In vesicoureteral reflux urine flows backward from the bladder up the ureters toward the kidneys, most often because the ureter enters the bladder through a tunnel that is too short. It is usually found in young children after a febrile urinary tract infection, and repeated kidney infections can scar the kidneys.
Key symptoms
- Fever with a urinary infection in an infant, often with no other urinary clues
- Irritability, poor feeding or vomiting in babies
- Painful urination, frequency or flank pain in older children
- Kidney swelling (hydronephrosis) seen on a prenatal ultrasound
What you find on exam
- Temperature, blood pressure and growth
- Abdominal and flank tenderness
- Signs of constipation and bladder and bowel dysfunction
- Inspect the genitals and lower back for a dimple or tuft of hair
Tests
- Urinalysis and catheter urine culture for a febrile infection
- Kidney and bladder ultrasound after a first febrile UTI
- Voiding cystourethrogram to diagnose and grade reflux from I to V if ultrasound is abnormal or UTIs recur
- DMSA scan for kidney scarring; creatinine
Treatment basics
- Treat each urinary infection promptly
- Treat bladder and bowel dysfunction: timed voiding and constipation care
- Antibiotic prophylaxis such as trimethoprim-sulfamethoxazole in selected children
- Many low-grade cases resolve as the child grows
- Endoscopic injection or ureteral reimplantation for high grades, breakthrough infections or scarring
Red flags
- Infant with fever and lethargy or poor feeding (kidney infection or urosepsis)
- Rising creatinine or high blood pressure (reflux nephropathy)
- Febrile infection despite antibiotic prophylaxis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.