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

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.

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

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).
*keyword: urinary reflux
Posted by Sonya on August 14, 1999 at 05:02:43
Dear Lisa,
I understand you'r feelings on on-going antibiotics.  Emma was diagnosed with grade two kidney reflux at 3 months, she is now almost 8 months.  It was such a shock to hear that she had this problem let alone the fact she had to have antibiotics for years on end.  Being a pre-school teacher I heard all the facts on antibiotics lowering the ammune system and ofcourse the effect some have on teeth!  But I was lucky to have a M.D and Specialist who took time and explained to me that the medication used had no effect on teeth and was such a low dosage that her ammune system would be fine.  The decision was very easy for med's when you weigh up the options ie kidney trans plant--medication.  We were originlly told that Emma would be on med's for 8 years and found out last week that she will come off them at 2years because the stat's show she will have a 99% chance of having growen out of it by then.  There is a light at the end of the tunnel so keep you chin up.  Would like to hear back from you on how you'r wee one is doing.

Posted by charlie on August 18, 1999 at 09:45:57
Dear Sir, My son 14 months, has been diagnosed with Reflux.  It only affects his left side.  As a child I under went corrective surgery for the same problem, only both sides were affected.  After reading others comments, is it possible for his Reflux to be corrected naturally, or is surgery the only way to correct the problem.  In my case I had no flaps at the top of my ureturs, and they were reemplanted.  Can these flaps grow at a later date?  I would appreciate any information you might have. Sincerely,   Charlie

Posted by HFHS M.D.-AK on August 19, 1999 at 13:31:49
Dear Charlie,
Surgery is not performed unless there are indications.  These would be, progressive VUR with renal insufficiency, break through infections on antibiotics, renal scarring or unresolved reflux over several years that is unlikely to change.
Before you do anything, you should talk to a Urologist and discuss the percentage chance that reflux will resolve without surgery.  I always tell people the chance of grade one reflux resolving is about 80%, grade two, 60%, grade 3, 50%, grade 4, 30%, and grade 5, less than 20%.  If you have already seen a Urologist, you could discuss an antibiotic regimen for conservative therapy.  Another option to determine if the left kidney has been damaged, would be to do a DMSA renal scan, particularly if the reflux was found after a urinary tract infections associated with high fever.  Overall, children do very well with prophylactic antibiotics and you can follow the kidney and bladder over time with repeat Ultrasounds, and VCUGs.
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