Vesicoureteral reflux

DEFINITION

Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux is the abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. Normally, urine flows only down from your kidneys to your bladder.

Vesicoureteral reflux is usually diagnosed in infants and children. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage.

Vesicoureteral reflux can be primary or secondary. Children with primary vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Secondary vesicoureteral reflux is due to a urinary tract malfunction, often caused by infection.

Children may outgrow primary vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.

CAUSES

Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste products from your body.

The kidneys, a pair of bean-shaped organs at the back of your upper abdomen, filter waste, water and electrolytes — minerals, such as sodium, calcium and potassium, that help maintain the balance of fluids in your body — from your blood.

Tubes called ureters carry urine from your kidneys down to your bladder, where it is stored until it exits the body through another tube (the urethra) during urination.

Vesicoureteral reflux can develop in two forms, primary and secondary:

• Primary vesicoureteral reflux. The cause of this more common form is a defect that’s present before birth (congenital). The defect is in the functional valve between the bladder and a ureter that normally closes to prevent urine from flowing backward.

  As your child grows, the ureters lengthen and straighten, which may improve valve function and eventually resolve the reflux. This type of vesicoureteral reflux tends to run in families, which indicates that it may be genetic, but the exact cause of the defect is unknown.

• Secondary vesicoureteral reflux. The cause of this form is a blockage or malfunction in the urinary system. The blockage most commonly results from recurrent UTIs, which may cause swelling of a ureter.

SYMPTOMS

Urinary tract infections commonly occur in people with vesicoureteral reflux. A urinary tract infection (UTI) doesn’t always cause noticeable signs and symptoms, though most people have some.

These signs and symptoms can include:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in the urine (hematuria) or cloudy, strong-smelling urine
• Fever
• Pain in your side (flank) or abdomen
• Hesitancy to urinate or holding urine to avoid the burning sensation

A UTI may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may also include:

• An unexplained fever
• Diarrhea
• Lack of appetite
• Irritability

As your child gets older, untreated vesicoureteral reflux can lead to other signs and symptoms, including:

• Bed-wetting
• Constipation or loss of control over bowel movements
• High blood pressure
• Protein in urine
• Kidney failure

Another indication of vesicoureteral reflux, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys (hydronephrosis) in the fetus, caused by the backup of urine into the kidneys.

When to see a doctor

Contact your doctor right away if your child develops any of the signs or symptoms of a UTI, such as:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Abdominal or flank pain
• A hesitancy to urinate

Call your doctor about fever if your child:

• Is younger than 3 months old and has a rectal temperature of 100.4 F (38 C) or higher
• Is 3 months or older and has a fever of 102 F (38.9 C) or higher without any other explainable factors, such as a recent vaccination

In addition, call your doctor immediately if your infant has the following signs or symptoms:

• Changes in appetite. If your baby refuses several feedings in a row or eats poorly, contact the doctor.
• Changes in mood. If your baby is lethargic or unusually difficult to rouse, tell the doctor right away. Also let the doctor know if your baby is persistently irritable or has periods of inconsolable crying.
• Diarrhea. Contact the doctor if several of your baby’s stools are especially loose or watery.
• Vomiting. Occasional spitting up is normal. Contact the doctor if your baby spits up large portions of multiple feedings or vomits forcefully after feedings.