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Vesicoureteral Reflux—Child

(VUR—Child; Reflux Nephropathy—Child; Chronic Atrophic Pyelonephritis—Child; Vesico-Ureteric Reflux—Child; Ureteral Reflux—Child)

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. The urine flows from the bladder back into the kidneys.
Urine normally flows out from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. This connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back-up can also put extra pressure on the kidney. This can cause kidney damage.
This is a potentially serious condition. It requires care from a doctor. Early treatment and prevention of infections can lead to better outcomes.
The Urinary Tract
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Causes

Common causes of VUR include:

Risk Factors

VUR is more common in Caucasians. Other factors that may increase your child’s chance of developing VUR include:

Symptoms

Your child may not have any symptoms. In some cases, VUR is found after a urinary tract or kidney infection is diagnosed. Symptoms of urinary tract infections include:

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Tests may include:
The doctor will grade your child’s condition. The grading scale ranges from 1 (mild) to 5 (severe).

Treatment

The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include:

Monitoring

Treatment may not be needed right away for grades 1-3. VUR may go away on its own as the ureters develop. The doctor will monitor your child’s condition. This may include:
  • Antibiotics—If an infection is present or possible.
  • Tests to check how the kidneys are functioning
Children are advised to stay well-hydrated by drinking plenty of fluids. They should also empty their bladders frequently.

Surgery

In most cases, surgery is not needed. If your child does need surgery, the options include:
  • Ureteral reimplantation surgery—This can be done in two ways. One requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically, with cameras being inserted through small incisions in the abdomen and/or bladder to do the surgery.
  • Endoscopic injection into the ureter—This is a minimally invasive surgery that is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can block urine from flowing back up the ureter.

Prevention

VUR cannot be prevented in most cases. Avoid complications by getting prompt treatment. If you suspect a urinary tract or kidney infection, call your child's doctor.

RESOURCES

National Kidney Foundation http://www.kidney.org

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

BC Health Guide http://www.bchealthguide.org

The Kidney Foundation of Canada http://www.kidney.ca

References

Valla JS, Steyaert H, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience. J Pediatr Urol. 2009;5(6):466-471.

Vesicoureteral reflux (VUR). Cincinnati Children’s website. Available at: http://www.cincinnatichildrens.org/health/info/urinary/diagnose/vesicoureteral-reflux.htm. Updated October 2012. Accessed January 21, 2015.

Vesicoureteral reflux (VUR) in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/vesicoureteral-reflux-vur. Accessed January 21, 2015.

Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2014. Accessed January 21, 2015.

4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.

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