Figure 1: Schematic representation of factors involved in progression to ESRD for patients with VUR. In the majority of patients with VUR, VUR resolves and the patients demonstrate normal renal function (green pathway). Some patients with renal scarring and/or who have recurrent pyelonephritis also retain normal renal function (green arrows). Other patients with VUR develop RN, proteinuria, and hypertension. In all cases, abnormal renal development can accompany RN and contribute to renal scarring, proteinuria, hypertension, and progression to CKD (solid black arrows). Prevention of ESRD focuses on intervening to prevent recurrent pyelonephritis (1), by actively evaluating and treating episodes of pyelonephritis to prevent renal scarring (2), and by treating hypertension (3) and proteinuria (4) to preserve renal function.