Urinary Tract Infections
and VUR in Children
A parent’s guide
Understanding your child’s urinary tract
Understanding your child’s urinary tract
The urinary tract is a term for the parts of the body that are involved
The urinary tract is a term for the parts of the body that are involved
in making and passing urine, including the kidneys, ureters, bladder,
in making and passing urine, including the kidneys, ureters, bladder,
and urethra:
and urethra:
How do I know if my child has a UTI/febrile UTI?
How do I know if my child has a UTI/febrile UTI?
Unfortunately, children and infants with UTIs may not always have
Unfortunately, children and infants with UTIs may not always have
symptoms. However, it is important to contact your doctor if your
symptoms. However, it is important to contact your doctor if your
child has any of the following:
child has any of the following:
Kidney
Kidney
Ureter
Ureter
persistent fever of unknown cause
persistent fever of unknown cause
burning or pain when urinating
burning or pain when urinating
frequent or urgent urination
frequent or urgent urination
strong-smelling, cloudy, or bloody urine
strong-smelling, cloudy, or bloody urine
abdominal, back, or side pain
abdominal, back, or side pain
Symptoms of febrile UTIs are similar to those seen with UTIs.
Symptoms of febrile UTIs are similar to those seen with UTIs.
However, a high-grade fever of unknown cause is the hallmark sign
However, a high-grade fever of unknown cause is the hallmark sign
of a febrile UTI.
of a febrile UTI.
Bladder
Bladder
Urethra
Urethra
What is a urinary tract infection (UTI)?
What is a urinary tract infection (UTI)?
UTIs occur when bacteria (or germs) enter the urinary tract and
UTIs occur when bacteria (or germs) enter the urinary tract and
multiply, causing infection. The bacteria can remain in the lower
multiply, causing infection. The bacteria can remain in the lower
urinary tract (urethra, bladder) or travel up the ureters into the upper
urinary tract (urethra, bladder) or travel up the ureters into the upper
urinary tract (ureters, kidneys).
urinary tract (ureters, kidneys).
What is a febrile UTI?
What is a febrile UTI?
Infected urine that travels into the upper urinary tract and the kidneys
Infected urine that travels into the upper urinary tract and the kidneys
resulting in fever is known as a febrile UTI (febrile means relating
resulting in fever is known as a febrile UTI ( febrile means relating
to fever). Infection in the kidneys may lead to permanent scarring of
to fever). Infection in the kidneys may lead to permanent scarring of
kidney tissue. Excessive scarring can reduce kidney function.
kidney tissue. Excessive scarring can reduce kidney function.
Symptoms may be more difficult to detect in babies, as they cannot
Symptoms may be more difficult to detect in babies, as they cannot
tell you how they feel. Babies with UTI may show irritability, poor
tell you how they feel. Babies with UTI may show irritability, poor
feeding, listlessness, fever, or below normal temperature.
feeding, listlessness, fever, or below normal temperature.
Your doctor will do some tests to find out whether your child has
Your doctor will do some tests to find out whether your child has
bacteria in his/her urinary tract. If your child has a UTI, the infection
bacteria in his/her urinary tract. If your child has a UTI, the infection
will normally be treated with antibiotics to kill the bacteria. If your
will normally be treated with antibiotics to kill the bacteria. If your
doctor suspects that your child has a febrile UTI, he/she may send
doctor suspects that your child has a febrile UTI, he/she may send
your child for more tests. This is especially important if the doctor
your child for more tests. This is especially important if the doctor
thinks bacteria have reached the kidneys.
thinks bacteria have reached the kidneys.
Can
Can UTIs
UTIs be
be prevented?
prevented?
The
getting
into
thethe
urinary
tract
can can
be reduced
by: by:
The risk
riskofofbacteria
bacteria
getting
into
urinary
tract
be reduced
diapers frequently
cchanging
hanging diapers
frequently
wiping
from front
front to
to back
back after
w
iping from
after going
going to
to the
the bathroom
bathroom
wearing
cotton underwear
underwear
w
earing cotton
frequently
urinating
u
rinating frequently
preventing
and treating
treating constipation
constipation
p
reventing and
What
What does
does it
it mean
mean if
if my
my child
child has
has had
had many
many
UTIs/febrile
UTIs/febrile UTIs?
UTIs?
Many
in in
thethe
Many children
children who
who have
have had
had aaUTI
UTIwill
willget
getadditional
additionalUTIs
UTIs
future.
others
and,
in in
future. Some
Some children
childrenare
aremore
moreprone
pronetotoUTIs
UTIsthan
than
others
and,
most
cases,
frequent
UTIs
can
be
treated
with
antibiotics.
most cases, frequent UTIs can be treated with antibiotics.
Some
Some children
children with
with febrile
febrileUTIs
UTIshave
haveananunderlying
underlyingproblem
problemwith
with
their
a serious
their urinary
urinary tract,
tract,making
makingititmore
morelikely
likelyfor
forthem
themtotosuffer
suffer
a serious
infection.
infection. The
The most
mostcommon
commonunderlying
underlying problem
problem isisvesicoureteral
vesicoureteral
reflux
of of
all all
children.
Conditions
such
reflux (VUR),
(VUR),which
whichaffects
affectsabout
about1%
1%
children.
Conditions
such
as
VUR
can
be
treated
to
prevent
your
child
from
getting
febrile
UTIs
as VUR can be treated to prevent your child from getting febrile UTIs
in
in the
the future.
future.
