Vesicoureteral reflux (VUR) is a common urological anomaly that is found in 1% of children. VUR can cause recurrent febrile urinary tract infection (UTI). The recurrent infections can result in renal scarring, which can lead to renal hypertension and end-stage renal disease. Thus, our therapeutic goal is to prevent febrile UTI in the short term and, in the long term, to preserve renal function by inhibiting renal scarring and the associated complications.

Normally, urine flows down the urinary tract, from the kidneys, through the ureters, to the bladder. With VUR, some urine will flow back up—or reflux—through one or both ureters and may reach the kidneys.

How common is vesicoureteral reflux?

About 1 in 3 children who has a UTI with a fever has VUR. The number of children with VUR may be higher, because some children with VUR who don’t have symptoms or problems are not tested.

SYMPTOMS

Problems with bladder or bowel function can sometimes be related to VUR. A child with VUR is more likely to have

• UTIs, including bladder or kidney infections
• other bladder problems, such as urinary incontinence, bedwetting, and urinary retention
• bowel problems, such as constipation

DIAGNOSE

To diagnose the grade of VUR, doctors use imaging tests.

Imaging tests

Before you and your child’s doctor decide to use urinary tract imaging to diagnose VUR in your child, a doctor considers the child’s

• age
• symptoms
• family history of VUR
• sexual activity level in an older child

Child tested for VUR

VUR is diagnosed by a test called a voiding cysto-urethrogram (VCUG). A VCUG is usually done if:

1. A child has had one UTI with fever and a kidney ultrasound shows a problem.

2. An infant or young child under 2 years who has had 2 or more UTIs with fever.

OTHER TESTS 

Ultrasound: This test uses sound waves to create an image of a child's kidneys and bladder. It is recommended for all infants and toddlers after their first UTI with a fever.

Blood test: Creatinine measures kidney function.  The creatinine level may be too high in a child with damaged kidneys. 

Dimercaptosuccinic Acid (DMSA) Scan: A DMSA scan can give more detail about whether kidneys have developed scars as a result of kidney UTIs. A doctor may order it if a child has had many UTIs with fever.

Blood pressure: Blood pressure should be checked at least once a year. Children with kidney problems are at higher risk for high blood pressure.

TREATMENT

VUR can occur in varying degrees of severity. It can be very mild, when urine backs up only a short distance in the ureters. Or, it can be severe and lead to kidney infections and permanent kidney damage (scarring). A Children’s National, specific treatment for VUR will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history
• The severity or grade of reflux
• Your child's ability to take specific medications, procedures, or therapies
• Possibility of the reflux going away on its own
• Your opinion or preference

• Thanks and Regards,
• Alpine
• Associate Editor
• Journal of Clinical Trials
• clinicaltrials@eclinicalsci.com