Overview
Vesicoureteral reflux is the abnormal flow of urine from your bladder back up the tubes (ureters) from your kidneys. Normally, urine flows only down from your kidneys to your bladder.
Most commonly a condition of infancy and childhood, vesicoureteral reflux increases the risk of urinary tract infections. Untreated, it can lead to kidney damage.
Vesicoureteral reflux can be primary or secondary. Children with primary vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Secondary vesicoureteral reflux is due to a urinary tract blockage, often caused by infection.
Children may outgrow primary vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.
Types
There are two types of VUR: primary and secondary. Primary reflux is caused by a congenital (present at birth) abnormality, and secondary reflux is caused by a urinary tract infection (UTI) or an obstruction in the urinary tract.
Reflux is graded according to its Severity :
- Grade I results in urine reflux into the ureter only.
- Grade II results in urine reflux into the ureter and the renal pelvis, without distention (hydronephrosis).
- Grade III results in urine reflux into the ureter and the renal pelvis, causing mild hydronephrosis.
- Grade IV results in moderate hydronephrosis.
- Grade V results in severe hydronephrosis and twisting of the ureter.
Signs and Symptoms
The most common symptom of VUR is urinary tract infection (UTI). Other symptoms might include the following:
- Bedwetting (nocturnal enuresis)
- Collection of urine in the renal pelvis (hydronephrosis)
- Distention in the abdomen (caused by hydronephrosis)
- Failure to thrive
- High blood pressure (hypertension; caused by kidney damage)
- Nausea and vomiting
- Protein in the urine (proteinuria)
Complications
Untreated VUR provides access for bacteria to enter the kidneys and may result in kidney infection (pyelonephritis), kidney damage, and progressive renal failure.
Diagnosis
VUR is commonly diagnosed during infancy or childhood as a result of a urinary tract infection (UTI). UTI is diagnosed using urinalysis and urine culture. VUR that causes hydronephrosis (collection of urine in the renal pelvis) is often diagnosed during prenatal ultrasound.
A cystogram (also called cystourethrogram) and a voiding cystourethrogram (VCUG) are performed to determine if an abnormality in the urinary tract is causing reflux. In these procedures, a contrast dye is instilled into the bladder through a catheter and a series of x-rays are taken.
Other diagnostic tests used to diagnose VUR include the following :
- Bladder ultrasound (to detect abnormalities that cause reflux)
- Renal ultrasound and renal scan (to evaluate hydronephrosis, kidney growth, and scarring)
- Urodynamic studies (e.g., filling cystometrogram, voiding cystometrogram)
Treatment For Vesicoureteral Reflux:
VUR can occur in varying degrees of severity. It can cause mild reflux, when urine backs up only a short distance in the ureters. Or, it can cause severe reflux leading to kidney infection(s) and permanent kidney damage.
Specific treatment for VUR will be determined by your child's physician based on :
- Your child's age, overall health, and medical history
- The extent of the condition
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Your child's physician may assign a grading system (ranging from 1 to 5) to indicate the degree of reflux your child has. The higher the grade, the more severe the reflux.
Most children who have grade 1 through 3 VUR do not need any type of intense therapy. The reflux resolves on its own over time, usually within five years. Children who develop frequent fevers or infections may require ongoing preventative antibiotic therapy and periodic urine tests.
Children who have grade 4 and 5 reflux may require surgical intervention. During the procedure, the surgeon will create a flap-valve apparatus for the ureter that will prevent reverse flow of urine into the kidney. In more severe cases, the scarred kidney and ureter may need to be surgically removed.
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