Sunday, April 18, 2010


Vesicoureteral reflux is a condition in which there is a defect where the ureter joins the bladder and urine goes back to the kidney. Bladder infections quickly turn into life threatening kidney infection. Bladder infections are also more likely due to incomplete flushing of the bladder. Even if the urine could be kept sterile through constant antibiotic consumption, the pressure of the urine could destroy the kidneys. It appears that 1% of children have this condition but girls are more likely to develop symptoms. It also tends to run in families with 20% of siblings likely to be affected and 66% of children whose parent has it are affected. Many times it spontaneously resolves as the child grows. The urinary tract is fully mature at age 7 or 8. This condition reared its ugly head when Shanna was 2.5 years presenting with a high fever and pain all over. It was puzzling as she had not had a cold recently so no ear infection or the usual secondary infection suspects. Although she was generally more articulate than most kids her age, she could not tell where it hurt other than everywhere. Even the pediatrician was initially puzzled until a urine sample was obtained (fun for a toddler). Antibiotics quickly cleared the infection. A week after we stopped the antibiotics, the situation returned. All sorts of very invasive tests were scheduled (conveniently on Josh's due date)to identify it. She had it on both sides and given a 50% chance of it going away as she matured. At the time, there were only 2 pediatric urologists in the state. The one we had to deal with at UM was a very unpleasant person with absolutely no social skills. Fortunately for us, he was replaced by a much more reasonable person that we dealt with for many years. The first one looked at my belly and told me I better hope that it was a boy. Really not much was known about the condition at the time. I had access to a medical library so I read everything there was. Now they know that boys can get it just as often if not more often than girls. Much, much later when they started having higher resolution ultrasounds, I had Naomi and Josh screened. They are fine. But Shanna was on antibiotics for many years developing allergies to the more commonly used ones and developing a lung condition from another. She did not outgrow it. They like to do surgery before puberty as there are much less blood vessels to deal with. The doctor told me after the surgery that I took her in at the nick of time as her blood supply increased considerably due to impending puberty. He was ignoring the more obvious signs. So she had the very invasive surgery at 10 (now done laproscopically)to reimplant both ureters and after a very difficult recovery, was fine.
Last week Oliver, just a few months younger than herself when diagnosed, came down with a mysterious high fever. Oh no, did she warn the pediatrician about herself. Even worse, her husband's nephew lost a kidney due to it so it is on both sides. She took him in. The pediatrician said that now every baby is checked prenatally for this condition during the midpregnancy ultrasound. There are many false positives with boys but rarely false negatives. It is amazing what they can see on these ultrasounds. The fever was gone the next day.

Sunny and cold here. Need to convince Naomi to study with me.

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