Summary about Disease
Vesicoureteral reflux (VUR) nephropathy is a kidney disease resulting from vesicoureteral reflux, a condition where urine flows backward from the bladder into the ureters and sometimes the kidneys. This abnormal flow can cause kidney infections (pyelonephritis) and, over time, lead to scarring of the kidneys (reflux nephropathy). Reflux nephropathy can impair kidney function and potentially lead to kidney failure. It is often diagnosed in childhood.
Symptoms
VUR itself often has no symptoms. However, associated kidney infections can cause symptoms such as:
Fever
Abdominal, flank, or back pain
Frequent or painful urination
Urinary urgency
Bedwetting (in children)
Poor growth and development (in children)
High blood pressure
Causes
The primary cause is a defect in the vesicoureteral valve, which normally prevents urine from flowing backward. This defect can be:
Primary VUR: Present at birth due to a malformation of the ureterovesical junction (where the ureter connects to the bladder). It is often hereditary.
Secondary VUR: Caused by another problem, such as:
Bladder outlet obstruction (e.g., due to posterior urethral valves in males)
Neurogenic bladder (bladder dysfunction due to nerve problems)
Infrequent Voiding
Medicine Used
Antibiotics: Used to treat and prevent urinary tract infections (UTIs). Low-dose antibiotics may be prescribed daily (prophylactic antibiotics) to prevent recurrent UTIs in individuals with VUR.
Antihypertensives: If high blood pressure develops due to kidney damage, medications to lower blood pressure may be prescribed.
Other medications: Other medications may be needed to address complications, such as anemia or electrolyte imbalances, depending on the severity of kidney damage.
Is Communicable
No, vesicoureteral reflux nephropathy is not communicable. It is not caused by an infectious agent and cannot be transmitted from person to person.
Precautions
Adherence to medication: Taking prescribed antibiotics as directed is crucial to prevent UTIs and kidney damage.
Regular check-ups: Regular follow-up appointments with a nephrologist or urologist are essential to monitor kidney function and manage the condition.
Good hygiene: Proper hygiene practices, such as wiping from front to back after using the toilet, can help prevent UTIs.
Frequent urination: Emptying the bladder regularly can help prevent urine from backing up into the ureters.
Monitor blood pressure: Regularly monitor blood pressure and manage it with medication if needed.
Dietary Modifications: Depending on the severity of kidney damage, dietary modifications, such as limiting sodium and phosphorus intake, may be recommended.
How long does an outbreak last?
Vesicoureteral reflux nephropathy is not an "outbreak" like an infection. It is a chronic condition. Urinary tract infections, which are a complication of VUR, can last for several days to a couple of weeks with appropriate treatment. The underlying VUR condition persists unless it resolves spontaneously (more common in mild cases in children) or is corrected surgically. Kidney damage is generally permanent.
How is it diagnosed?
Voiding cystourethrogram (VCUG): This is the gold standard for diagnosing VUR. A catheter is used to fill the bladder with contrast dye, and X-rays are taken while the bladder is filling and during urination to visualize the flow of urine.
Renal ultrasound: This imaging technique can detect kidney abnormalities and hydronephrosis (swelling of the kidney due to urine backflow).
DMSA scan: This nuclear medicine scan assesses kidney function and can identify areas of scarring.
Urine analysis: To check for signs of infection.
Blood tests: To assess kidney function (e.g., creatinine, BUN).
Timeline of Symptoms
The timeline can vary greatly:
Infancy/Childhood: VUR is often diagnosed after a UTI. Symptoms might include fever, irritability, poor feeding, and bedwetting. Sometimes, VUR is detected prenatally via ultrasound showing hydronephrosis.
Later Childhood/Adolescence: Untreated or severe VUR can lead to recurrent UTIs, high blood pressure, and potentially slowed growth.
Adulthood: Some individuals are diagnosed in adulthood, often due to hypertension or during investigation for other conditions. Kidney damage may already be present. Progressive kidney damage can eventually lead to kidney failure.
Important Considerations
Early diagnosis and treatment are crucial to prevent or minimize kidney damage.
Severity of VUR is graded (I-V), with higher grades indicating more severe reflux and greater risk of kidney damage.
Spontaneous resolution: Mild VUR (grades I and II) often resolves spontaneously in children as they grow.
Surgical correction: Surgery (ureteral reimplantation) may be necessary for severe VUR or when medical management fails.
Long-term monitoring: Even after treatment, long-term monitoring of kidney function is important to detect and manage any complications.
Pregnancy: Women with VUR nephropathy require careful monitoring during pregnancy due to the increased risk of complications.
Genetic component: There is a genetic component to VUR, so siblings and children of affected individuals may be screened.