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Kidney Reflux

Related concepts:
Kidney infection, Urinary tract infection – pyelonephritis

Possible scarring of the kidneys is an important reason to recognize, treat, and, when possible, to prevent urinary tract infections. Scarring can lead to serious kidney problems years down the road.

•What isRelated concepts:
Kidney reflux

Antibiotics are overused. In recent years, we have become increasingly cautious about their misuse. When parents hear that long-term, daily antibiotics might be recommended for their children with reflux just to prevent urinary tract infections, they are often concerned. But protecting the kidneys can be an excellent reason to take antibiotics.

•What is it?
Urine is normally created by the kidneys, flows down through tubes called ureters, and enters the bladder. The bladder is a holding tank. When the bladder muscle contacts and the sphincter relaxes, urine flows down and out of the body through the urethra.

Why doesn’t the urine flow back into the ureters when the bladder contracts? The ureters enter the thick-walled bladder at an angle. The long path through the muscle acts as a valve. The ureters close as the bladder contracts — an elegant system.

Reflux happens when the muscle-valve doesn’t work. The path of the ureters through the muscle may be too straight or too short, or the muscle in that area may be too thin or too weak. Sometimes the person has an extra ureter with poor valve function. When the bladder contracts, some of the urine is propelled down and out, but some is ejected back up into the ureters.

This puts pressure on the kidneys, and provides an opening for bacteria to travel further up into the body.

•Who gets it?
Reflux affects about 1 child in 100. It tends to run in families. Children with reflux are usually born with it. If one child has it, about 1/3 of the siblings will have it. If a woman has reflux, about half of her children will.

Reflux is more common in people with other urinary tract problems and in some other conditions, such as spina bifida.

•What are the symptoms?
Reflux usually comes to medical attention because someone looked for it after a urinary tract infection.

Apart from infections, the damage done by reflux is often silent and unobserved. Reflux can lead to scarring of the kidneys, high blood pressure, poor growth, and kidney failure.

•Is it contagious?
Reflux is not contagious.

•How long does it last?
How long it is expected to last depends on the severity of the reflux. Reflux is classified on a scale of Grade I to Grade V. In Grade I reflux, the urine flows up a short way through a normal-appearing, undilated ureter. In Grade II, the urine makes it all the way to the kidney, but the structures still look normal. By Grade V reflux, though, the ureters are dilated like elongated water balloons all the way up the kidney, where the normal structures are compressed and pushed out of place.

Grade I and Grade II reflux will likely go away on their own. Grade III reflux is more likely to resolve the younger the child is when it is diagnosed. Grade IV reflux may also go away, especially if it is only on one side. Grade V reflux rarely disappears without surgery.

If reflux does heal on its own, the average age is 6 or 7.

•How is it diagnosed?
Imaging studies are needed to diagnose reflux. These are often wise to obtain in young children who have had urinary tract infections. Most will need both a renal ultrasound and a cystogram (a study where a catheter is put into the bladder, some marker is put into the urine, and pictures are taken when the bladder contracts).

The ultrasound is easy, and shows if there is damage to the kidney. When there is a normal ultrasound, parents often wonder why a VCUG or other cystogram is needed. The ultrasound detects kidney scarring (which the VCUG cannot), but it does not detect most reflux.

•How is it treated?
The most significant lasting damage from reflux comes when infections scar the kidneys. The goal of treatment is to prevent infections and prevent scarring.

Sometimes surgery is done to correct the reflux. Sometimes children are treated with long-term antibiotics to prevent infections while waiting for them to outgrow the reflux.

The American Urological Society published evidenced-based guidelines to help determine the best treatment options depending on the age of the child and the nature of the reflux.

•How can it be prevented?
Children are born with reflux. Preventing the complications of reflux involves either long-term antibiotics to prevent urinary tract infections or surgery to correct the reflux.

•Related A-to-Z Information:
E. Coli, Enuresis (Bedwetting), Gastroesophageal Reflux, Hernia (Inguinal hernia), Hydrocele, Hypospadius, Meatal Stenosis, Pyelonephritis, Undescended Testicle (Cryptorchidism)

Retrieved from “”
Urinary tract infections can occur in the bladder (cystitis) or in the kidney (pyelonephritis). Stool bacteria are the most likely to cause urinary tract infections. Usually these bacteria come up through the urinary tract from the outside. Sometimes bacteria in the bloodstream settle into the kidney, causing an infection.

Viruses such as adenovirus can also cause urinary tract infections.

•Who gets it?
In boys, urinary tract infections are most common in the first year of life. In girls, the peak time occurs during toilet training. Uncircumcised boys are much more likely to have these infections than circumcised boys. After the first year or two of life, girls are far more likely to have urinary tract infections than boys.

Children with VU reflux, or other urinary tract problems, are more likely to have pyelonephritis. Constipation, pinworms, labial adhesions, and neurologic problems, such as spina bifida, are among the other factors that can lead to these infections.

•What are the symptoms?
Classic symptoms of pyelonephritis include fever, flank pain, and/ or vomiting. Diarrhea is sometimes present as well. Young babies with pyelonephritis may be irritable, jaundiced, and feed poorly.

•Is it contagious?
Pyelonephritis is not directly contagious, although the bacteria in stool that can lead to pyelonephritis can be spread by touch.

•How long does it last?
Pyelonephritis may last until treated. Once appropriate treatment is begun, improvement is often rapid. The infection is generally cleared within 2 weeks or less.

•How is it diagnosed?
An infection of the urinary tract is generally diagnosed with a urine culture. The location of the infection in the urinary tract is usually determined based on the history and the physical examination. If the diagnosis is not clear, imaging studies such as a renal scan can solve the puzzle.

•How is it treated?
Antibiotics are used to treat pyelonephritis. Prompt and adequate treatment is important.

•How can it be prevented?
Avoiding wiping from back to front and avoiding tight-fitting underwear can prevent some urinary tract infections.

Children who have had pyelonephritis once (and most young children who have had any urinary tract infection) should have imaging studies of the urinary tract to identify specific ways to prevent further infections. Depending on the situation, preventive antibiotics or even surgery might be wise.

•Related A-to-Z Information:
Adenovirus, Constipation, Dehydration, Diaper Rash, Diarrhea, E. Coli, Enuresis (Bedwetting), Febrile seizures, Hematuria, Hypospadius, Inconspicuous Penis, Jaundice (Bilirubin, Hyperbilirubinemia), Labial Adhesions, Pinworms, Sexual Abuse, Sexual Curiosity in Young Children, Spina Bifida, Urinary Tract Infection (Cystitis), Vesicoureteral Reflux, Vomiting

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Date : 05 May 2016

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