Vesicoureteral Reflux (VUR)

Vesicoureteral reflux is the backflow of urine from the bladder into the ureters and sometimes the kidneys, which lets bacteria reach the upper urinary tract and causes recurrent urinary tract infections and pyelonephritis in children. Primary reflux is congenital, from a faulty valve where the ureter enters the bladder, while secondary reflux comes from high bladder pressure. The danger is renal scarring from repeated febrile kidney infections, which leads to hypertension and reduced kidney function later. A voiding cystourethrogram makes the diagnosis, and reflux is graded from I, mild, to V, severe. Many children outgrow mild reflux within a few years; low-dose antibiotic prophylaxis may be given once daily, every day, even when the child is well, and surgery is considered for severe grades or breakthrough infections. Infants show only fever, poor feeding, vomiting or irritability, so the nurse collects a urine culture before the first antibiotic dose, by catheter if the child is not toilet-trained. Teaching covers timed and double voiding, preventing constipation, and reporting a fever of 100.4 °F or higher promptly.