Vesicoureteral Reflux in Children

When urine from the bladder flows back up into the kidneys, this is called vesicoureteral reflux. Urine normally goes only one way. When urine flows back up from the bladder to the kidneys, germs can get into the kidneys. This can lead to 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).

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.

There are several tests that look at the urinary tract. An ultrasound of the kidneys and bladder is a painless test that gives your doctor a good look at the kidneys and bladder.

An X-ray called a voiding cystourethrogram (VCUG) is a good way to look at the bladder, kidneys and ureters. A small tube is put into your child's bladder. A liquid is passed through the tube into the bladder. This liquid shows up on the X-ray. X-rays are then taken as the bladder fills and while your child urinates and are used to see if your child has reflux.

Another test called a radionuclide cystogram is sometimes used in children who have UTIs. For this test, a small amount of radioactive medicine is put into your child's blood stream with an IV line. Pictures of the kidneys and bladder are then taken 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. It is a lot like a kidney scan.

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

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.

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.