Blood in Daughters Urine

[Cyndi__0__0]

  My 14 month old daughter had two kidney infections last August and Septmeber, which led to a diagnoses of grade 3 reflux on the left side.  She has had no breakthrough infections, but has consistently had blood in her urine since about December.  Usually it is just a trace amount.  This past Monday night she seemed to not feel well, vomited once, then was in terrible pain for most of the night.  She would cry in her sleep and draw her legs up as if having sharp pains in her abdomen.  I figured she had a stomach bug and sure enough she felt better by morning.  Well, Thursday the same symptoms began in the morning with the same behavior during her nap, except this time she did not vomit.  I checked her urine at home and according to the dipstick there was much blood this time.  The doc. had me collect another sample to take to the lab.  Because of her age, this took a while.  I was not able to get an adequate sample until about 5 hours later.  By then she seemed to be feeling better.  I saved some to dip myself and came up with only a trace amount of blood.  The lab reported the same finding.  My questions are:
  1) Could she have passed stones?  I have read that having UTI's could put one at a greater risk for developing stones.
  2) Could the trace amounts of blood be normal, or could there be some scarring from the infections?  She rarely has protein in the urine, though at one point there was 300+.  
  3)  If there is scarring, would you recomend going through with the surgery?  I am very concerned that waiting for a breakthrough infection could actually be the infection that causes damage to the kidney.  It is quite nerve racking to have these issues on my mind at every sign of illness!!!
  Any suggestions you could give me would be appreciated.  I will be discussing these issues with the pediatrician and urologist.
  Thanks,
  Cyndi

[HFHS M.D.-CK]

_
Dear Cyndi,
You have several questions that I will try to address.  Further information regarding vesicoureteral reflux may be found in archived answers regarding this subject on this website.  Kidney stones are possible at any age and infection can predispose to formation of certain types of stones (struvite).
Blood in the urine is abnormal; however, the trace positive finding on a dipstick test may be within the normal range, and this can be further evaluated with a microscopic urinalysis.  If there is microscopic hematuria or a question of scarring then a renal ultrasound would be suggested.
If renal scarring occurs, with or without documented breakthrough infection, then ureteral reimplantation would be suggested.  As you have indicated follow-up with a pediatric urologist with periodic radioloic study is necessary.
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. More individualized care is available through our department at the Henry Ford Hospital  and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
  * Keyword:reflux