All about kidney reflux in children

Kidney reflux in children is a condition that can increase the chance of developing a urinary tract infection (UTI). What is it, and what can be done about it?

Leading paediatric urologist in Birmingham Mr Andrew Robb answers these questions in expert detail and addresses parental-assisted lifestyle changes that can help.  

What is kidney reflux in children, and how does it impact their health and well-being?

Kidney reflux in children is a condition where urine goes up from the bladder to the kidneys. It's most often congenital, meaning that children are born with it. It can be due to other conditions such as posterior urethral valves or a neuropathic bladder. The vast majority of cases is because children are born with it, and the valve that stops the urine going back up to the kidneys isn't working.     

Most of the time, it doesn't impact on their health and patients don't know they actually have reflux. It can cause problems with recurrent urinary tract infections, and it can cause injury to the kidney. There are a small number of young people whose kidney function is affected by reflux. 

That might be a little bit of work, because it's only the kidney that's affected by the reflux that gets damaged, not the side where there's no reflux.  

What are the common causes of kidney reflux in children, and what steps can parents take to reduce their child's risk of developing this condition?

The vast majority of reflux, which is where it's present from birth, and then you can get secondary reflux in some conditions that affect the bladder, such as posterior urethral valves or a neuropathic bladder. Those are looked for by doctors who look after those conditions. 

There isn't anything that parents can do to reduce the risk of developing the condition because it's congenital. 

What happens to reflux in children how are born with it?

In general, kidney reflux resolves spontaneously, which means it gets better by itself and doesn't need any treatment. In well over 85 per cent of children with grade 1 reflux, it goes away by itself.

Whenever you've got some on the more severe grades of reflux; grade 4, grade 5, where there's swelling of the kidney and the urethra, which is the tube between the kidney and the bladder, often they don't resolve. They may get better but they don't completely resolve.  

What are the most effective treatment options for kidney reflux in children?

Treatment of kidney reflux depends on the grade and what effect it's having on the young person. So, most of the time, all young people actually need to have surveillance by a doctor. The aim of the treatment is to prevent them from getting any waterwork infections. So, they many need prophylactic antibiotics; they may need urine surveillance with urine dipsticks.

If the bladder's not working properly, they may need to have their bladders assessed and they may need to have their bladder managed, whether that's with simple drill or making sure that the bladder's emptied completely. They may need to have any constipation managed.

If a young person is getting a lot of urinary tract infections because of the reflux, then that's when you'd think about surgical management of kidney reflux. That needs to be discussed and needs to be right for the patient.

The options that you have are to do an endoscopic injection to the urethra to try and recreate the valve, and there's two techniques. One's called a sting, and one's called a hit. That involved passing a telescope into the bladder and then injecting implant material. 

For boys, they may benefit from a circumcision because that lowers the risk of developing a urinary tract infection. If those fail, it may be repeated, but if that is failing time and again, we would move on to bigger surgeries such as ureteral reimplantation which is where you replant the urethra into the bladder.

If the kidney isn't working, and people are getting infections and they've got kidney reflux, you may consider removing the kidney. There are also other techniques where you join the urethra of the kidney that's refluxing, to the good urethra. That's called a transurethral urostomy. It's not very common. If somebody has kidney reflux because of another condition, the treatment of that reflux is to manage the other condition, and almost invariably the reflux resolves if the bladder is managed properly.  

Does this condition present any signs or symptoms that parents can identify in their children?

Most of the time, the way that it presents is with recurrent urinary tract infections. The child becomes unwell 

• with a high temperature;
• there may be tummy pain;
• they may be running to the toilet alot;
• there may be blood in the urine;
• they may cry when they're peeing. 

Often, the kidney reflux is found whenever urinary tract infections are being investigated. 

Otherwise, it's a very silent condition. So, young people don't have any overt signs or symptoms often. There may be a family history, so families are more clued into it. In general, it can be difficult to spot.

How can parents support their child's overall health and well-being while managing kidney reflux, and what lifestyle changes may be recommended to improve their child's outcomes?

The most important thing that people can do, is to try and reduce the number of urinary tract infections that young people get. So, making sure that: 

• young people are drinking plenty of water;
• they're going to the toilet frequently - I normally recommend six times a day. 
• Making sure that, if there's any constipation that this is managed quickly so young people should be going to the toilet to do a poo at least once a day. And the poo should be nice and soft. 

If there's any doubt about if young people are actually emptying their bladder completely, they should use a technique called double voiding, which is where you get the child to pee, get them to count to 30. For young girls, encouraging them with good personal hygiene so they clean themselves from front to back and not the other way around.  

If you'd like to arrange an appointment with Mr Robb about kidney reflux in your child, you can do so via his Top Doctors profile.