Prevention of VUR
The kidneys filter the blood and extract waste products from the blood to make urine. Urine passes from the kidneys, down the ureters, and into the bladder for storage prior to urination. Normally, the ureter enters the bladder wall at an angle so that a flap valve is created. This valve prevents the bladder urine from backing up toward the ureter and kidney. Thus, when the bladder fills and when it squeezes down to empty, backup (also called reflux) is prevented because the valve operates in the same way as you might "step on a straw."
This valve-like action creates an important barrier that helps keep the kidneys free of bacteria. Once urine has passed from the upper urinary tract into the bladder, the normal valve not only makes certain that urine does not reenter the upper tracts, but it also ensures that the high pressures created at the moment of urination are not transmitted to the kidneys.
Another important feature of a properly working valve at the ureter-bladder (ureterovesical) junction is that it permits the body to remove all of the stored urine with a single act of urinationthat is, the bladder urine has nowhere to go other than out the urethra.
VUR Follow Up
Patients with a history of reflux should be monitored for life. Even if the reflux resolves (either spontaneously or by surgery), the risk of kidney malfunction, high blood pressure (hypertension), and, in women, pregnancy-related problems continues.
Follow-up care usually involves regular checkups to measure height, weight, and blood pressure, and regular urine analysis. Kidney function can be crudely evaluated by blood tests (creatinine and BUN) or more precisely checked by creatinine clearance or glomerular filtration rate. Occasional ultrasound tests will ensure that kidney growth is on target for age. Female patients should be carefully monitored during their pregnancy.
By the time surgical correction has been performed, some children have already had significant kidney damage. In other patients , the kidney damage from reflux early in life may result in kidneys that don't grow appropriately in size or function and thereby seem to deteriorate with age. When kidney deterioration has been demonstrated, pediatric nephrologists must begin careful surveillance with appropriate medication and dietary restriction.
Does Reflux Run in the Family?
If a child with reflux has a brother or sister, there is a 1 in 3 chance that the sibling will also have reflux, even in the absence of any urinary infections. Because we know that the chances of kidney damage are highest in the first 6 years of life, siblings in that age range should be aggressively studied with ultrasonography and VCUG, even though they may not have had any urinary infection. Older siblings, in the absence of symptoms, may be more simply screened with urine analysis and ultrasonography.
There is also evidence that offspring of the patients with reflux are more likely to develop reflux.