by Jennifer Bunn

Created on: August 12, 2008   Last Updated: August 19, 2008

Vesicoureteral reflux (VUR) is the formal medical term for urinary reflux, a condition that affects children and causes urinary tract infection and, in some cases, kidney damage.

In children with VUR, the normal ability of their body to prevent urine from flowing upwards, or refluxing, to their kidneys is impaired. Normally, urine is prevented from this action by way of a one-way valve where the ureters connect to the bladder. Sometimes the ureters are implanted at an angle that allows reflux to occur. This condition is present from birth, but may not be identified for some time after birth.

The danger of VUR is that the kidneys can be exposed to contaminants from the urine, leading to urinary tract infection. Repeated kidney infections can lead to permanent damage to one or both kidneys, which can in turn lead to kidney failure.

Children can have urinary tract infections without having VUR, but infections in very young babies or repeated infections will likely raise a red flag for your doctor. Infection in females is more common than in males, so male infants who experience urinary tract infections should be screened for VUR.

Tests to diagnose VUR usually include a renal ultrasound and a voiding cystourethrogram. In this test, also called a VCUG, a catheter is inserted into the bladder. Dye is then introduced into the bladder, and technicians will be clearly able to see if the dye travels up the ureters to the kidneys. Both of these tests are done in hospital. VUR is graded on a five-point scale, with grade one being the mildest form and grade 5 being the most severe. Grade one and grade two reflux stand a good chance of resolving over time, while grade 4 and grade 5 reflux may require surgery.

If your child is diagnosed with VUR, watchful waiting may be all the treatment that is necessary. Often children will "outgrow" VUR; that is, as they grow their ureters will grow too, and this may be all that is needed. Some children may be required to take oral antibiotics every day to prevent infection (suppression therapy). Children who experience infections despite antibiotics or who have severe reflux may need surgery, which usually involves re-implanting the ureters in the bladder wall at the correct angle to prevent reflux from occurring.

All children who are diagnosed with reflux should be followed carefully throughout childhood to measure growth and monitor blood pressure. Abnormal growth or high blood pressure could be indications of damage to the kidneys, which requires further testing and treatment.

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