When i was 3(1985), i was diagnosed with vesicouretic reflux, and
a bladder reconstruction was performed.
Renal function was damaged and is only just sufficient so as to
not need dialysis/transplant.
As of 1996,two acute intestinal obstructions have occured.
Since May 98, creatinine,albumen and heamoglobin levels have
elevated.
I suffer from hypertension, and take 20mg nifedipine and 10mg
enalpril daily, though my pressure is still 130/80, and i am only
17.
I have 200ml residual urine in my "new" bladder, and thus was
prescribed septrin antibiotics to prevent UTIs. 1.What is the standard treatment for recurring reflux these days?
2.What chance is their of the intestinal obstructions being
related to the 1985 operation?
3.What is the immediate and long term effect of elevated
creatinine,albumen and heamoglobin on the body?
4.Is there a high success rate for operations removing scar
tissue from the small bowel, without creating more?
5.Is there a chance my BP medications have become ineffective?
I once conducted my own, if dangerous experiment, without my
doctors consent. I reduced my BP medications to less than a
quarter of normal dosage for a few days, and kept a close eye
on my BP. It remained stable, sometimes even dropping to
below its normally elevated level on occasions.
6.Since Jan1997, i have stopped taking my septrin. My doctor is
unaware of this. However, I have not caught a UTI. Is it safe
to completely stop this medication?
7.could heavy excerise and increased dietary protein be
responsible for the increased albumen levels?
Many thanks for anyone who can shed some light on my problems. -------------------------------------
Dear Chris,
I will answer your questions one by one to the best of my ability. You need to know that even though reflux has been corrected, there can be progressive deterioration of your kidney function.
1) The treatment of vesicoureteral reflux is dependent on the degree of reflux and the occurrence of infection. A patient that remains infection free with mild reflux may do no further damage to the kidney. This is why you have periodic evaluations of the kidneys, their function and assessment of recent infections. You are now 17 and your kidneys and body are nearing final size. The reason the kidney are followed so aggressively in childhood is to maximize kidney function throughout child and adulthood. A recent VCUG would tell you if you continually reflux and a periodic ultrasound and creatinine would help you follow the anatomy and function of the kidneys. What I’m trying to say is that if it is safe, conservative management (no surgery) with or without prophylactic antibiotics is acceptable at your age. If you have persistent high grade reflux and pyelonephritis, surgical intervention may be warranted.
2+4)Most probable your intestinal obstruction is secondary to adhesions resulting from prior surgery. This is a common sequella of abdominal surgery and can occur again later in your life. A surgeon can take every precaution, but adhesion will form regardless. Removing the scar from your intestine unfortunately will give your body another opportunity for form more scars. Sometime a narrowed section of bowel needs to be removed to allow normal bowel movements.
3)Creatinine is a marker of how well the kidney functions. Elevated creatinine itself does not have any negative effect. Elevated albumen and hemoglobin can be secondary to dehydration, but should have little effect on the body in a negative fashion. This probable means that you have an adequate diet and consume meat.
5)Blood pressure medications can become less effective overtime or a patients disease process can change. This is why your doctors periodically change the doses of your medication if symptoms develop or clinic readings change. I would not recommend experimenting with your doses
6)As I discussed above, with the proper follow-up and awareness of the symptoms of infection, prophylactic antibiotics can be safely stopped. This should be a decision of both the patient and physician. If you continue to have significant residuals in your bladder after voiding, prophylactic antibiotics may be necessary.
7)Heavy exercise will not increase your albumin levels. Increased protein in the diet is of particular concern in patients that have reduced kidney function and should be discussed with your doctor before doing so. They may both increase the amount of protein that is spilled into the urine each day.
I hope I answered your questions. The most important thing for you to do is stay in good contact with your physicians and try not to miss appointments.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568). Sincerely,
HFHS M.D.-AK
*keyword: vesicoureteral reflux, reflux nephropathy
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