Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Question Title: Two year old with severe reflux

Forum: The Urology Forum
Topic: Pediatric Urology


My two year old son was diagnosed with kidney problems in utero.
When he was born, his creatinine peaked at 2.74 and slowly got better. He had a pyleoplasty at 3 mos due to a blockage in the ureter. He was diagnosed with reflux about a year ago and his nephrologist said it was a level 5 reflux (I have not read about level 5, only to 4-is there a level 5?) She told me that it was as bad as it could possibly be, but feels he does not need surgery. He has damage on his left kidney and reflux on the right. His total function right now is a little over 50%. He also developed a bone deterioration in his hip, which the orthopedic specialist says is from his kidney function. Most of the information that I have read on this does not sound promising, but he looks and acts quite normal (although he is only in the fifth percentile for height) My questions are: Should he have another surgery to correct the reflux? What is the probability that his kidneys will fail?

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Dear Kkwalker,
Thanks for your query. In summary your 2 year old son has had a pyeloplasty for congenital ureteropelvic junction (UPJ) obstruction and now is having grade V vesicoureteric reflux (VUR) and (??) renal osteodystrophy (bone changes secondary to renal problems).
The fact that your son is experiencing these bone changes and the implication that he may be “falling off” his growth curve are not good signs as regards his long term renal function. I assume that his nephrologist has started him on medication and diet management.

Five to 25% of patients with UPJ obstruction develop associated VUR. Usually UPJ obstruction is corrected first. Your son needs specialized pediatric urological care. The main management principles are as follows:

The main problem due to VUR, are the multiple bouts of renal infections, which can cause scarring and deterioration of kidney function.

Renal function usually is preserved, if infection is kept under control by antibiotics and other medical means: such as frequent voiding to keep bladder empty and avoiding constipation

Any associated pathology, which can cause bladder hyperactivity, should be identified and treated.

However it should be noted that this protocol is usually applicable to low grade reflux such as I to III. Most experts believe that grade IV and more so grade V reflux must be treated surgically as it is unlikely to resolve spontaneously and the risk of renal scarring is greater than with medical management.


Hope my response will help you in making management decision for your son. Good luck.

This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.

The Henry Ford Hospital Department of Urology has experience in the evaluation and treatment of problems such as you describes. They would be most interested in helping you. You can reach us through our toll-free number (1-800-653-6568). We can also arrange local accommodations through this number if this is your need.
Sincerely,
HFHS M.D.-A.T.
*keyword: VUR, vesicoureteral reflux
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