VUR Symptoms: How Is It Noticed?

No, it does not. Urine flowing backward from the bladder toward the kidney does not cause pain, does not change urination, and produces no outward sign at all. Because of this, VUR is noticed not by its own 'symptoms' but by the consequences it causes or by incidental findings.

A baby cannot say 'it burns when I urinate'; the infection often shows up with fever alone. Whenever there is a temperature of 38°C or higher with no obvious source — such as a cold, cough, ear pain, or rash — a urinary tract infection should always be considered. The younger the child, the fainter and more deceptive the signs.

• Fever of 38°C or higher with no obvious source
• Poor feeding, drowsiness, unusual fussiness
• Vomiting, diarrhea, poor weight gain, or weight loss
• Prolonged or recurring jaundice in a newborn
• Sharp-smelling, cloudy urine on the diaper

In a child old enough to communicate, two pictures can be distinguished. Fever, chills, flank or back pain, vomiting, and malaise suggest a kidney infection (pyelonephritis); this is the picture that matters for reflux. Burning on urination alone, frequent small-volume voiding, urgency, and lower abdominal pain, on the other hand, are usually a bladder infection (cystitis) and are not on their own a sign of reflux.

In some babies, the first sign of reflux is kidney enlargement seen on a prenatal ultrasound. This is not a symptom but an incidental finding; the baby appears completely healthy at birth.

Reflux that was not diagnosed in childhood may first come to light in adulthood through recurrent urinary tract infections, flank pain, high blood pressure, or protein found on a urinalysis. Increased infection frequency during pregnancy is also one of the ways reflux is noticed in adults.

• Most reflux detected in adulthood is a holdover from childhood, and whether it has left scarring in the kidney is more decisive than the grade of reflux itself. For this reason, evaluation calls for blood pressure measurement, a check for protein in the urine, and kidney imaging together.

Whether or not there is a diagnosis of reflux, suspected febrile urinary tract infection in a child calls for same-day evaluation; early treatment reduces the likelihood of kidney scarring. Rather than giving a fever reducer and waiting, a urine sample should be collected using the correct method before antibiotics are started.

• Fever of unclear source in a baby, especially if younger than 3 months
• Fever together with flank pain, chills, or vomiting
• New fever in a child who has previously had a urinary tract infection
• Any fever in a child already diagnosed with reflux or kidney enlargement
• Frequent recurring voiding complaints together with constipation or daytime wetting

• From the diagnostic stage onward, our physicians give the family a written 'what to do if there is fever' plan; this way, antibiotics are not started without a culture when a fever begins on a weekend or at night. We recommend seeking care without delay in the following situations.