesicoureteral Reflux in Infants (0–1 Years)In infants, vesicoureteral reflux (VUR) most often comes to light through antenatal kidney enlargement or a first febrile urinary tract infection. In this age group, both the risk of infection-related kidney damage and the chance of spontaneous resolution are at their highest; the plan for the first year therefore combines protection with patient waiting.By age and special situationsVUR in Adolescents and Adults: Follow-up and PregnancyVesicoureteral reflux (VUR) that carries into adolescence and adulthood is most often low-grade and silent; but follow-up does not end here — it changes form. On this page we explain reflux that has not closed by adolescence, VUR in adults, and what infection–hypertension risk in pregnancy actually depends on.
Vesicoureteral Reflux (VUR) topic clustersMain treatment page →
Basics 6Diagnosis and evaluation 6By age and special situations 5Bladder and bowel 5Treatment pathways 10Kidney health and infection 5After treatment and follow-up 6
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