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Symptoms :- which make one suspect presence of a reflux in a child are very common, non specific and subtle. The doctor must have a suspicion and order investigations to prove the presence of the reflux. In a young infant below 1 year age, there may be fever and urinary infection; or may come with not thriving well - always ill, not putting on weight etc. In an older child, there may be recurrent urinary infections occurring every month with or without fever each time. There may be urinary symptoms like difficulty in passing urine, burning, dribbling of urine, poor stream of urine and straining to pass urine. Some children may have recurrent abdominal pain more at the back or in the flank. Reflux of long standing and not diagnosed nor treated - may cause a lot of complications. The damage is mainly to the kidney and its function and part of the damage is permanent, part is reversible depending on how early the diagnosis and therapy has begun. The effects of the reflux will spell out how the damage occurs. Reflux of urine can occur when the childs bladder begins to fill up with urine. Urine goes up into the ureter, additionally, when the bladder is full and the child is straining to pass urine, once again more urine goes up into the ureter. This urine is over and above the normal urine that is formed within the kidney and is coming down normally. Thus, the amount of urine in the ureter is more than normal and in order to accommodate the excess volume, the ureter dilates stretches. This will increase with time and more volumes of refluxed urine.The urine in the ureter is now stagnant and will enter the bladder after the child has passed urine and will remain there till the child wishes to pass urine again. This may be a period of hours or more. Part of the stagnant urine may again go up in the ureter and stagnate further. Stagnant urine is ideal for getting infected. Thus the child is given treatment for the urinary infection, then the antibiotic is stopped, but the process of reflux continues and after a lapse of a few day or weeks, the infection recurs and the cycle goes on. Reflux has been graded from 1 to 5. Higher the grade of reflux, the higher the urine goes up and into the kidney tissue due to the high pressure. Reflux pressure and the infection together hits the kidney substance and deposit the bacteria within the kidney tissue to cause an infection called Pyelonephritis. This infection can damage the kidney and if left untreated or incompletely treated, may lead to a permanent damage to the kidney on one or both sides and finally lad to renal failure which responds to Dialysis and later a renal transplant. Pyelonephritis can also be a cause of high blood pressure due to various mechanisms, and in all children will lead to stoppage of growth of the kidney in all dimensions.
Kidney Problems in Children Specialist Answer
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