Vesicoureteral Reflux Grading and How It Affects Treatment
Knowing which grade of VUR your child has helps their doctor understand whether they can benefit from treatment and what type of treatment might be best.
Vesicoureteral reflux (VUR) is when urine flows backward from your child’s bladder into one or both of their ureters and sometimes their kidneys. The ureters are the tubes that carry urine from your child’s kidneys to their bladder.
VUR most commonly affects young children. Doctors often grade it from 1 to 5 using the International Reflux Classification. Grade 1 is the mildest form, while grade 5 is the most severe.
| Description | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
|---|---|---|---|---|---|
| Urine side-effects/” title=”Chemotherapy Side-Effects”>reaches ureters | ✓ | ✓ | ✓ | ✓ | ✓ |
| Urine reaches kidneys | ✓ | ✓ | ✓ | ✓ | |
| Swelling of the collecting system inside the kidney | ✓ | ✓ | ✓ | ||
| Kinking of the ureter | possibly | possibly | ✓ | ||
| Damage to kidney tissues (intraparenchymal damage) | ✓ |
Vesicoureteral reflux grade 1
Grade 1 is the mildest form of VUR. Children with grade 1 have backflow only into their ureters and not into their kidneys. The ureter is not dilated or minimally dilated, meaning it isn’t swollen.
VUR doesn’t cause any specific symptoms, but it increases the chances that your child will develop a urinary tract infection (UTI).
Symptoms of a UTI can include:
- foul-smelling urine
- cloudy urine
- fever
- abdominal pain
- side pain
- back pain
- frequent and urgent urination
- headache
- vomiting
- blood in urine
- painful urination
Fever is often the only apparent symptom in young children. Your child may complain of abdominal pain once they complete toilet training and can speak.
Vesicoureteral reflux grade 2
Children with grade 2 VUR have reflux that reaches their kidneys, but there’s no swelling in the urine-collecting system inside their kidneys.
Both grade 1 and grade 2 VUR are often referred to as low grade VUR.
UTIs are a possible side effect.
Vesicoureteral reflux grade 3
Grade 3 VUR is characterized by mild or moderate swelling of the ureters with or without twisting or bending (called “kinking”). The urine collection system in your child’s kidneys is also moderately swollen, and they might have a structural change in part of the fornices of the kidney.
UTIs are most common in grades 3 to 5.
Children with grades 3 to 5 VUR have an especially high risk of UTIs and kidney scarring. These grades are often referred to as high grade VUR.
Vesicoureteral reflux grade 4
Stage 4 vesicoureteral reflux is characterized by moderate swelling, which causes an abnormal kidney shape. The typically pointed fornices in your child’s kidney now appear blunt on imaging.
Vesicoureteral reflux grade 5
Grade 5 VUR is characterized by severe swelling and kinking of the ureter. There’s significant swelling in the urine collecting system in your child’s kidney.
Urine flows deeper through the ducts in their kidneys and can cause damage to the kidney tissues.
Vesicoureteral reflux treatment by grade
The best treatment for VUR depends on factors like the grade of your child’s VUR and the underlying cause. Treatment might include:
- antibiotics to prevent or treat UTIs
- waiting to see if it gets better on its own
- injections
- surgery
Vesicoureteral reflux grade 1 treatment
Grade 1 vesicoureteral reflux often goes away by itself. Intense treatment isn’t usually required.
Children with grades 1 to 4 VUR might be suitable candidates for endoscopic injections. These injections are inserted into the tissue around the ureter to prevent the backflow of urine.
Regular follow-ups with or without antibiotic therapy are recommended for children with grades 1 or 2 VUR without a UTI and who have not achieved toilet independence. Antibiotics are generally always recommended for children who have not achieved toilet independence and who have a UTI.
Antibiotics are optional for children with toilet independence and a UTI but are recommended if they have bladder and bowel dysfunction.
Vesicoureteral reflux grade 2 treatment
Children with grade 2 VUR also often improve by themselves without treatment.
Endoscopic injections are considered most useful for children with grades 2 to 4 disease. Your child’s doctor might recommend antibiotics if your child has a UTI or bowel and bladder dysfunction.
Vesicoureteral reflux grade 3 treatment
In children with grades 3 to 5 VUR, antibiotics are typically administered to prevent UTIs before they occur. This is called prophylactic antibiotic therapy.
Vesicoureteral reflux grade 4 treatment
Your child’s doctor is most likely to recommend surgery if your child has:
- persistent grade 4 or 5 VUR, which is often considered VUR that persists past age 3
- progressive kidney scarring or failure
- multiple serious UTIs or kidney infections
- intolerance or non-compliance to antibiotics
- poor kidney growth
- parental request
Learn more about vesicoureteral reflux surgery.
Vesicoureteral reflux grade 5 treatment
As with grade 4, your child’s doctor may recommend that your child undergo surgery to prevent future infections or kidney damage.
