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Am Fam Physician. 2004;69(1):152

What is a urinary reflux?

Urinary reflux is when urine in the bladder backs up into the kidneys. Urine normally goes only one way—from the kidneys down into the bladder. So when urine flows backwards from the bladder, bacteria (germs) can get into the kidneys. This can lead to infection in the urinary tract. If reflux is not noticed, the repeated infections can lead to scarring of the kidneys. Reflux happens in about one third of children who have urinary tract infections (also called UTIs).

Does a UTI mean there is something wrong with my child's urinary tract?

Most children who get a UTI have a normal urinary tract. Just as some children get ear infections even though their ears are normal, some children get UTIs even though they have a normal urinary tract. However, some children with UTIs do have something wrong with their urinary tract. Your doctor may order special tests to find out. This is more likely if your child is very young at the time of a first infection, or if your child has had many infections.

What kind of tests will the doctor do?

There are several tests that look at the urinary tract. An ultrasound exam is a painless test that gives your doctor a good look at your child's kidneys and bladder.

A bladder x-ray, called a voiding cystourethrogram (VCUG), is a good way to look inside the bladder. A small tube is put into your child's bladder. A liquid is passed through the tube into the bladder. This liquid shows up on the x-ray. X-rays are then taken as the bladder fills and while your child urinates. This study gives good pictures of the bladder and urethra. It is used to see if your child has reflux.

Another test that is sometimes used in children with UTIs is a kidney scan. For this test, a small amount of radioactive medicine is put into your child's blood stream with an intravenous (IV) line. Pictures of the kidneys are then taken with a special camera. This is a good test to find scarring in the kidneys. It is most commonly used in children who are known to have reflux.

Which one of these tests is ordered for your child depends on your child's age and sex, how many infections your child has had, and how bad the infections were.

How is urinary reflux treated?

Reflux tends to go away on its own. So, most children with reflux do not need treatment, except to see their doctor regularly. However, some children with reflux need to take an antibiotic every day to prevent UTIs. It is important for your child to go to the doctor for regular check-ups and to take any medicines just the way the doctor says to. A few children may need surgery if they continue to get UTIs while taking antibiotics, if they develop new scarring of the kidneys, if they have serious reflux, or if they can't take antibiotics.

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