Vesicoureteral Reflux (VUR)

Healthy kidneys filter waste from the blood, producing urine which normally flows only one direction: down the ureters and into the bladder. When something is wrong with the connection between the ureter and the bladder, the urine may flow back up (reflux) from the bladder to the ureters and at times to the kidneys.

If you have had VUR as a child, there is a chance that your children will have the condition. In addition, if one of your children has it, his or her brothers and sisters may also have the condition, too.

Infrequent or incomplete urination, as well as constipation, are also associated with VUR. Frequent urinary tract infections (UTIs) may indicate the presence of VUR.

 
How is VUR diagnosed and treated?

Your Nemours pediatric urologist may order a test called a voiding cystourethrogram (VCUG) that uses X-rays and a special dye to show how your child’s bladder is working. This test can help determine if your child has VUR.

VUR is graded on a scale from I (mild) to V (severe). Many times, milder grades of VUR will go away on their own as your child grows and develops. However, UTIs in the presence of VUR can cause kidney infections, which can lead to scarring and sometimes result in kidney damage.

Depending on the severity of the VUR, your Nemours urologist may discuss several treatment options for your child, including antibiotics to prevent infections, surgery to repair the ureters, or endoscopic treatment in which a small telescope is inserted through the bladder and a gel is placed at the point where the ureter meets the bladder.

Urine Test: Creatinine

What It Is

Creatinine is a waste product that the muscles produce at a steady rate as part of normal daily activity. The bloodstream carries creatinine to the kidneys, which filter it out of the blood, and it is passed out of the body in urine.

A urine creatinine test measures the amount of creatinine in the urine. It can be done on its own or with other tests that determine the relative amounts of other substances being excreted in the urine.

Why It's Done

Healthy kidneys filter the blood to rid it of waste products that the body can't use. Low levels of creatinine in the urine may point to a kidney disease, certain muscular and neuromuscular disorders, or an obstruction of the urinary tract. If test results are abnormal, other tests will be done to make a specific diagnosis.

A creatinine clearance test measures the blood creatinine level as well as how much creatinine is being passed in the urine over several hours. This gives doctors information about how well the kidneys are functioning.

A doctor may order a urine creatinine test in combination with other urine tests even when no kidney dysfunction is suspected. Because creatinine is filtered out at a fairly steady rate, doctors compare the creatinine level with levels of other substances in the urine to determine if they're being excreted at a normal rate.

Preparation

Your child might need to temporarily stop taking certain drugs that affect the urine's creatinine levels and might be asked to not eat large quantities of meat in the day or two before the test.

The Procedure

Collecting the specimen should only take a few minutes. Your child will be asked to urinate into a clean sample cup in the doctor's office. If your child isn't potty trained and can't urinate into a cup, a small catheter may need to be inserted into the bladder to obtain the urine specimen.

If you collect the specimen at home, follow any storage and transportation instructions the lab gives you.

For a creatinine clearance test, you'll need to collect all the urine your child passes over a period of several hours (usually 24 hours). This usually involves first getting a special container from the lab in which to collect the urine, plus specific instructions about how to collect and store the timed urine sample.

What to Expect

Because the test involves normal urination, there shouldn't be any discomfort as long as your child can provide a urine specimen.

Getting the Results

In general, the results of the urine creatinine test are available within a day or two. Your doctor will go over the results with you and explain what they mean. If abnormalities are found, further tests may be needed.

Risks

No risks are associated with taking a urine creatinine test.

Infants may occasionally experience skin irritation from the adhesive tape on the collection bag. If a catheter is used to obtain the urine, it may cause temporary discomfort. If you have any questions or concerns about this procedure, talk to your doctor.

Helping Your Child

Collecting the specimen for a urine creatinine test is usually painless. Explaining how the test will be conducted and why it's being done can help ease any fear. Make sure your child understands that there should be no foreign matter, such as toilet paper or hair, in the sample.

If You Have Questions

If you have questions about the urine creatinine test, speak with your doctor.

Reviewed by: Yamini Durani, MD
Date reviewed: February 2012