Vesicoureteral reflux (VUR) is the most common congenital urinary tract anomaly in children. Most cases of VUR are diagnosed after urinary tract infection (UTI) or during follow-up for antenatally diagnosed renal anomalies. Patients with VUR are at high risk for UTI recurrence and renal scarring, which is also called reflux nephropathy (RN). RN can occur at any age and the important risk factors for renal scarring are a high-grade VUR, recurrent UTI, and delayed antibiotic treatment for acute pyelonephritis. Hypertension is the most common complication of RN seen in pediatric patients. Other complications that occur mostly in adults include proteinuria, recurrent UTI, and chronic kidney disease. Pregnancy-related complications have also been reported. Appropriate follow-up of patients with VUR, particularly in those with high-grade VUR, is recommended. Patients with renal scarring should be monitored for hypertension and those with significant scarring, particularly bilateral, should also be monitored for proteinuria and chronic kidney disease.