What Is Kidney Reflux In Children

What Is The Urinary Tract And How Does It Normally Work

The urinary tract is the kidneys, ureters, bladder, and urethra.

The kidneys filter and remove waste and water from the blood to produce urine. The urine travels from the kidneys down 2 narrow tubes called the ureters. The urine is then stored in the bladder.

When your child does a wee, urine flows out of the body through the urethra, a tube at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls.

Front view of the urinary tract

Side view of the female urinary tract

Side view of the male urinary tract

Who Is More Likely To Get It

Your chances of getting VUR are higher with the following:

Birth defect. This is the issue in most primary VUR cases. A child could have a short flap valve that doesnât work.

Genes. Youâre more likely to get VUR if youâre parents or siblings have had the condition. But no specific genes have been found responsible for VUR.

Abnormal bladder function. Children who have nerve or spinal cord problems such as spina bifida have a higher chance of VUR.

Urinary abnormalities. Children with problems in their urinary system are more likely to get this conditions. Some of those problems include:

• Bladder exstrophy
• Uterocele
• Ureter duplication

Bladder and bowel problems. Children with bathroom accidents, frequent urination or constipation are more likely to have VUR.

Key Points To Remember

• Most children will outgrow vesicoureteral reflux .
• Children who have recurrent UTIs with high fevers should be evaluated for possible urinary tract problems such as vesicoureteral refluxusually with a renal bladder ultrasound and VCUG.
• Repeated UTIs with high fevers can lead to serious infections with potential to damage a childs kidneys.
• Diet does not cause VUR and cannot prevent it.
• If your child shows signs of scarring on the kidneys or diminished kidney function, surgery may be necessary to correct VUR.

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What Are The Kidneys And What Do They Do

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The kidneys work around the clock a person does not control what they do. Ureters are the thin tubes of muscleone on each side of the bladderthat carry urine from each of the kidneys to the bladder. The bladder stores urine until the person finds an appropriate time and place to urinate.

The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called a glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which changes the fluid by sending needed minerals back to the bloodstream and removing wastes. The final product becomes urine.

How Is Kidney Reflux Treated In Children

UTIs that reach the kidneys can cause health problems. Therefore, it is important to diagnose kidney reflux early, monitor and treat if necessary. Pediatric Urology and Robotic Surgery Prof. Dr. Selçuk Slay talked about the treatment of kidney reflux in children for you.

What causes kidney reflux in children?

Some children are born with VUR and the cause is unknown. The childs urinary tract is usually in a one-way flow. Urine flows down from both kidneys through tubes called ureters. The ureters enter the bladder through the bladder muscle tunnel, which creates special one-way valves to prevent urine from returning to the kidneys. Urine in the bladder exits the body through another tube called the urethra.

In children with VUR, the tunnel in the bladder for one or both ureters may be too short or angled, resulting in backflow of urine. VUR can also occur as a result of the bladder not emptying normally. This is a less common cause of VUR.

What are the signs and symptoms of kidney reflux?

Kidney reflux is usually diagnosed in two ways. The first is recognized by enlargement of the kidneys in ultrasonography examinations performed in the womb. The other is revealed in the examinations made when a febrile urinary tract infection develops.

What tests are done to diagnose kidney reflux?

What to expect during a kidney reflux test?

What other tests can be done for kidney reflux?

How is kidney reflux treated?

Treatment approaches include:

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What Are The Complications Of Urinary Reflux

• urinary reflux may increase the chance of your child getting UTIs because of the incomplete drainage of urine
• urinary reflux alone does not usually cause kidney damage but recurrent UTIs in children with urinary reflux may cause kidney damage and scarring and can affect how well the kidneys work

Only a small proportion of children with urinary reflux develop significant kidney problems. In most children, the problem is easily managed with appropriate treatment and monitoring.

Kidney Reflux Also Known As Vesicoureteral Reflux Is Actually The Most Common Congenital Urinary Defect In Children

Normally in the urinary system, the kidneys produce urine which flows down to the bladder where its stored until the child urinates.Kidney reflux, or vesicoureteral reflux , commonly known as VUR, is a condition in which urine from the bladder backs up into the ureters. The ureters are the tubes that carry the urine from the kidneys down to the bladder. The ureters have a one-way valve system that normally stops urine from going from the bladder back up the ureters in the wrong direction. Sometimes when a child has VUR, urine can flow all the way back up into the kidney, and the valve system doesnt work.

This backed-up urine can carry bacteria which can cause urinary tract infections , kidney infections , and potentially long-term kidney damage .

Your doctor will diagnose your child based on an evaluation that may include a test called a voiding cystourethrogram, or VCUG. A VCUG takes an x-ray image of the bladder and ureters while the child is urinating to show anything unusual in the bladder and ureters.

