Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys. VUR is most common in infants and young children. Most children don’t have long-term problems from VUR.

Normally, urine flows down the urinary tract, from the kidneys, through the ureters, to the bladder. With VUR, some urine will flow back up—or reflux—through one or both ureters and may reach the kidneys.

Sometimes a child with VUR has no symptoms. If a child does have symptoms, the most common is a UTI. When urine flows backward, as it does with VUR, bacteria can grow more easily in the child’s urinary tract, causing a UTI.

Problems with bladder or bowel function can sometimes be related to VUR. A child with VUR is more likely to have

• UTIs, including bladder or kidney infections
• other bladder problems, such as urinary incontinence, bedwetting, and urinary retention
• bowel problems, such as constipation

Most children with VUR who get a UTI recover without other problems. However, in some cases, UTIs can lead to kidney scarring, also called renal scarring, or permanent scars on the kidney. A child is more likely to have kidney scarring if he or she is not treated at all—or not treated fast enough—for a UTI, repeat UTIs, or a high grade of VUR.

CAUSES

Primary vesicoureteral reflux

Most children who have VUR have primary VUR, which means they are born with an abnormal ureter. With primary VUR, the valve between the ureter and the bladder does not close well, so urine comes back up the ureter toward the kidney. If only one ureter and one kidney are affected, doctors call the VUR unilateral reflux.

Primary VUR can get better or go away as a child gets older. As a child grows, the entrance of the ureter into the bladder matures and the valve works better.

Secondary vesicoureteral reflux

Children can have secondary VUR for many reasons, including a blockage or narrowing in the bladder neck or urethra. For example, a fold of tissue may block the urethra. The blockage stops some of the urine from leaving the body, so the urine goes back up the urinary tract.

A child also can have secondary VUR because the nerves to the bladder may not work well. The nerve problems can prevent the bladder from relaxing and contracting normally to release urine.

SYMPTOMS

Urinary tract infections commonly occur in people with vesicoureteral reflux. A urinary tract infection (UTI) doesn't always cause noticeable signs and symptoms, though most people have some.

• These signs and symptoms can include:
• A strong, persistent urge to urinate
• A burning sensation when urinating
• The need to pass small amounts of urine frequently
• Cloudy urine
• Fever
• Pain in your side (flank) or abdomen

A UTI may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may also include:

• An unexplained fever
• Lack of appetite
• Irritability

As your child gets older, untreated vesicoureteral reflux can lead to:

• Bed-wetting
• Constipation or loss of control over bowel movements
• High blood pressure
• Protein in urine

Another indication of vesicoureteral reflux, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys (hydronephrosis) in the fetus, caused by the backup of urine into the kidneys.

DIAGNOSIS

Imaging tests

Before you and your child’s doctor decide to use urinary tract imaging to diagnose VUR in your child, a doctor considers the child’s

• age
• symptoms
• family history of VUR
• sexual activity level in an older child

Following lab investigation are done:

• Abdominal ultrasound
• Voiding cystourethrogram (VCUG).

COMPLICATIONS

Kidney damage is the primary concern with vesicoureteral reflux. The more severe the reflux, the more serious the complications are likely to be.

Complications may include:

• Kidney (renal) scarring.Untreated UTIs can lead to scarring, which is permanent damage to kidney tissue. Extensive scarring may lead to high blood pressure and kidney failure.
• High blood pressure.Because the kidneys remove waste from the bloodstream, damage to your kidneys and the resultant buildup of wastes can raise your blood pressure.
• Kidney failure.Scarring can cause a loss of function in the filtering part of the kidney. This may lead to kidney failure, which can occur quickly (acute kidney failure) or may develop over time (chronic kidney disease).

HOMOEOPATHIC TREATMENT

Homoeopathy today is a rapidly growing system and is being practiced all over the world. It strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. When vesicoureteral reflux is concerned there are many effective medicines available in Homoeopathy , but the selection depends upon the individuality of the patient , considering mental and physical symptoms

Pareira brava –renal colic pain going down thighs constant urging great strining pain in the thighs during effort to urinate can pass urine only when he goes on his knees pressing hard firmly on the floor.

Colocynthis –tenermus of bladder , pains on urinating over whole abdomen agonizing cutting pain in abdomen causing patient to bend double and pressing on the abdomen . sensitive in the calves cutting I abdomen <anger and indignation> doubling up hard pressure

Berberis vulgaris —main remedy for renal colic especially when the pain is on the left side and extends from kidneys to urethra , with urging to urinate . . Here the pain is found on the left side of renal region There is stitching, cutting pain from left kidney following course of ureter into bladder & urethra. Burning & soreness in region of kidneys. Pain in small of back, very sensitive to touch in renal region <when sitting & lying, from jar, fatigue. Numbness, stiffness & lameness with painful pressure in renal & lumbar regions. Bubbling sensation in kidneys. Urine greenish, blood red, with thick, slimy mucus, transparent, reddish or jelly like sediment

Cantharis --Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in whole renal region. Violent tenesmus & strangury. Drinking even small quantities of water increases pain in bladder