Vesicoureteral Reflux

Definition

Vesicoureteral reflux (VUR) is a urinary tract disorder in which urine flows back (reflux) into the ureters from the bladder. Normally, urine flows in one direction—from the kidneys, urine flows through narrow tubes called ureters, and into the bladder. It is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection (UTI). In fact, about one-third of children with UTI are found to have VUR. Infection occurs when urine remains in the urinary tract, which provides a place for bacteria to grow. In some cases, the infection itself is the cause of VUR.

This disorder has two types, primary and secondary VUR. In primary VUR, the child is born with an impaired valve where the ureter meets with the bladder. This usually occurs during the development of the fetus in the womb where the ureter did not grow long enough. Urine backs up from the bladder to the ureters and even the kidneys because the valve does not close properly. This type of VUR may not require special treatment because the function of the valve may improve as the ureter gets longer when the child grows. However, it requires medical intervention when it causes complications.

Secondary VUR results when there is a blockage in the flow of urine anywhere in the urinary tract. An infection in the bladder that can lead to swelling of the ureter may cause blockage to urine flow. This can also cause urine to reflux to the kidneys.

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Signs and Symptoms

The most common symptom of VUR is an infection. But as the child grows older, other symptoms may also appear, which may include

 Bedwetting

 High blood pressure or hypertension

 Foamy urine

 Proteinuria (presence of protein in the urine)

 Fever

 Kidney failure

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Tests and Diagnosis

Urinalysis and cultures are two of the most common tests that can reveal the presence of a urinary tract infection.

The following imaging tests may also be recommended by the doctor to view abnormalities in the urinary tract:

 Kidney and bladder ultrasound. This test uses sound waves to examine the bladder and kidney. It shows shadows of the kidney and bladder that may point out certain abnormalities in them. However, this test cannot reveal all important urinary abnormalities or measure how well the kidneys are working.

 Voiding cystourethrogram (VCUG). This test is used to examine the urethra and bladder while the bladder fills and empties. It can reveal abnormalities in the inside of the urethra and bladder. The test can also determine whether urine flow is normal as the bladder empties.

 Intravenous Pyelogram (IVP). This test can be used to examine the whole urinary tract. A liquid that can be seen on x rays is injected into a vein. The substance, as it travels through the kidneys and bladder can reveal possible obstructions in the tract.

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Treatment

Vesicoureteral reflux can lead to permanent damage to the kidneys if not treated promptly. Preventing the occurrence of kidney damage is the primary goal of treatment in patients with VUR.

When infections occur, it should be treated immediately with antibiotics to prevent the infection from traveling into the kidneys. A reflux caused by an infection is usually corrected with medically supervised antibiotic therapy.

Surgery may be necessary only when severe reflux has caused infection that can’t be treated with antibiotics.

References:
National Kidney and Urologic Diseases Information Clearinghouse. Vesicoureteral Reflux. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/vesicoureteralreflux/index.htm.
National Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. NIH Publication No. 07-4555, November 2006. Retrieved July 3, 2008

National Kidney and Urologic Diseases Information Clearinghouse. Kidney Diseases Dictionary:U-W. http://kidney.niddk.nih.gov/kudiseases/pubs/kdictionary/U-Z.htm#V.
National Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. NIH Publication No. 03-4359, May 2003. Retrieved July 3, 2008

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