Kidney reflux can be very mild, requiring little treatment, or it can be severe.

The VUR grading scale ranges from grade 1 to grade 5 . The higher the grade of VUR, the greater the chance that kidney damage will resultand the less likely your child is to outgrow it.1

Resources:

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How Is Vur Graded

VUR is graded according to the images obtained on a VCUG. The lower the grade of reflux the higher the chances are that it will resolve without surgery. It is possible to have VUR bilaterally and that the grades will be different.

Grade 1: This is the mildest form of VUR. The ureters appear normal in size and urine flows up into the ureter but not into the kidney.Grade 2: Urine travels all the way up the ureter and enters the part of the kidney where urine is collected before draining . The ureter is normal in size.Grade 3: Similar to grade 2 expect that the ureters and/or the renal pelvis look more full.Grade 4: Similar to grade 3 except that the ureter is grossly enlarged and the calyces of the kidney are more blunted.Grade 5: Most severe state of VUR. Similar to grade 4 plus the ureter is very full and tortuous .

What Questions Should I Ask My Healthcare Provider

Have a conversation with your healthcare provider where you get answers to all of your questions about vesicoureteral reflux . Recommended questions include:

• Is this a UTI or VUR?
• Is this BBD or VUR?
• Will my childs primary VUR get better without treatment?
• Does my child also have kidney problems?
• Should I see a specialist?
• How will you treat my childs VUR?
• What are the consequences of untreated VUR?
• What can I do at home to improve my childs condition?
• Will this condition cause my child pain?
• How can I prevent a urinary tract infection?
• How can I prevent BBD?
• Should my other children be checked for VUR?

A note from Cleveland Clinic

Remember that vesicoureteral reflux isnt usually painful or life-threatening. It is manageable and treatments are usually successful. There is no way to prevent it, but still make sure to have your child drink plenty of water, get exercise and eat nutritious meals to maintain overall health.

Rely on your healthcare providers expertise. They will help diagnose and treat your childs VUR. Dont hesitate to contact them with questions and concerns and be open and honest about your childs symptoms, even if theyre awkward to talk about.

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How Do Doctors Diagnose Reflux And Gerd In Children

In most cases, a doctor diagnoses reflux by reviewing your child’s symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include:

Is Vesicoureteral Reflux Life

Vesicoureteral reflux itself is not life-threatening. However, VUR can lead to recurrent urinary tract infections , which can result in renal scarring and then worsen into renal hypertension and renal disease. End-stage kidney disease requires dialysis and/or a transplant. Without those interventions, kidney disease is fatal.

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How Do I Take Care Of My Child

Follow everything your healthcare provider recommends regarding vesicoureteral reflux . Do everything you can to keep your childs urinary tract healthy, including enough drinking water. Change your infants diaper right away when soiled and watch for infrequent urination. Remember, to protect your childs kidneys you must do what you can to prevent urinary tract infections.

What Treatment Does My Child Need For Urinary Reflux

Urinary reflux usually gets better by itself as your child grows, especially if it is mild.

The treatment aims to prevent UTIs while your child is young, when they can cause damage to the kidneys. Sometimes, your doctor may prescribe a small dose of antibiotics to prevent UTIs until the urinary reflux improves or gets better by itself.

In most children, no treatment is necessary and your child’s doctor will monitor the growth and health of your child’s kidneys with scans. This will depend on how severe your child’s reflux is.

Regular urine tests may be necessary to make sure there is no infection present. If your child develops any symptoms of a UTI while on antibiotics, take them to your family doctor for an immediate urine test.

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How Is Reflux Diagnosed Are There Signs To Alert Parents To The Problem

Usually, reflux is found when you take your child to the doctor after a urinary tract infection. About 50 percent of babies and 30 percent of older children with infections will have reflux. The back flow of urine to the kidney can cause a urinary infection to spread to the kidney, which can make your child very sick and can lead to kidney damage. You may notice that your child:

• goes to the bathroom more often
• says, “It burns” or “It hurts” when urinating
• says, “My stomach hurts”
• has a fever.

Take your child to a doctor, who will get a urine culture if he or she suspects an infection.

How Does The Vesicoureteral Reflux Grading System Work

The grades are one through five. Five is the most severe form of vesicoureteral reflux . The grading system is based on how far the urine backs up into the urinary tract and on the width of the ureter.

• Grade One: The urine goes backwards up into a ureter that is normal in size.
• Grade Two: The urine backs up into the kidneys pelvis area through a normal-sized ureter. Neither the kidney pelvis nor the calyces have gotten larger in size.
• Grade Three: The ureter, kidney pelvis and calyces are mild to moderately enlarged due to the backup of urine.
• Grade Four: The ureter are curved and dilated, moderately, and the kidney pelvis and calyces are also moderately dilated because of too much urine.
• Grade Five: The ureter are extremely distorted and enlarged. The kidney pelvis and calyces are very large from an extreme amount of urine retained in them.

