ies ▁stem ming ▁from ▁chron ic ▁high - press ure ▁ster ile ▁ur ine ▁re fl ux ▁and ▁often ▁leads ▁to ▁rec urrent ▁ur inary ▁tract ▁in fe ctions ▁( UT Is ) ▁in ▁the ▁early ▁child hood . ▁ ▁Path oph ys i ology ▁The ▁underlying ▁cal y ces ▁lose ▁their ▁normal ▁con ca ve ▁shape ▁and ▁show ▁club bing . ▁ ▁Di agn osis ▁It ▁is ▁diagn osed ▁by ▁m ict ur ating ▁c yst ography ; ▁sc arring ▁can ▁be ▁demonstrated ▁by ▁ul tras ound ▁or ▁D MS A . ▁ ▁Tre at ment ▁The ▁aim ▁of ▁treatment ▁is ▁to ▁reduce ▁ren al ▁sc arring . ▁Those ▁children ▁with ▁grade ▁II ▁or ▁worse ▁should ▁receive ▁low ▁do se ▁pro phy la ctic ▁ant ib iot ics ▁( N it ro fur anto in , ▁trim eth op rim , ▁cot rim ox az ole , ▁c ef ale x in ▁in ▁those ▁with ▁CR F ). ▁Hy pert ension ▁should ▁be ▁managed ▁with ▁A CE ▁in hib itor ▁or ▁AR B s . ▁Other ▁treatment ▁modal ities ▁include ▁surg ery ▁( end os cop ic ▁injection ▁of ▁col lagen ▁behind ▁the ▁int ra - ves ical ▁u re ter , ▁u re ter ic ▁re - impl ant ation ▁or ▁length ening ▁of ▁the ▁subm uc os al ▁u re ter ic ▁tunnel ) ▁which ▁has ▁its ▁protagon ists . ▁ ▁Ep ide mi ology ▁There ▁is ▁a ▁gen etic ▁pre dis position , ▁first - deg ree ▁relatives ▁have