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Urology (Expert Forum)
concerns associated with reflux
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
concerns associated with reflux
by Cyndi__0__0, Jan 08, 1999 12:00AM
I received some information today from my daughters nephrologist that I would like a second opinion on. My daughter, age 11 mo., has grade 3 reflux and had protein in her urine last week. Her urine is fine this week. Does this mean the proteinuria is not significant at all? Serum albumin was 4.6 and total protein was 6.4. Also, do you agree that UTI's after age 4 will not affect the kidneys? We were told that if the reflux persisted after age 4, we would not have to worry about the condition even if it continued to cause infection. One more thing, please. She has been on Septra, but does not seem to be tolerating it well. For this reason the doctor switched her to amoxicillin. The bacteria that caused her first two infections was the common e. coli. Will the new antibiotic be as effective?
Thanks!
Cyndi
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Thanks Cindi for your questions.
Protein in the urine is usually an indicator that the kidney filtering function maybe compromised. It is important to know how the protein was found. A dipstick for protein can often be false positive. A 24 hour urine for protein is the best indicator for proteinuria but is impractical for an eleven month old. It is doubtful your child has significant proteinuria if she has not pyelonephritis ( infection of the kidneys) and or demonstrable renal scarring on nuclear renal scan.
Reflux of infected urine, in the older child, is less likely to cause renal scarring. The decision to surgically correct pediatric reflux is not straightforward and is open to argument. Females are often recommended to have their reflux corrected because pyelonephritis during pregnancy can cause pre -term labor.
Septra, trimethoprim/ sulfa... is usually a very well tolerated medication. Bone marrow suppression can occur and maybe screened for by a complete blood count about every 6 months or so. Trimethoprim by itself is also well tolerated without this side effect. Ampicillin is a good medication until the infant is 2-3 months old but is not frequently a first choice prophylactic antibiotic because Ampicillin resistant strains of E. coli are common. Macrodantin (Nitrofurantion) is a good alternative but can be distasteful in the liquid form. I recommend 25 mg capsules to sprinkle on foods if you can find that dosage.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: vesicoureteral reflux
