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 in one direction only, from the kidneys through the ureters to the bladder. VUR can increase the risk of urinary tract infections (UTIs) and, if severe, can lead to kidney damage (reflux nephropathy).
Symptoms
Often, VUR has no noticeable symptoms, especially in mild cases. Symptoms, when present, are usually related to urinary tract infections (UTIs) which VUR makes more likely. These symptoms may include:
Fever
Frequent urination
Painful urination (dysuria)
Abdominal pain
Back pain
Bedwetting (enuresis), especially in children who are toilet-trained
Poor appetite
Irritability (in infants)
Causes
VUR is usually caused by a defect in the valve-like mechanism where the ureter connects to the bladder. This valve is designed to prevent urine from flowing backward. The defect can be:
Primary VUR: Present at birth due to a problem with the ureterovesical junction (where the ureter joins the bladder). This is the most common cause.
Secondary VUR: Caused by a blockage or malfunction in the urinary tract. This can be due to:
Posterior urethral valves (in males)
Bladder or bowel dysfunction
Other urinary tract abnormalities
Medicine Used
The primary goal of medical treatment is to prevent UTIs, as UTIs can cause kidney damage in children with VUR. Medications used may include:
Prophylactic antibiotics: Low-dose antibiotics are prescribed to prevent UTIs. Common antibiotics used include trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid), or cephalexin (Keflex).
Antibiotics to treat UTIs: When a UTI occurs, appropriate antibiotics are prescribed based on the bacteria causing the infection.
Is Communicable
No, vesicoureteral reflux is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Precautions focus on preventing UTIs and managing the condition:
Adhere to antibiotic prophylaxis: If prescribed, consistently administer prophylactic antibiotics as directed by the doctor.
Good hygiene practices: Teach and reinforce good hygiene habits, such as proper wiping techniques after using the toilet, to minimize the risk of UTIs.
Frequent urination: Encourage frequent urination to help flush bacteria from the urinary tract.
Adequate fluid intake: Ensure adequate hydration to promote healthy urinary function.
Regular follow-up: Attend all scheduled appointments with the healthcare provider to monitor the condition and adjust treatment as needed.
Prompt treatment of UTIs: Seek prompt medical attention if symptoms of a UTI develop.
How long does an outbreak last?
VUR itself is not an "outbreak" that lasts for a specific period. It is a chronic condition. However, the associated urinary tract infections (UTIs) can last for a week or two with appropriate antibiotic treatment. The risk of UTIs persists as long as the VUR is present and untreated.
How is it diagnosed?
VUR is diagnosed through various tests:
Voiding Cystourethrogram (VCUG): This is the gold standard for diagnosing VUR. A catheter is inserted into the bladder, which is then filled with a contrast dye. X-rays are taken while the bladder fills and while the child urinates, showing if urine flows backward into the ureters and kidneys.
Renal Ultrasound: This imaging technique uses sound waves to create images of the kidneys and bladder. It can identify kidney abnormalities (like hydronephrosis, swelling caused by a back-up of urine) that might indicate VUR. However, ultrasound is not as sensitive as VCUG for detecting VUR itself.
Radionuclide Cystography (RNC): Similar to VCUG, but uses a radioactive tracer instead of contrast dye. It delivers a lower dose of radiation than VCUG.
Urinalysis and Urine Culture: These tests are used to detect UTIs. A urinalysis checks for signs of infection in the urine, while a urine culture identifies the specific bacteria causing the infection.
DMSA Scan: This nuclear medicine scan can detect scarring in the kidneys. It is performed after a UTI to assess for kidney damage.
Timeline of Symptoms
VUR is often diagnosed in infancy or early childhood, frequently after a child experiences a UTI. The timeline of symptoms is more related to recurring UTIs than the VUR itself:
Infancy: Frequent fevers, irritability, poor feeding, vomiting.
Toddler/Preschool: Daytime wetting, abdominal or flank pain, unexplained fevers.
School-Aged Children: Bedwetting, frequent UTIs with typical UTI symptoms (dysuria, frequency, urgency). Symptoms are usually episodic, occurring when a UTI is present. The underlying VUR is always present, predisposing to these UTIs.
Important Considerations
Long-term Monitoring: VUR requires long-term monitoring and management, especially in children, to prevent kidney damage.
Family History: VUR can run in families. If one child is diagnosed with VUR, siblings should be screened.
Surgical Options: Severe cases of VUR may require surgical correction to create a functional valve at the ureterovesical junction.
Psychological Impact: Bedwetting and frequent UTIs can have a psychological impact on children. Support and reassurance are important.
Compliance with Treatment: Adherence to prescribed medications and follow-up appointments is crucial for managing VUR and preventing complications.