Primary vesicoureteral reflux (VUR)—the retrograde flow of urine from the bladder into the upper urinary tract—is the most common urological anomaly in children. It occurs in 1%–2% of the pediatric population and in 30%–50% of children who present with urinary tract infection (UTI).1 , 2 The association of VUR, UTI, and renal damage is well known. Marra et al.3 reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. Parenchymal injury in VUR occurs early, in most patients before age 3 years. Kidneys of young infants are more vulnerable to renal damage. Most renal scars are present when reflux is discovered at initial evaluation for UTI. One of the main goals of treating the child with VUR is prevention of recurring febrile UTIs and minimizing risk of renal damage and long-term renal impairment.