Vesicoureteral Reflux in Children


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What is vesicoureteral reflux?

Urine normally only goes one way—from the kidneys to the bladder. When urine from the bladder flows back up into the kidneys, this is called vesicoureteral reflux. When it happens, germs can get into the kidneys and cause infection in the urinary tract. If reflux isn't noticed, the repeated infections can lead to scarring and disease of the kidneys. Reflux happens in about one-third of children who have urinary tract infections (UTIs).

Does a UTI mean there is something wrong with my child's urinary tract?

Most children who have a UTI have a normal urinary tract. Just as some children get ear infections even though their ears are normal, some children get UTIs even though they have a normal urinary tract. However, some children who have UTIs may have something wrong with their urinary tract. Your doctor may order special tests to find out. This is more likely if your child is very young at the time of his or her first infection, or if he or she has repeated infections.

What kind of tests will the doctor perform?

Several tests help your doctor look at the urinary tract. An ultrasound is a painless test that gives your doctor a good look at the kidneys and bladder.

An X-ray called a voiding cystourethrogram (VCUG) also is a good way to look at the bladder, kidneys and ureters. During the test, the doctor will put a small tube into your child's bladder and pass some liquid through the tube into the bladder. This liquid shows up on the X-ray as the bladder fills and while your child urinates.

Another test called a radionuclide cystogram is sometimes used in children who have UTIs. For this test, the doctor will put a small amount of radioactive medicine into your child's blood stream with an IV line. Then, your doctor will take pictures of the kidneys and bladder with a special camera. This is a very good test for finding scarring in the kidneys. It is most commonly used in children known to have reflux.

An intravenous pyelogram is another test that can be used to look at the kidneys and urinary tract.

The tests your child receives will depend on his or her age, gender, how many infections he or she has had and how bad the infections are.

How is reflux treated?

Reflux tends to go away on its own. Most children who have reflux do not need treatment other than seeing their doctor regularly. However, some children who have reflux need to take an antibiotic every day to prevent UTIs.

Is surgery ever needed?

Most children who have reflux don't need surgery. A few children who continue to get UTIs while they are taking antibiotics, who develop new scarring of the kidney, who have structural abnormalities of the urinary tract or have serious reflux may need surgery. If your child needs surgery, your doctor will discuss the options with you.

Source

Pediatric Urinary Tract Infection and Reflux by JH Ross, M.D., and R Kay, M.D (American Family Physician March 15, 1999, http://www.aafp.org/afp/990315ap/1472.html)

Written by familydoctor.org editorial staff

Reviewed/Updated: 07/10
Created: 03/99

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