Is your child dealing with frequent urinary tract infections (UTIs) coupled with a fever? Do antibiotics not seem to treat these infections as well as they used to?
If you are asking yourself or your pediatric provider these questions, then there is a possibility your child may have vesicoureteral reflux (VUR). You can either be born with VUR, called primary VUR, or VUR can occur secondary to elevated bladder pressures, which is seen in patients with neurogenic bladder from neurologic conditions such as spina bifida. Here, we will focus on primary VUR.
In a child without VUR, when the bladder contracts to void, all of the urine drains from the bladder via the urethra, the channel through which your child urinates. VUR is a condition where urine flows backwards (retrograde flow or reflux) from the bladder into the upper urinary tract during bladder filling or voiding. The upper urinary tract consists of the kidneys and ureters, the small drainage tubes connecting the kidney to the bladder. The amount of urine that travels back up to the ureters or kidneys can vary.
Although uncommon, your child’s VUR can be entirely asymptomatic. However, the most common presenting symptoms are recurrent UTIs accompanied with a fever.
According to the National Institute of Diabetes, Digestive, and Kidney Diseases, about 1 in 3 children who have febrile UTIs are diagnosed with VUR. Your provider likely will order an ultrasound of the kidneys and bladder first. If there is an abnormality on the ultrasound, or if your child has had multiple febrile UTIs, then a voiding cystourethrogram (VCUG) may be ordered.
A VCUG is the test of choice to diagnose VUR and distinguish the severity of reflux. This test involves placement of a temporary catheter, which is a small flexible tube, into the urethra (the tube through which you urinate) up into the bladder. Contrast dye then is inserted via the catheter while x-ray images are taken. Images are reviewed to determine if the contrast or dye refluxes (travels backwards) to the ureters and/or kidneys.
The VCUG test allows your provider to determine the severity, or degree of VUR, if present. VUR is graded from 1 to 5, with 1 being the most mild, and 5 the most severe. Your child may have VUR only on one side or may have different grades of VUR on either side.
The presence of VUR alone does not cause UTIs or kidney damage. However, if urine in the bladder becomes infected, VUR can propagate, or spread, the infection from the bladder to kidneys, creating a kidney infection known as pyelonephritis. There is a risk of kidney damage or scarring with each kidney infection that occurs. Kidney damage or scarring, most often associated with recurrent infections, can lead to long term problems such as high blood pressure, growth impairment, or eventual kidney impairment or failure. Fortunately, there are treatment options to prevent this from occurring.
Low grades of VUR may resolve spontaneously as children grow, especially in younger boys. More severe grades of VUR, and VUR that does not resolve, can increase your child’s risk of kidney damage as discussed above. Preventative antibiotics often are the first line treatment aimed at keeping the urine as sterile as possible. However, if your child has breakthrough infections while on daily preventative antibiotics, your child may need surgery to correct the VUR and avoid future kidney damage.
You can help your child’s medical team by keeping records of your child’s history of UTIs, including dates of infection, noting typical UTI symptoms, urine study results, and which antibiotics were prescribed.
For more information on VUR and other urological conditions, or to schedule an appointment with the TCH Urology Department, click here.
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