Grade IV VUR in a child with one kidney

[lower pike]

I have identical 15 month twin boys, both who were born with one non-functioning kidney.  These were removed at 12 months of age.  One of my sons had a grade II-III vesicoureteral reflux on his remaining kidney, which worsened post-nephrectomy to a grade IV on his last VCUG.  My question is, what are the chances that such a high grade VUR will correct itself spontaneously?  I have been unable to find any information regarding best treatment options, and am hesitant to just "wait and see", knowing the risk for scarring, and realizing that he does not have a "back up".  He is on prophylactic Bactrim, and has had only one known kidney infection (when on a different antibiotic).  If reimplanataion surgery is done, would he have to be on dialysis at all while the kidney heals?  What is the minimum age suggested for reimplantation surgery (if that IS the best course of action)?

Thanks!

[Kevin Pho, MD]

There are no clear recommendations regarding medical and surgical options of treatment.  It is also difficult to give recommendations without knowing the case personally.  

With grade IV reflux, studies have shown that medical therapy can be considered.  If there is bilateral reflux or scarring, surgery can then be considered.

Surgery can also be considered if medical therapy fails, there is breakthrough resistance despite antibiotics or there are significant antibody side effects.

Regarding what the right course of action is, you may want to discuss this with your urologist - or consider another opinion.  

I am not a urologist, and cannot answer whether dialysis is needed during reimplantation surgery.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[marie50]

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