What is the long-term outlook for vesicoureteral reflux?
The outlook for vesicoureteral reflux tends to be better the earlier it’s diagnosed and treated. It can be a challenge for doctors to figure out which children will outgrow VUR and which ones won’t. Abnormal bowel function is associated with a higher risk of developing UTIs.
About 75% of children with grade 1 and 2 disease resolve spontaneously without treatment by age 5. Spontaneous resolution occurs in about 60% to 70% of children with grades 3 and 4. It’s most likely to resolve if it only occurs on one side and is diagnosed before age 2.
In cases where VUR develops on both sides, only about 10% to 20% of children have spontaneous resolution over 5 years.
What is Vesicoureteral Reflux (VUR)?
Vesicoureteral Reflux (VUR) is a condition where urine flows backward from the bladder into the ureters or kidneys, increasing the risk of urinary tract infections (UTIs) and kidney damage.
How is Vesicoureteral Reflux Graded?
Vesicoureteral Reflux is graded on a scale from I to V, with Grade I indicating mild reflux and Grade V indicating severe reflux that involves the kidney.
Why is the Grading of Vesicoureteral Reflux Important?
The grading helps determine the severity of the condition and guides the treatment approach. Higher grades may require more intensive treatment to prevent kidney damage.
What Treatments are Available for Vesicoureteral Reflux?
Treatment options include behavioral and lifestyle changes, medication, and sometimes surgery, depending on the severity of the reflux and the patient’s age and health.
Can Vesicoureteral Reflux Improve Over Time?
Yes, particularly in children. Lower grades of vesicoureteral reflux may resolve as a child grows and the ureter matures. Regular monitoring by a healthcare provider is essential.
Does Vesicoureteral Reflux Require Surgery?
Surgery is considered for higher VUR grades or when medication and lifestyle changes do not prevent recurrent infections or kidney damage.
Are There Complications Associated with Vesicoureteral Reflux?
Potential complications include frequent urinary tract infections and kidney scarring, which can lead to reduced kidney function over time.
How is Vesicoureteral Reflux Diagnosed?
VUR is usually diagnosed using imaging tests such as a voiding cystourethrogram (VCUG) or ultrasound to visualize urine flow and detect any backward movement.
Can Adults Have Vesicoureteral Reflux?
Yes, while VUR is more common in children, adults can have the condition as well, often due to anatomical abnormalities or dysfunction.
Is Vesicoureteral Reflux Hereditary?
There may be a genetic component, as the condition can run in families. If one child has VUR, there is an increased likelihood that siblings may also have it.
Takeaway
Vesicoureteral reflux is graded from 1 to 5 based on its severity. Grades 1 and 2 are often considered low grade, while grades 3 to 5 are often considered high grade.
Low grade VUR may go away on its own spontaneously. Children with high grade VUR or repeated UTIs may need surgery to prevent future kidney damage or infections.
Great post! Understanding the different grades of vesicoureteral reflux is crucial for tailoring treatment plans effectively. This article provides a clear explanation of the grading system and highlights how each grade can impact the choice of intervention. Very informative and helpful for both medical professionals and those affected by VUR!
This is a very informative post! Understanding the grading of vesicoureteral reflux is crucial for both clinicians and patients to determine the appropriate treatment pathway. It’s fascinating how different grades can influence the decision between monitoring and opting for surgical intervention. Thanks for sharing this detailed overview!
Great post! Understanding the grading of vesicoureteral reflux is crucial for determining the appropriate treatment plan. The clarity you provided on how each grade affects treatment decisions is very helpful. Thanks for breaking down such a complex topic!
This is a very informative post! Understanding the grading of vesicoureteral reflux (VUR) is crucial for determining the right treatment approach. It’s important for patients and parents to know how each grade differs in terms of severity and the potential need for surgical intervention versus watchful waiting. Your explanation helps clarify a complex subject and aids in making informed decisions regarding management options. Thanks for shedding light on this important topic!
This is a really informative post! Understanding the grading system for vesicoureteral reflux is crucial for determining the appropriate treatment plan and potential intervention. It’s helpful to see how each grade impacts the approach to treatment and management, ensuring better outcomes for patients. Thank you for breaking down a complex topic into something more comprehensible.
Thank you for sharing this comprehensive post on Vesicoureteral Reflux (VUR) grading! Understanding the nuances of each grade and its implications for treatment is crucial for both patients and healthcare providers. It’s great to see such detailed information that helps demystify the diagnosis and guide appropriate interventions. This will undoubtedly be a valuable resource for anyone navigating this condition.
Thank you for sharing this informative post on vesicoureteral reflux (VUR) grading! Understanding the different grades and their implications for treatment is crucial for better management of the condition. It’s great to see such detailed explanations that help medical professionals and patients alike grasp the importance of each grade. Looking forward to more posts like this!