Re: Kidney Reflux - How long does it take to correct itself on average? Operate?

[Lisa__0__0]

Posted By Lisa on August 07, 1999 at 12:57:48
Daughter has borderline Grade 2/Grade 3 in one kidney, Grade 3 in the other.
She is on antibiotics which I understand are necessary but I don't like it.
I'm wondering if there's any kind of ballpark idea of how long they wait for the reflux to correct itself - when do they decide to operate? She is only 3 months old - should I see a pediatric urologist? She is under the care of her pediatrician for this currently.

[HFHS M.D.-BE]

Posted By HFHS M.D.-BE on August 11, 1999 at 16:05:19




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Dear Lisa,
The most important issues for children with reflux are preservation of renal function and  trying to assure normal and complete growth of both kidneys.  This means avoiding infections of the kidneys to prevent harmful scarring.  Sometimes patients are placed on long-term prophylactic antibiotic therapy as your child has been.  These regimens are usually safe as long they are tolerated well by the patient.  Since your daughter's problem is being managed conservatively(medically), periodic follow-up studies must be done to ensure normal scar free growth.  Whether or not reflux would resolve, or when it would resolve, is a variable situation which differs in every patient.  Often, however, reflux could persist for a few years before resolving.
Also a physical exam should be performed, being certain that height and weight parameters and blood pressure measurements are taken.  Laboratory studies should include a urinalysis and urine culture at each visit  In terms of radiology tests, an ultrasound and VCUG may be obtained every 18-24 months.  After the initial VCUG has been performed to establish a grade, a follow-up study should be performed to determine if any interval change has occurred.
On the other hand, surgery or reimplantation of the ureters is a very successful procedure.  One should expect success rates as high as 95-98% in patients with normal caliber ureters and normal bladders.  This drops to 54% when the ureter is markedly dilated which is seen in grade four and five reflux.
There are several schools of thought on whether or not the reflux of sterile urine causes damage to the kidney and alters growth.  The decision to proceed with surgical therapy will largely depend on if medical therapy fails, i.e., breakthrough infection while on antibiotics or if the family along with the urologist come to a decision to go ahead with surgery.  You definitely need to see a urologist for appropriate follow up and management.

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.-BE
*keyword: urinary reflux











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