Vesicoureteral Reflux

As these tubes carry urine from the kidneys to the bladder, any flow back to the kidneys is cause for irritation and infection. Bacteria growing in urine enters the kidneys where it stays and creates more bacteria.

• Additionally, bacteria from feces may contaminate the urine, are drawn up through ureter tubes and cause infections.
• It can also cause the kidneys to swell. If left untreated, kidney infection, damage, and chronic kidney failure may occur.

A congenital defect causes primary vesicoureteral reflux. Normally, after urine leaves the kidneys, it flows down the ureter tubes and collects in the bladder, where a flap or valve closes where the ureter meets the bladder. This flap or valve keeps urine in the bladder under usual circumstances. The congenital defect existing in infants and children either leaves the ureter too short to close, or it is connected abnormally with the bladder.

Certain infants and children may be predisposed to developing VR:

• Genetic or familial patterns – Higher chance of developing VR if parents or siblings had it
• Abnormal bladder function – Children born with spinal bifida or have nerve or spinal cord malfunctions have greater risk of VR
• Bowel and bladder difficulties – Children with frequent urination, inability to hold their urine, or constipation are more prone
• Urinary abnormalities – Children with other problems involving the urinary system are at greater risk for VR, including ureter duplication (a condition where one kidney has an additional ureter), bladder exstrophy (a defect present at birth involving the urinary tracts), and uterocele (a defect that occurs in the ureters)

Symptoms in infants naturally stem from observation and tests, but children have reported these problems associated with VR:

• Frequent urinary tract infections: Vesicoureteral reflux is the responsible cause for about one out of every three children experiencing frequent urinary tract infection. Signs of UTI’s in infants include fever, vomiting, fussiness, poor weight gain, or diarrhea. Bladder infections often result from VR in babies or children. Signs include: wetting or lack of ability to control urination, frequent urination, painful urination, or urgent need to urinate.
• Bedwetting, also known as nocturnal enuresis
• Hydronephrosis, swelling of the kidney due to urine build up
• Unexplained high blood pressure
• Protein in urine
• Abdominal mass from swollen kidneys
• Kidney failure

A renal ultrasound scan may be performed to view bladder and kidneys for abnormalities. There are also other scans that can view the bladder as it fills or empties to check for problems. Once VR is diagnosed it is graded from 1 to 5. Grade 1 is the mildest, Grade 5 is the worst and involves twisting of the ureter and severe swelling in the kidneys.

Many babies and children with milder VR grades outgrow the condition. The physician simply monitors these cases.

Medication therapy in the form of antibiotics is typically used regardless of grade, while surgical intervention is necessary to repair or reinforce the cases with the worst grades.