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what is kidney reflux

What is kidney reflux?
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Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys. Urine normally travels from the kidneys via the ureters to the bladder. In vesicoureteral reflux the direction of urine flow is reversed (retrograde).

Vesicoureteral reflux may present before birth as prenatal hydronephrosis, an abnormal widening of the ureter or with a urinary tract infection or acute pyelonephritis. Symptoms such as painful urination or renal colic/flank pain are not symptoms associated with vesicoureteral reflux.

Newborns may be lethargic with faltering growth, while infants and young children typically present with pyrexia, dysuria, frequent urination, malodorous urine and GIT symptoms, but only when urinary tract infection is present as the initial presentation of VUR.

In healthy individuals the ureters enterposteriorly. Together these features produce a valvelike effect that occludes the ureteric opening during storage and voiding of urine. In people with VUR, failure of this mechanism occurs, with resultant retrograde flow of urine.

Hardikar syndrome can include Vesicoureteral reflux, Hydronephrosis, cleft lip and palate, Intestinal obstruction and other symptoms.[1]

Primary VUR
Insufficient submucosal length of the ureter relative to its diameter causes inadequacy of the valvular mechanism. This is precipitated by a congenital defect/lack of longitudinal muscle of  the urinary bladder obliquely and run submucosally for some distance. This, in addition to the ureter's muscular attachments, helps secure and support them the intravesical ureter resulting in an ureterovesicular junction (UVJ) anomaly.

Secondary VUR
In this category the valvular mechanism is intact and healthy to start with but becomes overwhelmed by raised vesicular pressures associated with obstruction, which distorts the ureterovesical junction. The obstructions may be anatomical or functional. Secondary VUR can be further divided into anatomical and functional groups as follows:

Anatomical: Posterior urethral valves; urethral or meatal stenosis.

These causes are treated surgically when possible.

Functional: Bladder instability, neurogenic bladder and non-neurogenic neurogenic bladder Urinary tract infections may cause reflux due to the elevated pressures associated with inflammation.
Resolution of functional VUR will usually occur if the precipitating cause is treated and resolved. Medical and/or surgical treatment may be indicated.

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Sorry Allisonsnana,

Despite my thinking i was typing so fast i submitted the answer carrying on................

It has been estimated that VUR is present in more than 10% of the population. In children without urinary tract infections 17.2-18.5% have VUR, whereas in those with urinary tract infections the incidence may be as high as 70%

Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. This susceptibility decreases with age as the length of the ureters increases as the children grow. In children under the age of 1 year with a urinary tract infection, 70% will have VUR. This number decreases to 15% by the age of 12.

Although VUR is more common in males antenatally, in later life there is a definite female preponderance with 85% of cases being female.

Medical Treatment
Medical treatment entails low dose antibiotic prophylaxis until resolution of VUR occurs. Antibiotics are administered nightly at half the normal therapeutic dose. The specific antibiotics used differ with the age of the patient and include:

Amoxicillin or ampicillin - infants younger than 6 weeks
Trimethoprim-sulfamethoxazole (co-trimoxazole) - 6 weeks to 2 months
After 2 months the following antibiotics are suitable:

Nitrofurantoin{5–7 mg/kg/24hrs}
Nalidixic acid
Urine cultures are performed 3 monthly to exclude breakthrough infection. Annual radiological investigations are likewise indicated. Good perineal hygiene, and timed and double voiding are also important aspects of medical treatment. Bladder dysfunction is treated with the administration of anticholinergics.

Surgical Management
A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. Similarly if the VUR is severe (Grade IV & V), there are pyelonephritic changes or congenital abnormalities. Other reasons necessitating surgical intervention are failure of renal growth, formation of new scars, renal deterioration and VUR in girls approaching puberty.

There are three types of surgical procedure available for the treatment of VUR: endoscopic (STING/HIT procedures); laparoscopic; and open procedures (Cohen procedure, Leadbetter-Politano procedure).

I hope you will find this information useful,
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