Re: vesicoureteral reflux

[HFHS M.D.-KR]

Posted By HFHS M.D.-KR on March 30, 1999 at 09:22:01:

In Reply to: vesicoureteral reflux posted by staci porter on March 02, 1999 at 14:06:04:






When my daughter was 2 she got her first uti with a fever.  At 3 she got one more uti, again with a fever.  At this point our dr sent her to get an ultrasound.    One kidney was bigger than the other, but nothing else was shown.  Another ultrasound was given 2 mo later to check on the kidney, the ultrasound showed exactly the same results.  At 3 and 4 mo, she got another uti.  Our Dr at this point sent us to childrens hospital in Boston to  a pediatric urologist as well as starting her on a propholactic dose of sulfa.  There she had another ultrasound, where they found that on her right side she had 2 ureters going into the bladder and they could see the bladder enlarge and then get smaller.  They said that the movement indicated reflux and that we should have the radionuclide cystogram, which we did.  The RNC showed bilateral reflux with a grade of 3.  At this point the dr scheduled her for a DMSA scan and continued her on the sulfa.  It was found however that at the time of the RNC, she had another uti.  She was placed on augmentin which cleared it up.  4 days after finishing the augmentin we tested her again for a uti and it was again positive.  This time she was put on another medicine (I cant remember the name.)  
ANyway, the specialist just called and wants her to get the surgery.  After reading all the questions and all the literature I am not sure about the surgery.  Her reflux isnt that severe, but she is getting a lot of uti's.  Wouldnt it seem more wise to try swithching the propholactic dose, since sulfa doesnt even seem like a common one used in this instance?  ALso should the original ultrasounds havebshown something?  The ultrasound at children's picked it up so quickly.  One last question.  Twice, when my daughter got the stomach flu, she was hospitalized for dehydration while my other son got through it just fine.  I know this is stretching it, but could there be any correlation with reflux that makes her prone to dehydration in stressful situations like that?
Thank you for your time and I look forward to hearing your response,
Staci




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Dear Staci,
Urinary tract infections in children are a common problem. Bladder infections alone are not usually dangerous . However, reflux of urine into the kidney in combination with urinary tract infections can lead to kidney damage. Diagnosis of reflux in childhood must be made to prevent this damage. The evaluation of a child with recurrent UTIs includes a renal ultrasound looking for dilation of the kidney and a VCUG to find reflux.
The VCUG ( Voiding CystoUrethroGram) is performed by placing a catheter in the bladder and instilling contrast material while X-rays are taken. This is a very safe test performed at most hospitals.Your daughter has undergone this exam and was found to have reflux.  Reflux often resolves with time however it is imperative that she remain on antibiotics until that time. Otherwise, she will develop renal scarring and subsequent renal damage.
The fact that your daughter has a duplicated ureter (two ureters on one side) makes it less likely to resolve spontaneously and more likely to require surgery. In addition, the indications for operating include inability to suppress infection with antibiotics, significant scarring and high grade ( IV or V ) reflux. Your daughter has the first two of three. Therefore, I agree with the assessment by your urologists that surgery is indicated. With regard to the second part of your question, I am not aware that the flu can worsen the symptoms of reflux. However, in general if you have an infection that is making you ill a second problem such as the flu can make you feel worse.

HFHS M.D.-KR
*keyword: pediatric UTIs