What is vesicoureteral reflux?

What is vesicoureteral reflux?

Normally, urine is created in the kidneys and filters out through the ureters into the bladder and then out the urethra. This flow is unidirectional, which means should only go one way. Vesicoureteral reflux is a condition in which urine flows in the wrong direction, from the bladder back into the ureters.

Vesicoureteral reflux (VUR) may affect infants and children after a urinary tract infection (UTI). It may also be congenital, or present at birth.

Studies suggest that between 25 percent and 40 percent of children who have a UTI also have VUR. Having stagnant urine in the urinary tract increases the risk of infection, but VUR can also occur as the result of an infection.

Types of vesicoureteral reflux

In VUR, the urine flows back towards the kidneys.

There are two types of VUR:

Primary VUR is when an infant is born with a faulty valve between the ureter and the bladder. If the ureter is too short, the valve does not close properly, allowing urine to back up, or reflux, from the bladder to the ureters, and if severe enough, back to the kidneys.

Primary VUR may resolve itself in time, as the ureter and valve function improve. Even if it is discovered at birth, no surgical intervention will normally be performed until the infant is at least several months old.

Secondary VUR stems from a high pressure causing backward flow somewhere in the urinary system. This may be a bladder infection that makes the ureter swell, causing urine to flow back to the kidneys.

Left untreated, VUR can lead to kidney damage.

Signs and symptoms of vesicoureteral reflux

Symptoms of VUR are variable. The condition can range from mild reflux, when urine backs up just a short distance into the ureters, to severe reflux, resulting in kidney infections and permanent kidney damage.

A urinary tract infection (UTI) is the most common indication of VUR. It may develop without noticeable signs or symptoms. In adults, UTI is very common in women and rare in men.

UTI is a common source of fever in infants, and the incidence of UTI is approximately equal between girls and boys. A UTI always needs to be treated in young children, due to the risk of the infection ascending to the kidneys and causing permanent scarring.

The most common signs and symptoms of UTI are:

  • Urgency to urinate
  • A burning sensation or pain when urinating
  • Blood in the urine
  • Cloudy urine
  • Urine with a strong, unpleasant smell
  • Dribbling urine, incontinence, and bed-wetting
  • Fever and abdominal pain

Long-term symptoms, if VUR is not treated, include:

  • A palpable abdominal mass, caused by a swollen kidney
  • Poor weight gain
  • Hypertension, or high blood pressure
  • Kidney failure
  • Protein in urine
  • Scarring of kidney tissue

An infant may have vomiting, diarrhea, lethargy, and may not be growing normally.

Parents or caregivers should consult a doctor if the child has a strong and persistent urge to urinate, experiences a burning sensation when urinating, and has abdominal or flank pain.

Medical advice should be sought if a child Is under 3 months old and has a temperature of 38 degrees Celsius or 100.4 degrees Fahrenheit, or if the child is over 3 months old and has a temperature of 38.9 degrees Celsius or 102 degrees Fahrenheit.

If the child has a fever, and the source is not obvious, a doctor should be consulted. Apart from a UTI, it could be an upper respiratory infection, viral gastroenteritis, or pneumonia.

An infant who is refusing food, eating poorly, is lethargic, difficult to wake up, has inconsolable crying, diarrhea, or vomiting also needs medical attention.

Risk factors and causes of vesicoureteral reflux

Infants and very young children are more likely to have VUR than older children or adults. It is most common in children aged 2 to 3 years old.

If a parent or sibling has had primary VUR, the chance of a child being born with it is higher.

Diagnosis of vesicoureteral reflux

An ultrasound scan can sometimes reveal VUR either before or after birth.

A UTI is a common cause of fever in children and can lead to VUR.

A urine test can detect a UTI.

A voiding cystourethrogram (VCUG) looks at the bladder and urethra while the bladder fills and empties, and it can reveal any abnormalities inside the urethra and the bladder. It can also determine whether urine flow is normal when the bladder empties.

Patients lie on their back on an X-ray table, and a catheter is inserted through the urethra and into the bladder. A contrast liquid dye which shows up on X-rays is injected through the catheter and into the bladder, filling it up.

Pictures are taken when the bladder is filled, and when the patient urinates.

Adverse effects include a slight risk of developing a urinary tract infection, discomfort during urination, and an allergic reaction to the dye that may cause bladder spasms.

In a nuclear scan, radioactive material is injected into a vein to highlight kidney shape and function, including whether urine empties normally from the kidneys.

A radionuclide cystogram uses a radioisotope, or radioactive material, that is injected into the bladder through a catheter. The test shows how well the urinary tract is working, but it may miss mild cases of VUR, and it does not give a very clear image of the bladder wall.

Urine may be pink for 2 days after, and there may be discomfort during urination.

Treatment for vesicoureteral reflux

Treatment depends on the patient's age, overall health and medical history, and the severity of the condition.

The doctor will recommend "watchful waiting," as the problem often resolves itself. The parents or caregivers should look out for possible urinary tract infections.

In moderate to severe cases, patients may need medication or surgery. Medication, usually an antibiotic, is more common. The antibiotic is used to prevent urinary tract infections, so there is less chance of renal scarring. Surgery is also an option.

Very severe cases may need surgery as a first-line therapy, to repair the faulty valve between the affected ureter and the bladder.

The surgeon creates a flap-valve apparatus for the ureter that prevents reverse flow of urine into the kidney. In very severe cases, the scarred ureter and kidney may have to be surgically removed.

The surgery may be endoscopic, laparoscopic, or open.

Complications of vesicoureteral reflux

The most serious complication is kidney damage.

Renal, or kidney, scarring can result in permanent kidney damage, if a UTI is left untreated. Renal scarring is also known as reflux nephropathy.

Hypertension, or high blood pressure, is a risk if the kidneys do not work properly.

Acute kidney failure can result if toxins build up rapidly in the blood because of a loss of kidney function. The patient will need emergency dialysis.

Chronic kidney disease is when the kidneys progressively worsen. If a person has chronic kidney disease, it usually means that the doctor does not expect the kidney function to return to normal.

If function falls below 15 percent of normal capacity, the patient is in end-stage kidney disease, and they will need either a kidney transplant or regular dialysis.

Vesicoureteral reflux - causes, symptoms, diagnosis, treatment, pathology (Video Medical And Professional 2020).

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