Childhood urine problems

We have a 2-year-old daughter who’s just been diagnosed with Grade II vesicoureteral reflux. What can you tell us about this condition? She’s been put on a one-year course of an antibiotic called Septra.

Vesicoureteral reflux (VUR) is the name given to the abnormal backward flow of urine from the bladder into the ureter–the tube that drains urine from the kidney into the bladder – or into both the ureter and kidney. It ranges from mild (Grade I) to very severe (Grade V). So your daughter’s case is not too severe.

The greatest concern about VUR is kidney damage due to scarring from repeat infections. A child with VUR is most at risk for kidney scarring in her first two years of life. After age 5, it’s uncommon. However, VUR frequently goes undetected until a child develops a urinary tract infection (UTI): As many as 50 percent of children with VUR have also had a urinary tract infection. Siblings of a child with VUR are also at high risk. This is why pediatricians check the urinary tract of children under the age of 5 who’ve had even one UTI.

Because reflux in children with Grades I and II usually goes away by itself, it’s standard practice to treat these children medically. Once- or twice-daily antibiotics, like the Septra prescribed by your doctor, prevent recurrent UTIs and kidney scarring while the reflux clears up. Children with Grades III to V reflux are more likely to need surgery to correct the problem.

To determine whether reflux still exists, children on antibiotics are usually retested at one- to two-year intervals. Remember, even though your child is taking an antibiotic to prevent UTIs, nothing is 100 percent effective. If your daughter develops a fever, irritability, frequent or painful urination, daytime or nighttime wetting, or similar concerns, talk with her physician.

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