Vur

[alotofyarn]

I'm starting a new thread to keep up with E's urinary issues. In January she had her first UTI - she never had a fever, but her urine smelled like mine does when I have a UTI, and she had been constipated, so I took her several days later when it hadn't gotten better and we had gotten back into town and had her checked. They did a cath and didn't bother with the bag, and she handled it really well. Her UA came back clean, but her culture came back positive. She also had an ear infection, so we treated her with augmentin. So, last week I noticed her urine smelled a little strong, but it wasn't quite infected smelling, so I didn't do anything. My mom and her teacher actually noticed it too, and then Friday morning it smelled infected again, so I took her to the pediatrician. The catheter was awful, because the nurse just couldn't get it in, but finally she peed on her own, so they caught that. The UA came back negative, and we're still waiting on the culture. The pediatrician prescribed bactrim anyway, and referred us to the pedi urologist. I had Grade V VUR, was septic, and had surgery to correct it when I was around 4 or 5. Since it's hereditary, we always knew it was likely that our kids might have it. We actually talked to the pedi urologist today at a social event, and he said her likelihood was 60% given my history. So, he's not even going to bother with an office visit since he knows us, and he's going to just order an ultrasound, potentially a VCUG depending on how the ultrasound goes. I'll report back once we learn anything else, I just wanted to share where we were now!

[Pollyanna]

Wow! Thanks for the update. I have no idea what a VUR is but it doesn't sound fun!

[alotofyarn]

Vesicoureteral reflux.

[Ladybug]

I'm glad you already have a good relationship with a doc you trust. Fingers crossed for some treatable answers. Poor E!

[TulipsAndSunscreen]

As mentioned in another thread, our neighbor has a Grade IV and they have maintained her on abx until now she's 4 and she will have surgery this fall. The good news is that if she's not febrile, it's likely not as bad as yours was and/or she hasn't had any kidney damage. She could take abx daily for a while until she's older for surgery.

The group here is currently debating optimal time for reimplant surgery for kids who can be controlled on abx. Studies are just now showing that sustained anesthesia time is undesirable in children so now there's a question of when you should time the surgery (previously thought earlier was better so they don't remember). Peds Uro dept here has asked for a position on this issue and is awaiting reply. If they're uncontrolled on abx, then surgery is immediately indicated to prevent kidney damage.

[alotofyarn]

Thanks, T&S! Hubby had recently learned a lot about it, but he hadn't explained much to me because for whatever reason he's not sure she actually has anything wrong.

[TulipsAndSunscreen]

Well DH said that if she's my febrile and UA is negative, she could easily not be treated. Because there's nothing to treat...but we will see what they see on VCUG.

[scarlett09]

Nothing to add, just lots of hugs for you and E! I hope the U/S and VCUG come back clear.


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[alotofyarn]

Well DH said that if she's my febrile and UA is negative, she could easily not be treated. Because there's nothing to treat...but we will see what they see on VCUG.

Right, I just don't trust the UA, because last time the UA was negative but her culture came back positive, and because it was a cath, there was a low risk of contamination. And because that's how mine presented, although I did have high fevers. Hopefully we'll get the culture back tomorrow. I'm not sure when we'll get in for the ultrasound.

[alotofyarn]

Culture came back today, and it was negative as well. We're still going to do the ultrasound though, because my UAs and cultures came back negative when I was a kid too.

[alotofyarn]

And, her urine smells again this morning.

[TulipsAndSunscreen]

DH said there have been published papers that indicate that urine smell is not an accurate indicator of UTI or not. Surprised me since I feel like that's what everyone always mentions. Maybe it's not a UTI? That would be a good thing!

[alotofyarn]

I read one of the studies, and it had a really small N. I know it's not a totally accurate indicator, but it always has been for me personally, and it was for me when I was a child and my mom smelled it too. She agreed with me about E's smelling this time. I'm not going to start her on antibiotics if the culture isn't positive, especially in the absence of a fever or any other symptoms, but I do want to have her checked out still, sooner rather than later. I need to get hubby on it with talking to the pedi uro and scheduling it.

[alotofyarn]

Ultrasound today - no reflux! She was not cooperative for it - I should have spoken up when hubby scheduled it for 2pm (naptime is generally about 12-2), but I figured we could make it work. She was a grump and did not want to lay down, so finally I laid down with her and was able to get her to mostly lay still for it. The ultrasound tech was great though, and she did an ultrasound on Elmo first to try and show her how fun it was. Hubby was funny and wanted to talk to the radiologist before we left, and then he called the pedi uro to talk to him. They agreed that there was maybe a tiny bit of splitting if he was being picky, but nothing to worry about at this point, and to follow up if she had a febrile UTI.