Thursday, February 5, 2009

VU Reflux... what is that?

Yesterday Addison had her doctor's appt and basically this is what is wrong with her: What is vesicoureteral reflux? With normal urination, the bladder contracts and urine leaves the body through the urethra. With vesicoureteral reflux, some urine goes back up into the ureters and possibly up to the kidneys. Reflux exposes the kidneys to infection. In children, particularly those in the first 6 years of life, urinary infection can cause kidney damage. The injury to the kidney may result in renal scarring and loss of future growth potential or widespread scarring and atrophy. Even a small area of scarring in one kidney may be a cause of high blood pressure later in life. Untreated reflux on both sides can, in the most severe instances, result in kidney failure requiring dialysis or kidney transplantation. Why does vesicoureteral reflux occur? The valve system at the ureterovesical (ureter-bladder) junction may be abnormal: In some children the tunnel of the lower ureter through the muscular wall of the bladder may not be long enough. For these children, there is a good chance that growth may provide the necessary difference to allow the valve to work. The ureter may enter into the bladder abnormally (usually too much to the side), resulting in a short tunnel. This reflux is less likely to resolve with growth. Some children have reflux because of underlying problems such as lower urinary obstruction (such as urethral valves), abnormal bladder behavior (such as uninhibited bladder contractions or hyperreflexic bladders), infrequent voiding, or constipation. How is reflux evaluated? Children who are suspected of having reflux should have a renal ultrasound and a voiding cystourethrogram (VCUG). Based on these studies, reflux can be classified into five grades - grade 1 is the least and grade 5 is the worst. Mild degrees of reflux have a good chance of resolving spontaneously with age. Chances of resolution with high-grade reflux (grade 4-5, or reflux related to an anatomic problem such as a long-standing obstruction) are much lower. How is reflux treated? Since many children will outgrow their reflux, they can be followed carefully, with their reflux monitored at intervals by tests such as VCUG, renal ultrasound, or nuclear voiding cystogram. During this follow-up period they are kept on a prophylactic (low-dose) antibiotic to keep the urine free of infection. Any fever or urinary tract symptoms (such as burning, frequency, urgency, straining, foul odor, bloody urine, or unusual incontinence) must be evaluated with urine analysis and urine culture. Children who develop breakthrough urinary infections in spite of prophylaxis are at risk for kidney damage and need to be considered for surgical correction of reflux. How is reflux treated surgically? Correction of reflux (ureteral reimplantation or ureteroneocystostorny) is recommended for high grades of reflux, for reflux that fails to resolve, or for patients with breakthrough infections. The traditional surgical approach involves opening the bladder and creating a new longer tunnel for the ureter through the bladder wall. What about long-term follow-up? Children with a history of reflux should probably be monitored life-long with measurement of height and weight, blood pressure, and urine analysis. Occasional ultrasound tests will assure that kidney growth is on target for age and size. If kidney function from previous reflux should deteriorate, the pediatric nephrology team can begin appropriate medication and dietary restriction. She has Grade IV. And what I've found out is that 1% of babies have this. She will be monitored once every three months. So what I'm hoping for is no breakthrough infections and that this resolves itself. We don't want any procedures done. She was great during the test and did not even cry when they gave her the cathether but she did have the look that said, "What the deuce?" lol. She's such a trooper!!! Good news, she now weighs 11 lbs. 4 oz. Getting to be a little chunk!!! Here is a video my 16 year old shot with her cell phone the other day. That is Becca you hear in the background picking on Addison's "big" head and "nappy" hair... lol


Just A Mom (Call me JAM for short) said...

When I was young I was diagnosed with VU Reflux. I had corrective surgery when I was 12 years old. My son was diagnosed with it when he was about 12 months old. The urologists put him on an ongoing antibiotic until he was about four (too long in my opinion and the opinion of the kidney specialist). Then he was monitored with annual ultrasounds and visits with the pediatric kidney specialist. When he was eleven he was released by the specialist. He outgrew it. Glad the doctors were able to diagnose Addison.

mommaof4wife2r said...

that is just too precious! i am in love with her little gabbing! sorry to hear about the dr appt...another hurdle, but that little precious face is worth anything!

Tess Jones said...

Sorry to hear about the baby having VU, never heard of it before. I pray that it correct itself. She is such a cutie all the same! Love the little video.