Question Title: kidney malfunction - reflux

First we would like to thank you for your help. Our son is 18 years old and was asymptomatic until 6 weeks ago. When joining a health-club they asked him to do some tests. As a result of an ultrasound which revealed hydronephrosis in the left kidney, we took him to the hospital for more tests. The results were:
1) ultrasound of the right kidney appeared normal while the parenchimal mass of the left kidney is reduced. 2)IVP: decreased secrection from the left kidney with an impression of a reflux to the left ureter on voiding. 3)kidney scan was 19% left and 81% right.(But, 3 days later when we came to ask for the films they recalculated the results and this time they were: 27%to the teft and 73% to the right. 4)scan+open catheter (taken 4 weeks later):14% left and 86% right. 5)voiding cystoureterography showed 4th grade reflux on the left side.6)blood:o.k.
As a result the doctors recommended a left nephrectomy + ureterectomy.
Our questions are:1)were all the necessary tests done?
2)scan results:why did we get different results of the first scan? will we get different results if they recalculate the second scan(injection + catheter)?
3)there are 3 possibilities: a)leaving things as they are since he is asymptomatic and deal with a problem when and if it arises b)correct reflux by surgery c) left nephrectomy+ureterectomy. What is your opinion considering that he is 18 years old and asymptomatic?
4)in case God forbid something happens to his healthy kidney would the left one be of any use?
Thank you again. Your reply will help us understand and make things easier to cope with.
Hadas.

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Dear Hadas,

Your son appears to be having vesicoureteric reflux (VUR). The condition is the result of defect in the normal valvular mechanism which prevents back flow of urine in to the kidney. Such patients, especially female kids and pregnant women have high risk for developing multiple urinary tract infections. That may damage the kidney if not treated by antibiotics or surgery.

Male patients have lower risk for infection especially at the age of 18 years. Since he is asymptomatic at this time, I feel we should not do any thing. Wait and watch. If any problem occurs, we should deal with it then.

As regards your specific question: a) was every thing done to investigate: I think yes.
reason for differences in scan results: results vary with status of hydration and weather or not catheter was in the bladder.
Need for surgery at this time: It is a matter of choice. There are people who believe that it should be done. Others think that we can wait. I prefer waiting.
Weather one kidney can sustain required body functions: Yes. Many patients who donate kidney for transplant, have normal life expectancy.

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.

Dr. Stephen Liroff at the Henry Ford Hospital Department of Urology has experience in the evaluation and treatment of problems such as you describes. He would be most interested in helping you. You can reach him 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: vesicoureteral reflux

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