Abstract

Background: Vesicoureteral reflux (VUR) is one of the main causes of chronic kidney disease (CKD) in adolescence and young adult. It can be a congenital or an acquired anomaly and its uncommon in adult life.
Case presentation: A 19th years old male with neurogenic bladder, VUR grade 4, CKD stage 4, malnutrition, and short stature. Radiological examinations show a spastic neurogenic bladder, cystitis, right VUR grade 4. Abdominal ultrasonography (USG) results were bilateral severe hydronephrosis due to post-renal causes. This patient had a history of myelocele excision at the age of 1.5 years. He had recurrent urinary tract infection with CKD stage 4.
Discussion: The diagnosis of VUR and neurogenic bladder in CKD stage 4 is a rare case in nephrology.
Conclusion: Indonesian male confirms of diagnosis VUR grade 4, neurogenic bladder, and CKD stage 4.
Keywords: Vesicoureteral reflux, Neurogenic bladder, Chronic kidney disease

1. Introduction

Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder into the ureters or renal pelvis which is a significant risk factor for pyelonephritis and renal scarring [1,2]. VUR can occur through various mechanisms such as congenital bladder dysfunction, acquired or behavioral etiology. The causes of neurogenic bladder dysfunction are neurospinal dysraphisms such as spina bifida, sacral agenesis, tethered cord syndrome, and spinal cord injury [3].

Primary VUR is common in the children population while secondary VUR could occur in adults. VUR is not well described or understood in the adult population. The incidence of VUR in children with recurrent UTI (Urinary Tract Infection) is about 30–50%. The prevalence of asymptomatic VUR in children ranges from 0.4 to 1.8%. The prevalence of VUR in infants with hydronephrosis on ultrasound is about 16.2%. The risk of siblings getting VUR with their siblings who have VUR is around 27.4%. If parents have a history of VUR, then their offspring have an incidence of VUR around 35.7%. In patients with LUTD (Lower Urinary Tract Dysfunction), the incidence of VUR increases up to 30% [1]. The prevalence of VUR in adults is not exactly known and it rarely affects young adults [4].

Recurrent urinary tract infection in children with a history of VUR could induce renal scaring and impaired renal function up to end-stage renal disease in adult age [5,6]. VUR is one of the causes of end-stage renal disease in children, but uncommon in adult. Good maintenance therapy and monitoring of VUR in children can prevent chronic kidney disease (CKD) in adolescents and young adults. We report a case report in a young adult who suffered from VUR since he was a child but with good close monitoring, so he can survive up to 19 years old age. We report base on Surgical Case Report (SCARE) 2020 Guideline [7].