A cropped shot of a child holding a cut-out illustration of the kidneys.

What Is Vesicoureteral Reflux (VUR)?

Vesicoureteral reflux (VUR), also known as kidney reflux, is a condition that affects 1-3% of children. It occurs when one or both ureters are too short, causing urine to wash back up toward the kidneys.

Symptoms of Vesicoureteral Reflux (VUR)

Recurring urinary tract infections are common in patients with VUR, although vesicoureteral reflux is far from the only cause of UTIs in children. Other potential symptoms include:

Poor weight gain
High blood pressure
UTI accompanied by fever
Burning sensation with urination
A stomach mass from a swollen kidney
Trouble with urination, including urgency, dribbling, and bedwetting

What Are the Different Types of VUR?

While severe VUR can lead to renal scarring and kidney failure, low-grade VUR usually resolves spontaneously. Low-grade VUR generally includes grades 1-2, while high-grade VUR includes grades 3-5.

There are two primary types of VUR, including:

Primary Vesicoureteral Reflux

Primary VUR occurs in children who are born with a defective valve, which is supposed to prevent urine from flowing backward from the bladder into the ureters.

Secondary Vesicoureteral Reflux

Secondary VUR occurs when the child's bladder fails to empty properly due to an outlying issue, such as a blockage, bladder muscle failure, or nerve damage.

What Are the Risk Factors for VUR?

While the exact cause of VUR is unknown, there is a definite genetic component involved that causes this condition to run in families. This condition is also common in children with other urinary tract abnormalities, such as posterior urethral valves, ureterocele, and ureter duplication, which is the most common renal abnormality occurring in approximately 1% of the population and 10% of children with urinary tract infections.

Additional risk factors for VUR include:

Race — White children are typically at a higher risk of VUR.
Sex — Girls are diagnosed with VUR at a higher rate than boys in early childhood.
Age — Infants and children under two years of age are more likely to receive a VUR diagnosis.
Family history — Children with familial histories of VUR are at an increased risk of developing the condition.
Bladder and bowel dysfunction — Children with BBD often experience UTIs at a higher rate, potentially leading to a VUR diagnosis.

Health Complications Stemming from VUR

Left untreated, VUR can lead to a wide range of adverse health outcomes. Depending on the grade and severity, potential complications include:

Renal scarring — Untreated VUR can lead to permanent damage to kidney tissue, increasing the risk of high blood pressure and kidney failure.
Hypertension — The kidneys are responsible for removing waste from the bloodstream. Renal scarring and waste build-up due to VUR can lead to hypertension in affected patients.
Kidney failure — In severe cases, untreated VUR can lead to kidney failure.

How Many Children Are Diagnosed with VUR?

According to the National Kidney Foundation, 1-3% of children have vesicoureteral reflux (VUR). Approximately 1 in 3 children with recurring UTIs and a fever have kidney reflux.

How Is VUR Diagnosed?

While the voiding cystourethrogram (VCUG) is the decades-old “gold standard” for diagnosing VUR in pediatric patients, it remains the most controversial area of pediatric urology. Research shows that the majority of children with grades 1-3 don’t require any intense therapy. This is because low-grade reflux typically resolves on its own within a few years. However, children who experience frequent fevers and infections may require ongoing preventative care in the form of antibiotic therapy, urine tests, and surgical treatment in serious cases.

How Is VUR Treated?

Treatment methods for VUR depend on numerous factors, including grade severity, familial history, and patient preferences. It’s imperative to understand that the VCUG procedure does not treat VUR, but is simply a diagnostic tool to identify the condition in patients. Instead, treatment for VUR may include the following:

Wait-and-see approach — This is commonly prescribed for children with low-grade VUR, who are most likely to outgrow the condition.
Antibiotic therapy — Antibiotics may be prescribed in daily low doses to manage urinary tract infections (UTIs) in children with mild to moderate VUR.
Renal ultrasound — This external, non-invasive test uses a transducer to produce images of the kidneys and urinary tract.
Ureteral reimplantation surgery — This procedure reconstructs the connection between the bladder and the ureter(s).
Endoscopic surgery — This procedure involves the insertion of a cystoscope into the urethra to visualize the bladder, then inject a gel-like agent around the opening of the affected ureter(s) to strengthen the valve.

Is VCUG the Only Diagnostic Test for VUR?

No, VCUG is far from the only diagnostic method for diagnosing VUR in kids. Most mild cases of reflux resolve spontaneously without treatment. Other diagnostic techniques include various imaging tests, including renal ultrasound and urinalysis (lab tests). Screening for a family history of VUR is another effective way to diagnose VUR in pediatric patients.

Another effective diagnostic method is contrast-enhanced voiding urosonography (ceVUS), a radiation-free imaging test that utilizes ultrasound instead of ionizing radiation. ceVUS is not only more cost-effective for families, but also has an equal or superior diagnostic value to VCUG.

Additional diagnostic techniques include:

DMSA renogram
Renal MAG3 scan
Computed tomography (CT) urogram
PIC cystogram (positioned instillation of contrast cystogram)

Join the Unsilenced Movement

If you or a loved one is struggling with vesicoureteral reflux, you’re not alone. The Unsilenced Movement understands the immense physical, emotional, and financial toll that comes with VUR diagnosis and treatment. That’s why our grassroots organization is committed to bridging the gap between providers and families by raising awareness about VCUG trauma, alternatives to VCUG/MCUG, and VUR management. Join us in advocating for overdue reform in pediatric urology. Because kids deserve better. #MoreThanATest

Whether you’re healing from VCUG trauma or supporting a loved one with VUR, the Unsilenced Movement is here to walk with you. Submit our online form to get connected and explore free resources for VUR/VCUG management.