Primary vesicoureteral reflux (VUR) is diagnosed mostly after a urinary tract infection (UTI). It is also diagnosed during postnatal evaluation of antenatally diagnosed hydronephrosis or other congenital anomalies of the kidney and urinary tract. VUR is associated with recurrent UTI and renal scarring, which is also called reflux nephropathy. Prevention of UTI and renal scars and the preservation of renal function in cases with renal scars are the most important treatment objectives in children with VUR Until recently, most children with VUR were treated with long-term antimicrobial prophylaxis or surgical correction. However, lately a third option of surveillance-only has become acceptable. As a result, it is necessary to evaluate the risk factors for UTI recurrence and renal scarring for individual patients before deciding on any or no intervention for VUR. The important risk factors that need to be considered include severity of VUR, coexisting renal scarring, patient age and sex, presence of bladder-bowel dysfunction, socioeconomic factors and parental choice. Patients with renal scarring should be monitored and treated for potential complications such as hypertension, proteinuria, and progressive CKD. Appropriate counseling of patients during discharge from pediatric care is recommended.