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Paediatrics
Vesicoureteral Reflux and Urinary Tract Infection in Paediatrics Complete Guide
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Vesicoureteral reflux is a condition in which urine flows backward from the bladder into the ureters and sometimes the kidneys due to an abnormal ureterovesical junction. It increases the risk of recurrent urinary tract infections and kidney damage in children.
The most common cause of urinary tract infection in children is Escherichia coli. Other organisms include Klebsiella, Proteus, Enterococcus and Pseudomonas. Risk factors include vesicoureteral reflux, poor hygiene, constipation, urinary obstruction and neurogenic bladder.
Symptoms vary by age. Infants may have fever, irritability, vomiting and poor feeding. Older children commonly present with dysuria, urinary frequency, urgency, abdominal pain, flank pain and fever.
The gold standard test for diagnosing vesicoureteral reflux is a voiding cystourethrogram. Ultrasound is often used as an initial screening test, while a DMSA scan helps detect renal cortical scarring.
Vesicoureteral reflux is graded from I to V. Grade I involves reflux into the ureter only, Grade II reaches the renal pelvis without dilation, Grade III shows mild dilation, Grade IV shows moderate dilation and Grade V represents severe dilation with loss of papillary impressions.
Untreated vesicoureteral reflux can lead to recurrent urinary tract infections, pyelonephritis, renal scarring, reflux nephropathy, hypertension and chronic kidney disease.
Common imaging tests include renal ultrasound to detect structural abnormalities, voiding cystourethrogram to identify vesicoureteral reflux and DMSA renal scan to evaluate renal scarring.
Treatment usually involves antibiotics such as amoxicillin clavulanate, cephalosporins or ceftriaxone in severe cases. Hydration, fever control and addressing underlying causes like constipation are also important.
Surgery may be required in children with high grade reflux, recurrent infections despite antibiotic prophylaxis or progressive renal scarring. Surgical options include endoscopic injection therapy and ureteral reimplantation.
Prevention includes good hydration, proper perineal hygiene, treating constipation, regular bladder emptying and antibiotic prophylaxis in selected children with vesicoureteral reflux.
