Primary vesicoureteral reflux (VUR) is the most common disease of the urinary tract in children, occurring in 1–2% of the pediatric population and in 30–50% of those who present with urinary tract infection (UTI). It is caused by the maldevelopment and malfunction of the ureterovesical junction, which causes the urine to flow retrogradely from the bladder to the kidneys. The association of VUR, urinary tract infection and renal damage is well known, and reflux nephropathy is a major cause of childhood hypertension and chronic renal failure. The hereditary and familial nature of VUR is well recognized. Several studies have shown that siblings of index patients with VUR have a much higher incidence of VUR than the general population with a reported incidence of 26–50%. The transmission of VUR from parent to child has been reported at a rate up to 66%. The screening of asymptomatic siblings and offspring is controversial. The aim in the management of childhood VUR is prevention of permanent renal damage by minimizing the risk of recurrent febrile UTIs. It is reported that there is increased risk of renal cortical abnormalities in siblings with a previous urinary tract infection, siblings with high-grade VUR and siblings older than 1 year of age. It is recommended that the families of children with VUR should be informed that siblings and offspring have a higher chance of VUR and be counseled regarding prompt treatment of acute UTI and subsequent voiding cystourethrography especially if there is evidence of renal cortical abnormalities or renal size asymmetry on ultrasound.