(VUR—Child; Reflux Nephropathy—Child; Chronic Atrophic Pyelonephritis—Child; Vesico-Ureteric Reflux—Child; Ureteral Reflux—Child)
Vesicoureteral reflux (VUR) is the backward flow of urine. The urine flows from the bladder back into the kidneys.
Urine normally flows out from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. This connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back-up can also put extra pressure on the kidney. This can cause kidney damage.
This is a potentially serious condition. It requires care from a doctor. Early treatment and prevention of infections can lead to better outcomes.
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Common causes of VUR include:
- A problem in the way the ureter inserts into the bladder
- A ureter that does not extend far enough into the bladder
- Neurogenic bladder —loss of normal bladder function due to damaged nerves reaching the bladder
Things that may increase your child’s chance of developing VUR include:
- Family history (especially if a sibling or parent has VUR)
- Birth defects that affect the urinary tract
- Birth defects that affect the spinal cord, such as spina bifida
- Tumors in the spinal cord or pelvis
- Frequent and urgent need to urinate
- Passing small amounts of urine
- Pain in the abdomen or pelvic area
- Burning sensation during urination
- Cloudy, bad-smelling urine
- Increased need to get up at night to urinate
- Blood in the urine
- Leaking urine
- Low back pain or pain along the side of the ribs
- Fever and chills
You will be asked about your child’s symptoms and medical history. A physical exam will be done. Tests may include:
- Blood tests—to assess how well the kidneys are functioning
- Urine tests—to look for evidence of an infection or damage to the kidneys
Voiding cystourethrogram (VCUG)—a liquid that can be seen on
is placed in the bladder through a catheter; x-rays are taken when the bladder is filled and when urinating
- Note: This test is not done routinely in children aged 2-24 months.
- Radionuclide cystogram (RNC)—a test like VCUG, but uses a different kind of liquid to obtain images
- IV pyelogram —also uses a liquid that can be seen on x-rays; images are taken as the substance travels from the blood (after being injected into a vein) into the kidneys and bladder
- Nuclear scans—a variety of tests using radioactive materials injected into a vein to show how well the urinary system is working
Your child's condition will be graded. The grading scale ranges from 1 (mild) to 5 (severe).
The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include:
Treatment may not be needed for grades 1-3. Higher grades may require treatment.
VUR may go away on its own as the ureters develop. Your child's condition will be monitored. This may include:
- Preventive antibiotics may be given under certain conditions, depending on your childs age, history of urine infections, and grade of reflux.
- Antibiotics will be used if a urine infection is present.
- Tests to check how the kidneys are functioning
Children are advised to stay well-hydrated by drinking plenty of fluids. They should also empty their bladders frequently.
In most cases, surgery is not needed. If your child does need surgery, the options include:
- Ureteral reimplantation surgery—This can be done in two ways. One requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically, with cameras being inserted through small incisions in the abdomen and/or bladder to do the surgery.
- Endoscopic injection into the ureter—This is a minimally invasive surgery that is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can block urine from flowing back up the ureter.
VUR cannot be prevented in most cases. Avoid complications by getting prompt treatment. If you suspect a urinary tract or kidney infection, call your child's doctor.
National Kidney Foundation
Urology Care Foundation
The Kidney Foundation of Canada
Valla JS, Steyaert H, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience. J Pediatr Urol. 2009;5(6):466-471.
Vesicoureteral reflux (VUR). Cincinnati Children’s website. Available at: http://www.cincinnatichildrens.org/health/info/urinary/diagnose/vesicoureteral-reflux.htm. Updated May 2015. Accessed March 20, 2018.
Vesicoureteral reflux (VUR) in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/vesicoureteral-reflux-vur. Accessed March 20, 2018.
Vesicoureteral reflux. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116455/Vesicoureteral-reflux. Updated October 2, 2017. Accessed March 20, 2018.
4/1/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T905359/Choosing-Wisely: Choosing wisely. EBSCO DynaMed Plus website. Available at: http://www.ebscohost.com/dynamed. Updated July 23, 2015. Accessed March 20, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board Kari Kassir, MD Last Updated: 5/5/2014