Summary about Disease
Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder into one or both ureters and sometimes to the kidneys. Normally, urine flows only one way, from the kidneys through the ureters to the bladder. VUR is most often diagnosed in infants and children. Severe VUR can lead to kidney infections (pyelonephritis) and kidney damage, potentially leading to scarring and, in rare cases, kidney failure.
Symptoms
VUR itself often doesn't cause noticeable symptoms. Symptoms are usually related to urinary tract infections (UTIs), which are common in children with VUR. These include:
Fever
Frequent urination
Painful urination (dysuria)
Abdominal pain
Back pain
Bed-wetting (enuresis), especially in children who are already toilet trained
Poor appetite
Irritability
Causes
VUR can be caused by two main types of problems:
Primary VUR: This is the most common type and is usually due to a defect in the valve-like mechanism where the ureter joins the bladder. This valve is supposed to prevent urine from flowing backward. The defect is usually congenital, meaning it's present at birth.
Secondary VUR: This is due to a blockage or malfunction in the urinary tract that causes increased pressure in the bladder. This increased pressure can force urine to flow backward into the ureters. Common causes include:
Posterior urethral valves (in males)
Bladder dysfunction (e.g., neurogenic bladder)
Medicine Used
Medications are primarily used to prevent UTIs, which are a major concern for individuals with VUR. Common medications include:
Antibiotics: Low-dose antibiotics (prophylactic antibiotics) are often prescribed to prevent UTIs. Common examples include trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid, Macrodantin), or cephalexin (Keflex). The specific antibiotic and duration of treatment will be determined by the doctor.
Medications to manage bladder dysfunction: If secondary VUR is caused by bladder dysfunction, medications like anticholinergics may be used to improve bladder emptying and reduce bladder pressure.
Is Communicable
No, VUR is not a communicable disease. It is a structural or functional abnormality of the urinary tract and cannot be spread from person to person.
Precautions
The main precautions revolve around preventing UTIs and managing any underlying bladder issues:
Prophylactic antibiotics: Adhering to the prescribed antibiotic regimen.
Good hygiene: Teach and reinforce proper hygiene practices, especially for girls, including wiping from front to back after using the toilet.
Adequate fluid intake: Encouraging sufficient fluid intake to help flush bacteria from the urinary tract.
Frequent urination: Encouraging regular and complete bladder emptying.
Prompt treatment of UTIs: Seeking immediate medical attention if symptoms of a UTI develop.
Management of constipation: Constipation can sometimes contribute to bladder problems, so managing constipation is important.
Following doctor's recommendations: Adhering to all recommendations made by the pediatrician or urologist.
How long does an outbreak last?
VUR itself is not an outbreak. If a UTI occurs as a result of VUR, the UTI will last a few days to a week with appropriate treatment. The VUR can be a persistent, ongoing condition.
How is it diagnosed?
Prenatal diagnosis is RARE and not always possible:
Prenatal Ultrasound: Occasionally, severe hydronephrosis (swelling of the kidneys) is detected on prenatal ultrasound scans. This may suggest VUR, but further testing after birth is required to confirm the diagnosis.
Postnatal Evaluation:
Voiding Cystourethrogram (VCUG): This is the gold standard for diagnosing VUR. A catheter is inserted into the bladder, and the bladder is filled with contrast dye. X-rays are taken while the bladder fills and during urination to see if the dye flows backward into the ureters.
Renal Ultrasound: Used to assess the size and structure of the kidneys and detect hydronephrosis.
Radionuclide Cystogram (RNC): An alternative to VCUG, using a radioactive tracer instead of contrast dye. It may involve less radiation exposure but may not provide as much detail as VCUG.
Urine Culture: To detect and identify any bacteria in the urine, confirming a UTI.
Timeline of Symptoms
VUR itself does not have a timeline of symptoms. The symptoms associated with VUR are primarily those of UTIs. UTIs develop quickly, usually within a day or two of bacterial infection. If not treated, UTI symptoms can persist and worsen over several days or weeks, potentially leading to kidney infection.
Important Considerations
Severity of VUR: VUR is graded from I to V, with I being the mildest and V being the most severe. The grade of VUR influences the risk of kidney damage and the need for intervention.
Family history: VUR can sometimes run in families. If there is a family history of VUR, siblings of affected children may be screened.
Long-term follow-up: Children with VUR require regular follow-up with a pediatrician or urologist to monitor kidney function, prevent UTIs, and assess the need for further intervention.
Surgical intervention: Surgery (ureteral reimplantation) may be considered for severe VUR, recurrent UTIs despite antibiotic prophylaxis, or VUR that does not resolve over time. The goal of surgery is to create a more effective valve mechanism at the junction of the ureter and bladder.
Psychological impact: Recurrent UTIs and the need for ongoing medical care can have a psychological impact on children and their families. Support and resources should be provided to address these concerns.
Prenatal identification is not definitive: A prenatal ultrasound showing hydronephrosis is only an indication that further testing is required after the baby is born. It doesn't guarantee the baby has VUR.