Pediatric Vesicoureteral Reflux

After Brooklyn scaring us with her trip to the hospital a couple weeks ago, we decided to investigate further to see if there was something wrong that might have possibly caused such a bad infection. The doctor told us that it is common for young girls to have this particular reflux issue and she should be tested.

Last week we took Brooklyn for a VCUG at Children's. They basically catheter her and run dye into her bladder and use x-ray to take video of what is happening. In Brooklyn, her urine was backing up towards her kidneys. So they diagnosed her with Pediatric Vesicoureteral Reflux at a Grade 2. For now we will give her a mild antibiotic every night to make sure she doesn't get anymore infections which could damage her kidneys. She will have the same VCUG test done in a year to see if she is growing out of it, which usually is the case. If she doesn't or it worsens we will look into a surgical procedure that would correct the issue. It is common for siblings to have the same issue so we will also closely monitor Marley.

More info is below...

Vesicoureteral reflux (VUR) is the backup of urine from the organ that stores urine (bladder) into the tube that carries urine from the kidney to the bladder (ureter) during urination. VUR may result in urine reflux into the renal pelvis, causing distention (hydronephrosis) and kidney damage. In children, this condition is usually caused by an abnormality that is present at birth (congenital) and is often diagnosed during prenatal ultrasound.

Types
There are two types of VUR: primary and secondary. Primary reflux is caused by a congenital (present at birth) abnormality, and secondary reflux is caused by a urinary tract infection (UTI) or an obstruction in the urinary tract.

Reflux is graded according to its severity:

Grade I results in urine reflux into the ureter only.
Grade II results in urine reflux into the ureter and the renal pelvis, without distention (hydronephrosis).
Grade III results in urine reflux into the ureter and the renal pelvis, causing mild hydronephrosis.
Grade IV results in moderate hydronephrosis.
Grade V results in severe hydronephrosis and twisting of the ureter.

Incidence and Prevalence
VUR is diagnosed in 17–37% of prenatal ultrasounds. The condition is more prevalent in females and in children who have red hair. One-third of UTIs in children are caused by vesicoureteral reflux.

Causes and Risk Factors

Undetermined genetic risk factors may affect the development of VUR. About 34% of patients who have the condition have siblings who are also affected. Siblings of patients with VUR are routinely tested for the condition, even when symptoms are not present.

The most common cause for primary reflux in children is an abnormality in the section of the ureter that enters the bladder (called the intravesical ureter). The intravesical ureter may not be long enough to enable the ureter to close sufficiently to prevent urine reflux, or the ureter may be inserted abnormally into the bladder. This condition often resolves as the child grows and the ureter lengthens.

Other causes of primary reflux include abnormalities in detrusor muscle tissue of the bladder, abnormalities in the location of the urethral opening (e.g., hypospadias), and abnormalities in the shape of the urethral opening.

Secondary reflux is often caused by urinary tract infection (e.g., cystitis) that results in inflammation and swelling of the ureter. UTI may cause vesicoureteral reflux or vesicoureteral reflux may promote the growth of bacteria in the urinary tract, causing UTI. Secondary reflux may also be caused by urinary tract abnormalities (e.g., narrowing, or stricture, of the ureter; duplicated ureters; ureterocele) and obstructions (e.g., UPJ obstruction, stones, tumor).