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Because it mainly affects small children who can’t express the issue and often isn’t symptomatic until there is an infection, vesicoureteral reflux can be difficult to diagnose.

Anyone can get a UTI, just like anyone can catch a common cold or get a sinus infection. That’s because a UTI is a urinary tract infection, and everyone is susceptible to bacterial infections. However, there are those that have a higher risk factor of developing a UTI or having recurring UTIs due to other underlying conditions they have. This is true of people of all ages, including children. In fact, there is most definitely a link between children with vesicoureteral reflux, or VUR, and excessive or frequent UTIs.

What is VUR?

Vesicoureteral reflux, more easily referred to as VUR, is a condition in which the urinary tract malfunctions and causes the urine to flow improperly. There are two types of VUR – primary and secondary – but both result in the same malfunction.

In a normal urinary tract, the kidneys pull excess water and waste from the body and pass it slowly through the ureters to the bladder. Here, it gathers, and when the bladder is full, a person feels the need to urinate. Urine passes out of the body through the urethra. In a healthy urinary tract, the urine is only allowed to flow down the ureters into the bladder. However, in those with VUR, some other condition causes the urine to flow back up the ureters into the kidneys.

The condition is most commonly found in infants and children, and in many cases, these young patients can outgrow the condition. However, there are also treatments and surgeries necessary in some cases.

Primary VUR

In primary VUR, the cause is a congenital defect. There is a valve that keeps urine from flowing back into the kidneys, and in VUR, that valve is defective, sometimes opening the wrong direction or even missing. This leads to urine being able to flow both directions through the ureters, which is unhealthy, to say the least.

Secondary VUR

In secondary VUR, the condition that causes the reflux is due to some other type of malfunction in the urinary tract, which can cause pressure in the bladder to become extremely high. This could be a congenital defect in the urethra or bladder, causing a blockage so urine can’t flow out normally, and that incredible pressure pushes urine back up into the kidneys, or it could be some other condition.

Symptoms and UTIs

In many cases, VUR doesn’t surface as symptomatic on its own. However, because of the nature of the ailment, it often causes chronic UTIs, thus forming the link between the two conditions. Note that, if a UTI is left untreated for a long time, the cause can be reversed as well, with the severe inflammation not allowing urine to pass through the urethra leading to VUR.

Either way, symptoms are typically related to a UTI:

  • Strong and persistent need to pee
  • Frequent need to urinate with small amounts produced
  • Blood in the urine, cloudy urine, or smelly urine
  • Fever
  • Pain in the sides and abdomen
  • Burning and pain during urination, or hesitancy to urinate because of this

Of course, this isn’t something that can be diagnosed in infants based on these criteria, and most often, these are the patients suffering from VUR. Infants will:

  • Have a fever that can’t be otherwise explained
  • Have a change in appetite, usually refusing to eat
  • Be extremely irritable
  • Often have diarrhea

In older children, other symptoms become more apparent, such as:

  • High blood pressure
  • Constipation or loss of bowel control
  • Wetting the bed despite being toilet trained
  • Protein in the urine

If left untreated, this can cause kidney damage or even kidney failure. If there is a family history of VUR, signs can be detected prior to birth through a sonogram, showing a backup of urine in the fetus or swollen kidneys.

Risk factors for VUR

While anyone can have VUR, it’s most commonly diagnosed in infancy due to the fact that it’s related to congenital deformities in the urinary tract, and these are usually detected at a young age. Still, there are several risk factors to consider when worrying if a child is going to present with the ailment and need treatment to avoid suffering frequent or chronic UTIs.

  • Age. Children up to age two are the most likely to be diagnosed.
  • Race. VUR most commonly appears in Caucasian children.
  • Sex. Interestingly, this varies. If the condition is present at birth and is primary VUR, the risk factor is higher for males. For later developed issues, or secondary VUR, girls are twice as likely as boys to suffer the ailment.
  • Family history. This seems to be a genetic condition, and children with parents who had VUR are more likely to have it. In addition, there is a slightly higher risk for children with siblings who already have VUR.

Complications

The kidneys are important in many ways. They regulate the amount of fluid in the body, temperature, and blood pressure, and they are the waste management center. If the kidneys are damaged, several other systems can fail as well, including the heart and liver. Some of the major complications that come from VUR greatly affect the kidneys, leading to a need for treatment and correction as soon as possible.

Things that can occur include:

  • Hypertension. Buildup of the waste that the kidneys should be removing in the system can lead to high blood pressure, which creates situations that increase risk of heart disease and coronary problems.
  • Renal scarring. VUR causes UTIs, which can lead to scarring of the kidneys. Scarring of the kidney tissue is permanent and can’t be fixed. This can lead to greater problems in the kidneys, including hypertension and failure.
  • Kidney failure. When the kidneys can no longer filter the blood, patients may experience acute (or quick and instant) kidney failure, or this may happen over a period of time. Either way, kidney failure requires hospitalization, dialysis, and other treatment that avoids sepsis and other fatal conditions.

A child should see a doctor immediately if:

  • The child is under three months of age and has a rectal temperature greater than 100.4 F
  • The child is older than three months and has a fever of 102 F
  • The child’s fever has no other explanation, such as a recent vaccination
  • The child’s appetite changes or the infant becomes extremely lethargic and moody
  • The child has diarrhea or is vomiting (not just spitting up a little formula here and there)

Conclusion

Because it mainly affects small children who can’t express the issue and often isn’t symptomatic until there is an infection, vesicoureteral reflux can be difficult to diagnose. Paying attention and knowing your child’s usual mood and habits can go a long way in helping to realize when there is a problem so that a physician can address the issue and find the best way to resolve it. Early recognition and treatment can avoid lifelong suffering from kidney problems and chronic UTIs, helping the patient live a fuller, happier, and healthier life overall.

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