A child is considered to have urinary tract infection(UTI) when the urine of the child grows bacteria during a microbiological test and the amount is significantly high (more than one lakh per ml). During childhood 5% of girls and 2% of boys get UTI. In the new-born period more boys get UTI than girls. Among the girls half can get a second UTI within a year.

http://www.medindia.net/patients/paediatrics/urinary_infection.htm

Normally the oblique entrance of the ureter through the bladder wall causes ureteric occlusion during bladder contraction. In VUR there is a structural abnormality of the intra-mural ureter allowing reflux of urine from the bladder to the kidney. CIN becomes established leading to further renal deterioration. By an uncertain mechanism, interstitial nephritis may cause focal scars and initiate a slowly progressive renal deterioration.

Diagnosis is confirmed by demonstration of focal renal scars (IVU or isotope renogram; ultrasound less reliable for this); will also reveal other abnormalities, e.g. obstruction. Urine culture necessary to show infection. Assess renal function, proteinuria etc. in usual way.

http://www.edrep.org/pages/textbook/reflux.php

http://bjr.birjournals.org/cgi/content-nw/full/80/954/392/F5

Grade I - Reflux into the ureter only
Grade II - Reflux into the collecting system, without dilatation
Grade III - Reflux into the collecting system with mild dilatation, slight ureteral tortuosity, and no or slight blunting of the fornices
Grade IV - Moderate dilatation and/or tortuosity of the ureter and moderate dilatation of the renal pelvis and calyces, with complete obliteration of the sharp angle of the fornices but maintenance of the papillary impressions in the majority of calyces
Grade V - Gross dilatation and tortuosity of the ureter, with gross dilatation of the renal pelvis and calyces and nonmaintained papillary impressions



http://emedicine.medscape.com/article/414836-overview

Vesicoureteral reflux assessment and treatment algorithm.

http:// emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) show a large, distended bladder with irregular and trabeculated margins. This patient had posterior urethral valves.


http://emedicine.medscape.com/article/414836-overview

Transverse sonogram in a boy with grade V vesicoureteral reflux and posterior urethral valves. Image demonstrates a thickened bladder wall.


http://emedicine.medscape.com/article/414836-overview

Nonenhanced CT scan in a 12-year-old boy demonstrates marked hydronephrosis and cortical thinning in a patient with grade V vesicoureteral reflux and a history of a posterior urethral valve. Note the free fluid in the pararenal space consistent with forniceal rupture after minor trauma to the abdomen (from football practice).


http:// emedicine.medscape.com/article/414836-overview

Nonenhanced CT scan at a level just above ureteral insertion demonstrates bilateral, markedly dilated ureters in a patient with grade V vesicoureteral reflux.


http://emedicine.medscape.com/article/414836-overview

Dimercaptosuccinic acid (DMSA) scans demonstrate photopenia at the right superior pole consistent with scarring in this patient with vesicoureteral reflux.


http://emedicine.medscape.com/article/414836-overview

Nuclear cystograms demonstrate grade III reflux. Reflux to the left kidney is shown, with dilatation of the renal pelvis.


http:// emedicine.medscape.com/article/414836-overview

Unilateral grade V vesicoureteral reflux secondary to a posterior urethral valve. There is gross dilatation of the renal pelvis and calyces. Papillary impressions are not visible. Gross intrarenal reflux is also identified.



http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) demonstrates a tortuous, dilated ureter in a patient with grade V vesicoureteral reflux.


http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) of the left kidney demonstrates grade V vesicoureteral reflux.


http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) demonstrates high-grade IV vesicoureteral reflux in a patient with a duplicated collecting system.


http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG)demonstrates bilateral grade III vesicoureteral reflux


http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) of lower ureter and ureterovesical junction in a patient with grade III reflux. The ureteral insertion on the left is between the 3- and 6-o'clock positions. There is a small bladder diverticulum at the ureteral insertion.



http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) demonstrates bilateral grade III reflux. The renal pelvis is mildly dilated on the right. There is some mild blunting of the calyceal fornices and loss of papillary impressions in the upper poles bilaterally.



http://emedicine.medscape.com/article/414836-overview

Grade II vesicoureteral reflux in a patient with ureteral duplication.



http://emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) demonstrates grade II VUR into the upper-pole moiety of a duplex collecting system and grade III VUR to the lower-pole moiety.

http:// emedicine.medscape.com/article/414836-overview

Voiding cystourethrogram (VCUG) shows grade I left VUR. Incidentally noted is vaginal reflux.



http://emedicine.medscape.com/article/414836-overview

cause of vesico-ureteric reflux

Excretory urogram demonstrates the classic cobra-head appearance of a ureterocele.



http://emedicine.medscape.com/article/414836-overview