Kidney Reflux Information and Articles

So now that we understand it, how in the world do you treat Vesicoureteral Reflux? For the purpose of this article we’re going to talk about the most commonly accepted treatment methods. You should know that they are widely debated. I have linked to some articles discussing that debate throughout this article if you are interested in reading more.

Treatment for VUR  is usually based on the grade of the reflux.  After diagnosis, the child is almost always started on a prophylactic antibiotic (abx), which is a daily low dose of antibiotic used to prevent UTI. The hope is that the abx will kill any bacteria before they can cause an infection. If there is no bacteria present, it reasons that there will be no UTI, and therefore no infection in the kidneys.  No kidney infection means no scarring or damage to the kidney. In recent years there has been a lot of debate as to whether this approach is effective or safe.  Most physicians believe that it is safe and until further studies can be completed (like the ongoing RIVUR study) it is generally recommended that low dose abx be used.  For more information about prophylatic antibiotic use, its safety and which types of abx are used click  here.

For reflux with the grades 1-3, the child is usually given daily abx, and then routinely monitored for any changes. Since about 80% of children in this group have spontaneous resolution, there may be no need for any other treatment, however monitoring should continue until the VUR has resolved. If the child has breakthrough infections, Endoscopic treatmet (Deflux) may be a good option for correcting the reflux in lower grades.

In grades 4-5, (sometimes 3 is also included in this group), abx are also started, and the child is routinely monitored. In the higher grades, spontaneous resolution is much less likely. For these children, Deflux injection, or reimplantation surgery may be required if the VUR does not resolve on it’s own, or if there are problems with breakthrough UTIs. If there are breakthrough infections, surgery may be considered, although most doctors try to delay surgery until the age of 18 months (except in cases of recurrent infection, or kidney damage).

There is a lot of debate on the treatment of VUR, but the overall goal is always to keep the kidneys healthy. From my experience and research, the first step is generally to start a child on abx at all grades (again, the effectiveness of antibiotics is widely debated). For all grades, if the child is under the age of 5, there is usually a waiting period given to monitor the child and allow time for growth.  The hope is that there may be some type of resolution (don’t forget, there is still a 10% chance that even grade 4 will resolve). A VCUG is performed yearly to monitor the child’s condition. When there are breakthrough infections, an aggressive approach may be needed to correct the reflux. Deflux is generally used for the lower grades, and the higher grades often require ureteral reimplantation.

Deflux has generally around 80% or higher success rate, and can be repeated to improve success rates. Reimplantation has a 95% or better success rate, but is much more invasive. You should discuss your options in detail with your urologist, and do your own research. For more detailed information on Deflux click  here. For more information on  ureteral reimplantation, click here.

For the very small percentage of failed reimplantation surgeries (of which our daughter Lizzie is a part), the child should undergo urodynamics study to rule out abnormalities in the bladder which may be causing the VUR. An MRI might also be a good option to rule out any neurologic problems which might be causing the VUR. Lizzie has done both of these tests in the past , and both have given us a great deal of information.

For a more in depth look at each of these treatment options, please check out the following articles:

Prophylactic Antibiotics for the Treatment of Vesicoureteral Reflux
Prophylactic Antibiotics – What’s the Big Debate?
Ureteral Reimplantation to correct Vesicoureteral Reflux
Endoscopic Treatment (Deflux) for the treatment of Vesicoureteral Reflux

What is Kidney Reflux?
How is Reflux Graded?
Symptoms of Reflux
Testing for Reflux
Treatment for Reflux