The current status of screening for vesicoureteral reflux.

Reflux nephropathy is responsible for a significant percentage of end-stage renal disease in late childhood as well as being the most common cause of severe hypertension in childhood and adolescence. To prevent reflux nephropathy, it is imperative to discover reflux at the youngest age possible and preferably before any urinary tract infections have occurred. Since screening of the general population for reflux is not feasible, we have focused our efforts on the siblings of known refluxers and, more recently, the offspring of known refluxers. We have found high rates of reflux in both groups and have shown in the sibling population that early discovery of sibling reflux has significantly lowered the rate of renal damage compared with the index patients. It is imperative to screen these two risk populations at the youngest age possible, but we have recently made modifications in our recommendations for the older sibling and offspring. The results of these two screening studies are given as well as our current recommendations for screening for reflux in these risk groups.