- Kidney Reflux (Vesicoureteral reflux - VUR)
Urinary bladder (bladder) urination backwards ducts (ureters) and escape towards the kidney. This situation makes it easier for bacteria to reach the kidney, causing infections that may result in loss of function in the kidney and enlargement of the kidney through the urinary ducts (hydronephrosis).
The most important cause of VUR The reason is the presence of a developmental defect in the final junction parts of the ureters, where they discharge into the bladder (Primary VUR). It is known that this defect occurs genetically and therefore its incidence within the same family is higher than normal. The probability of a sibling of a child with VUR to also have VUR is around 30% and therefore it should be checked. It is recommended.
Although the urinary duct-bladder junction is normal, in cases where there are congenitally double urinary ducts or in cases where there is an excessive increase in pressure in the bladder (such as bladder outlet obstruction, neurological diseases with excessive contractions in the bladder) renal reflux may occur (secondary VUR).
- Symptoms, Signs and Diagnosis
Not yet When enlargement is detected by ultrasonography in the kidneys of a fetus followed in the womb, one of the reasons that should be considered is VUR. These children are re-evaluated after birth and if deemed necessary, a radiological examination (voiding cystourethrography) is performed by administering medication into the bladder, which is used to diagnose VUR.
Febrile in infancy. VUR should be suspected in every child who has a urinary tract infection. The patient group we encounter most frequently is girls at preschool age who present with frequently recurring infections. In these children, urinary incontinence may occur during the day and at night, and constipation is often present.
Ultarsonography, which has no side effects or harm for children, can be performed to enlarge the kidney. However, since this finding will not occur in non-advanced reflux cases, ultrasonography is not sufficient for diagnosis. B. Although it is a bit troublesome for babies and children, the best diagnostic method currently available for those suspected of VUR all over the world is VCUG, in which a catheter is inserted into the bladder, medication is administered, and images are taken during filling and urination. . It is inevitable that the child will be exposed to some radiation during this examination. However, this is the most useful method to ensure the correct diagnosis of VUR, if any, to determine whether there is any other accompanying abnormality in the bladder and its outlet that may cause reflux, and to evaluate the reflux, if any.
If VUR is detected, it can be understood by performing kidney scintigraphy (DMSA Scintigraphy) whether there is any damage to the kidney. For this test, a very small amount of radioactive material is given intravenously to evaluate the losses that may occur in the fleshy part of the kidney due to reflux (renal scar).
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Treatment
First of all, if there are bladder problems that may cause VUR, these must be resolved. If there is an abnormality causing obstruction at the bladder outlet, it is eliminated, and if excessive contractions occur, relaxant medication is started.
The basic approach for low-grade (first, second and third degrees) primary VUR is follow-up. During follow-up, low-dose antibiotics are given continuously to prevent new infections. Intermittent urine culture follow-up and VCUG and renal scintigraphy are recommended once a year. In the meantime, if there is constipation, it must be prevented with diet or medication. In addition, during urination, it is important to ensure that the child urinates twice in a row (double urination) by sitting with his feet touching the ground and leaning forward, increasing the intra-abdominal pressure. This follow-up can be continued until adolescence, with the expectation that the urinary tract and bladder junction will develop as the child grows and develops and the reflux will subside on its own.
Situations requiring surgery: 1) VURs that are high-grade when diagnosed 2) Even if they are grade 3 Situations where the risks of new infections cannot be taken into consideration due to bilateral or severe renal scarring
3) Infection attacks that cannot be prevented despite preventive antibiotic treatment
Surgical treatment is basically, It can be done in two ways: open or endoscopic. In open surgery, a new junction is created at the urinary tract-bladder junction that will not allow reversal, and the chance of success is 95%. With endoscopic intervention, a partial closure is performed by injecting a substance into the urinary tract-bladder junction, but it is not as successful as open repair. Repeated interventions may be required.
After the operation, your doctor will ask you to use low doses of protective antibiotics for a while. If it is seen that the reflux has completely resolved after the VCUG control at the 3rd or 6th month, the antibiotic will be discontinued.
Blood pressure measurements of children with tissue loss in the kidney should be taken regularly. One of the leading causes of high blood pressure in childhood is scar development in the kidney after reflux and previous infections.
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