Vesicoureteral Reflux

Pediatric nephrologists and pediatric urologists are medical doctors who focus on kidney and urinary tract conditions. It’s likely your pediatrician will refer you to one or both of these specialists for your child’s care.

They may order the following tests to diagnose vesicoureteral reflux (VUR):

• Voiding cystourethrogram (VCUG): VCUG is an X-ray image of the bladder and urethra taken before, during and after urination. A small catheter is placed into the urethra and is used to fill your child’s bladder with a special dye that can be seen by X-ray. The X-rays show if urine is flowing backward from their bladder into the ureters. A provider performs this procedure in their office, an outpatient center or a hospital. Anesthesia isn’t necessary, but sedation may help some children.
• Ultrasound: This safe and painless imaging technique uses sound waves to create images of your child’s entire urinary tract, including their kidneys and bladder. The study occurs in a healthcare provider’s office, outpatient center or a hospital. A provider may use an ultrasound before a VCUG or RNC if you or your healthcare provider want to avoid exposure to X-ray radiation or radioactive material. A fetal ultrasound can also show signs of VUR (like swollen kidneys), which means a person can learn their child may have VUR during pregnancy.
• Dimercaptosuccinic acid (DMSA) scan: This imaging test reveals if scars developed in your child’s kidney due to kidney UTIs.
• Radionuclide cystogram (RNC): RNC is a type of nuclear scan that involves placing radioactive material into your child’s bladder. A scanner then detects the radioactive material as your child urinates or after their bladder is empty. The procedure happens in a healthcare provider’s office, outpatient center or a hospital by a specially trained technician, and the images are interpreted by a radiologist. Your child won’t need anesthesia, but sedation may help some children. RNC is more sensitive than VCUG but doesn’t provide as much detail of the bladder anatomy.

What other tests do children with vesicoureteral reflux (VUR) need?

If your child receives a vesicoureteral reflux (VUR) diagnosis, they should have the following tests regularly:

• Blood pressure checks: Kidney problems put a child at higher risk for high blood pressure.
• Blood tests: High levels of protein or creatinine are signs of kidney damage.
• Urine tests and culture: Protein in pee is a sign of kidney damage and bacteria in pee is a sign of infection.

Your child’s healthcare provider may also evaluate them for bladder and bowel dysfunction (BBD). Symptoms of bowel and bladder problems include:

• Having to pee often or suddenly.
• Long periods of time between bathroom visits.
• Daytime wetting.
• Constipation (three or fewer bowel movements a week).
• Fecal incontinence (lack of control of bowel movements).

Children who have VUR along with any BBD symptoms are at greater risk of kidney damage due to infection.