(VUR—Child; Reflux Nephropathy—Child; Chronic Atrophic Pyelonephritis—Child; Vesico-Ureteric Reflux—Child; Ureteral Reflux—Child)
Pronounced: VEH-sih-co-ya-REET-uh-rul REE-flux
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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. If you suspect your child has this condition, call the doctor right away.
Common causes of VUR include:
- A problem in the way the ureter inserts into the bladder
- A ureter that does not extend far enough into the bladder
- Neurogenic bladder (loss of normal bladder function due to damaged nerves reaching the bladder)
The following factors increase your child’s chance of developing VUR:
- Family history (especially if a sibling or parent has VUR)
- Birth defects that affect the urinary tract
- Birth defects that affect the spinal cord, such as spina bifida
- Tumors in the spinal cord or pelvis
- Ethnicity: Caucasian
- Frequent and urgent need to urinate
- Passing small amounts of urine
- Pain in the abdomen or pelvic area
- Burning sensation during urination
- Cloudy, bad-smelling urine
- Increased need to get up at night to urinate
- Blood in the urine
- Leaking urine
- Low back pain or pain along the side of the ribs
- Fever and chills
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Tests may include:
- Blood tests—to assess how well the kidneys are functioning
- Urine tests—to look for evidence of an infection or damage to the kidneys
- Ultrasound —a test that uses sound waves to examine the kidney and bladder
- CT scan —a type of x-ray that uses computers to make pictures of structures in the body
- Voiding cystourethrogram (VCUG)—a liquid that can be seen on x-rays is placed in the bladder through a catheter; x-rays are taken when the bladder is filled and when urinating
- Radionuclide cystogram (RNC)—a test like VCUG, but uses a different kind of liquid to obtain images
- Intravenous pyelogram —also uses a liquid that can be seen on x-rays; images are taken as the substance travels from the blood (after being injected into a vein) into the kidneys and bladder
- Nuclear scans—a variety of tests using radioactive materials injected into a vein or the bladder to show how well the urinary system is working
The doctor will grade your child’s condition. The grading scale ranges from 1 (mild) to 5 (severe).
The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include:
If your child’s condition