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Vesicoureteral Reflux Is A Serious Condition

It is important to know that your child may outgrow VUR. The average age when a child may outgrow VUR is five or six years old. Children are more likely to outgrow VUR with lower grades of Reflux. This is what your doctor or pediatric urologist calls spontaneous resolution. If your child has been diagnosed with VUR it is really important that VUR be treated to avoid long-term complications.

The likelihood of spontaneous resolution varies according to a childs age, grade of VUR, and whether the VUR is on one ureter or both.

VUR Resolution Chart Percent Chance of Reflux Resolution After A Specified Number of Years1.

American Urological Association

2.6%

12.5%

More severe grades of reflux are associated with lower rates of spontaneous resolution and a higher incidence of renal scarring.2

Continual UTIs can permanently damage the kidney

When a child has VUR, urine backs up into the kidney. Sometimes the urine contains bacteria that cause a urinary tract infection . Bacteria in the kidney can lead to damage over time, which may eventually lead to kidney failure and/or high blood pressure. Some kidney infections that develop suddenly can even be life threatening. The risk of kidney damage is greatest during the first 6 years of life. The goal is to find VUR early and prevent infection that could result in kidney damage.

Antibiotics are not an effective treatment for preventing kidney disease3

Resources:

What Is Vesicoureteral Reflux

Vesicoureteral reflux is a condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys. VUR is most common in infants and young children. Most children dont have long-term problems from VUR.

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

Doctors usually rank VUR as grade 1 through 5. Grade 1 is the mildest form of the condition, and grade 5 is the most serious.

VUR can cause urinary tract infections and, less commonly, kidney damage. The two main types of VUR are primary VUR and secondary VUR. Most children have primary VUR.

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What Causes Vesicoureteral Reflux

Primary VUR is when defects in one or both ureters let pee flow the wrong way. Most kids with VUR have this type. Babies born with primary VUR have a ureter that didn’t grow long enough before birth. This can affect where the ureter enters the bladder, letting pee flow back up the ureters to reach the kidney. Primary VUR is thought to be a genetic condition.

Secondary VUR is when a blockage in the urinary tract obstructs the flow of pee and sends it back into the kidneys. Kids with this type often have reflux in both ureters. This can happen because of nerve damage, infection, or pressure on the ureter from another organ.

What Are The Symptoms Of A Urinary Tract Infection

Urinary tract infections often result from VUR. If your child has symptoms of a UTI, they may also have VUR. Symptoms of a UTI include:

• Fever.
• Burning or pain when urinating.
• Pain in the lower abdomen.
• Pain in the lower or upper back.
• The need to urinate more often.
• Only a few drops come out when trying to urinate.
• Bladder leakage.
• Urine that is cloudy and smells badly.

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Symptoms Of Urinary Reflux

Urinary reflux does not have any symptoms. However, urinary tract infections, which can result from urinary reflux, can cause:

• burning sensation when passing urine
• wanting to urinate more often, if only to pass a few drops
• cloudy, bloody or very smelly urine
• pain in the lower part of the body
• stomach aches
• wetting new day or night wetting in a child who has been dry
• fever
• poor feeding, vomiting and ongoing irritability in babies and young children.

If your child has any of these symptoms, take them to a GP so that simple tests for urinary reflux can be performed.

How Is Primary Vesicoureteral Reflux Treated

As your child gets older and their urinary tract anatomy grows and matures, primary vesicoureteral reflux will often improve on its own. Until then, your healthcare provider will prescribe an antibiotic to treat a urinary tract infection , if one is present. UTIs can lead to bladder and kidney infections.

Use of long-term antibiotics for the prevention of UTI, however, is somewhat controversial. Extended use of antibiotics can lead to antibiotic resistance, meaning the medication will no longer work against the infection. This makes infections harder to fight and leads to the need to take different and potentially stronger drugs with more side effects.

Currently, the American Urological Association recommends antibiotic use under these specific conditions:

• Children younger than one year of age: Continuous antibiotics should be used if your child has a history of UTI and fever or if your child has a UTI without fever with VUR grade three through five identified through screening.
• Children older than one year of age with bladder/bowel dysfunction : Continuous antibiotics should be used while BBD is being treated.
• Children older than one year of age without BBD: Continuous antibiotics can be used at the discretion of the healthcare provider but is not automatically recommended however, UTIs should be promptly treated.

Other medications

Surgery

Several surgical approaches can be used to correct the connection between the ureters and bladder to prevent urine from refluxing.

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