Children with antenatal hydonephrosis, usually diagnosed on a prenatal ultrasound, are also at risk for vesicoureteral reflux.
Vesicoureteral reflux is an important cause of renal scarring and reflux nephropathy, a type of kidney damage that can lead to hypertension and even kidney failure. Reflux may be mild (Grades I - III), or moderate to severe (Grades IV - V). Most cases of reflux will go away with time, especially the mild grades in younger children. More severe forms of reflux, or children who have a lot of UTIs may need surgery to correct the problem that is causing the reflux.
Relux can also lead to kidney infections (pyelonephritis), because it allows the bacteria from a urinary tract infection to reach the kidney. Further testing, such as a renal scan or DMSA scan may be needed if renal scarring or pyelonephritis is suspected.
If your child has reflux, he will need to take a prophylactic antibiotic each day to prevent more urine infections (antibiotic prophylaxis). Commonly used antibiotics include amoxicillin for newborns. Older infants and children are usually placed on either trimethoprim-sulfamethoxazole (Bactrim) or nitrofurantoin (Macrodantin).
Since sterile urine, or urine that is not infected with a bacteria, does not cause kidney damage, it is more important to keep the urine free of infection (by taking a daily antibiotic) until the vesicoureteral reflux has cleared up on its own.
Testing with a VCUG and sonogram is then repeated every six to twelve months until the reflux has cleared. Fortunately, most children with reflux will outgrow it without developing any trouble with their kidneys.
Other monitoring techniques may including regular urine cultures, although most doctors just obtain a urine culture when a urinary tract infection is suspected, such as when a child has a fever without another source, urinary accidents or burning while urinating.
Children with high grade (IV or V) or severe reflux or those with more mild or moderate reflux, but who continue to get urinary tract infections despite being on prophylactic antibiotics (breakthrough infections), may need to see a Pediatric Urologist for further management and treatment. Surgical management, usually by ureteral reimplantation is often required in these cases.
Reflux does seem to run in certain families, and if one of your children is found to have reflux, your doctor will consider testing your other children. About 40% of siblings of children with reflux also have reflux, even though they may never have had a urinary tract infection. Reflux is also commonly found in the children of women who had reflux as a child.
The tests that are done include a sonogram (ultrasound) of the kidneys (to look for hydronephrosis) and another test called a VCUG (voiding cysto-urethrogram) that involves placing a catheter in to the bladder and then injecting a dye. X-rays are then taken to see if the dye moves up towards the kidney.
