Vesicoureteral reflux (VUR) is a condition of urinary tract in which the urine flows in wrong direction that is backwards from bladder to ureter and the kidney. This condition is less recognized in adult population, as it is more common in infants and children. Urine released from kidney normally passes in one direction from kidney to ureter and than in bladder. The back flow of urine is prevented due to a 1 way valve at the junction of ureter and bladder. Deficiency of valve predisposes an individual to develop retrograde urine reflux.
Vesicoureteral reflux increases risk of urinary tract infection and also subsequent kidney damage if not treated. Vesicoureteral reflux in adult can be since childhood but it may have remained undetected. It may also occur in adults having obstruction in bladder, history of prior surgery or due to neurological disorder. Many adult patients with VUR have other sequalae such as hypertension, renal calculi or end stage renal disease. Treatment consists of antibiotics and surgical correction if the condition is severe.
What Are The Causes Of Kidney Reflux?
Normally in a healthy person, the kidneys filter waste and extra fluid from the blood which is excreted in the form of urine.Urine passes down from kidney into the bladder through tube like structure called ureter. There are two ureter attached above to each kidney and below to the single bladder. Urine flows in one direction and does not flow backwards. The valve like mechanism between the ureter and bladder prevents its backflow. However, in vesicoureteral reflux, there is defect in the valve. This allows the urine to go upwards in the ureter and in kidney.
There are two types of vesicoureteral reflux; primary and secondary. Primary is congenital meaning the infant is born with this anomaly. The faulty valve can be between one or both ureters and bladder. The valve does not close properly because the ureter is extremely short. Usually primary VUR over a period of time improves as the child grows older.
Secondary vesicoureteral reflux develops as a result of pressure in the bladder. The pressure generated in bladder usually forces the urine to move upwards into the ureter and in some cases to the kidney. It is more common in adults having mass or a large stone in a bladder. Neurogenic bladder in adults can also cause vesicoureteral reflux. Blockage may also result from recurrent UTI.
Symptoms Of Vesicoureteral Reflux In Adults
The symptoms of vesicoureteral reflux in adults can be varied. In case of mild to moderate reflux, urine just backs up into the ureter. In more severe cases the urine backups in the kidney leading to its damage. One of most common symptoms is urinary tract infection. Without treatment the infection can spread to kidney leading to permanent scarring. Following are the symptoms noted:
- Frequent urinary tract infection leading to urgency of passing urine, burning in urine, red sandy urine due to passage of blood in urine, unpleasant smell in urine.
- Due to UTI patient may have other accompanying symptoms such as fever, vomiting, nausea, pain in back and abdomen.
- Passage of excessive protein in urine that is detected in urine examination.
- Kidney failure because of scarring in kidney due to frequent UTI infection.
- Palpable mass in the abdomen due to swelling of the kidney.
- Poor weight gain
Diagnosis And Treatment Of Vesicoureteral Reflux
Following tests help to diagnose vesicoureteral reflux:
- Medical history and clinical examination of the patient.
- Sonography of urinary tract.
- Urine analysis for proteinuria.
- Serum creatinine test for kidney function.
- Micturating cystourethrogram.
- Radioneucleotide cystography.
- Intravenous pyelography.
- CT scan of urinary tract.
Treatment of vesicoureteral reflux can be medical or surgical. Medical treatment consists of use of antibiotics for treating urinary tract infection or as a prophylaxis against infection in the urinary tract. Medicines may also be required to reduce hypertension which is common in adults suffering from vesicoureteral reflux.
In adults if blockage is found to the cause, surgical treatment may be necessary to remove or correct the blockage. Often draining of urine through urethra with the help of catheter may be required.