Why
Why are
are febrile
febrile UTIs
UTIs such
such a
a concern
concern in
in VUR?
VUR?
What
What is
is VUR?
VUR?
VUR
VUR isisan
anabnormality
abnormalityininthe
theconnection
connectionbetween
betweenthe
thebladder
bladder and
and
one
or
both
of
the
ureters
(the
tubes
that
carry
urine
from
one or both of the ureters (the tubes that carry urine from
thethe
kidneys
kidneys to
to the
the bladder).
bladder).
Normally,
Normally, urine
urine flows
flows from
from the
the
kidneys,
kidneys, down
down the
the ureters,
ureters, and
and
into
into the
the bladder.
bladder.
In
In children
children with
with VUR,
VUR, urine
urine is
is able
able to
to
flow
flow the
the wrong
wrong way,
way, from
from the
the bladder
bladder
toward
toward the
the kidneys.
kidneys.
Kidneys
Kidneys
Kidneys
Kidneys
Ureters
Ureters
Ureters
Ureters
Bladder
Bladder
Bladder
Bladder
Urethra
Urethra
Urethra
Urethra
VUR
chance
of your
child
getting
a febrile
UTI infection,
VURincreases
increasesthe
the
chance
of your
child
getting
a febrile
UTI
which
could
lead
to
kidney
scars.
infection, which could lead to kidney scars.
If
is is
more
likely
that
urine
willwill
reach
thethe
If your
your child
childhas
hasVUR,
VUR,it it
more
likely
that
urine
reach
kidneys.
this
increases
thethe
riskrisk
kidneys. And,
And,ififthe
theurine
urineisiscarrying
carryingbacteria,
bacteria,
this
increases
of
kidney
infections.
of kidney infections.
It
your
doctor
if you
think
youryour
childchild
has had
It isisimportant
importanttototell
tell
your
doctor
if you
think
has previous
had
UTIs
or
febrile
UTIs
so
that
the
doctor
can
look
for
and
treat
any
previous UTIs or febrile UTIs so that the doctor can look for
condition
increase
the
chance
of serious
infections.
Since each
and treat that
any may
condition
that
may
increase
the chance
of serious
febrile
UTI
could
increase
the
risk
of
kidney
scars,
it’s
important
see a
infections. Since each febrile UTI could increase the risk oftokidney
doctor
as soon
as fevertooccurs.
scars, it’s
important
see a doctor as soon as fever occurs.
While
While in
in some
some children
childrenVUR
VURwill
willgogoaway
awayon
onitsitsown
ownwithout
without
intervention,
many
children
will
need
treatment.
intervention, many children will need treatment.InInmost
mostcases,
cases,
that
treatment
will
focus
on
the
defining
symptom:
febrile
that treatment will focus on the defining symptom: febrileUTIs.
UTIs.
Prevention
Prevention of
of febrile
febrile UTIs
UTIswill
willhelp
helpavoid
avoidpossible
possibleinfections,
infections,
especially
especially kidney
kidney infections.
infections.
How is VUR treated?
In most cases, febrile UTIs are the only defining and active symptom
in VUR patients. This is why the goal for most VUR treatments is
to prevent infections that can lead to kidney damage and scarring.
Currently, there are 3 types of treatments available for VUR:
Antibiotics
How does
it work?
What does
it involve?
Will my child
be cured?
How well does
it protect my
child against
VUR-associated
UTIs?
Endoscopic
injection
Surgery
Antibiotics taken
every day to
prevent UTIs until
VUR goes away by
itself. This could
take years. You
should consult
your doctor for
more information.
A gel is injected
where the ureter
joins the bladder
so that urine
cannot flow back
up to the kidneys.
The connection
between the bladder
and ureter is
repaired surgically.
Medicine must
be taken every
day, often for
several years.
Outpatient
procedure—
children normally
go home the
same day.
Open surgery—
children normally
have to stay in
the hospital for
a few days.
No, your child
will need regular
follow-up until
VUR goes away
by itself.
About 70%
of children are
cured or improved
such that they do
not need any more
treatment.
About 95%
of children are
cured.
Antibiotics
may not always
reduce risk, and
in certain cases
may be the least
effective option.
Endoscopic
treatment has
been shown to
prevent VURassociated UTIs
nearly 4x better
than antibiotics
and comparable to
surgery.
After surgery,
the incidence of
recurrent infection
is very low.
Further information
Please visit the following Web sites for further information
about UTIs:
www.kidney.niddk.nih.gov/kudiseases/pubs/utichildren/
www.kidshealth.org/kid/health_problems/bladder/uti.html
(for patients)
www.kidshealth.org/parent/infections/common/urinary.html
(for parents)
www.urologyhealth.org
(mentions endoscopic treatments)
To learn more about VUR and its treatment, please visit:
www.vurinfo.com
If your child is diagnosed with VUR, you should discuss the risks,
benefits, and required follow-up of each treatment option with
your doctor. The risk of recurrent febrile or VUR-associated UTI
infections, severity of your child’s VUR, the age of your child, and
your personal views will be important in deciding which treatment is
best for your child.
For further information contact:
Salix Pharmaceuticals, Inc.
8510 Colonnade Center Drive
Raleigh, NC 27615
1-866-669-SLXP (7597)
www.salix.com
©2012 Salix Pharmaceuticals, Inc. All rights reserved. Printed in the USA. DEF 12/17-1