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Baby With Urine Reflux Found Because Of Bladder Neck Fat. Any Chances Of Recovery?
Question: Hi
This is follow up question. Below I pasted the previous conversation.
summary : pre term baby with PUV grade 5 ... fulgaration done. creatine from 3.5 to 1.5 after 4 weeks.
Now its 5 months old. weight : 4kgs. We all tests done. blood creatinine up to 1.8. Vitamin D suppliments. urine reflux found because of bladder neck fat. there is only 20ml space supposed to be 80ml. doctors say no treatment is suggested until one year. They are expecting the boy's kidney function will deteriorate. survival chances are very minimum. suggests wait and watch. we have 2 blood transfer in last 30 days. do you see any +ve for this boy.. how its going to be.. how long (months/days) he can live.. Please explain.
hi, please review the below and give your impression.
pre term baby bladder obstruction... grade 5... high creatinine 3.80 and potassium weight : 1.5g.
puv fulgaration done 2 weeks post birth. - weight 1.6kg.
after 4 weeks surgery .. creatinine 1.6 potassium normal
after 8 weeks scan result : .. right kidney 48% left kidney 52% function, moderate renal insufficiency
after 15 weeks current: creatinine 1.6.. high ph ... medicine for blood acidity.. weight 3kg. avg 25-30g per day.
doctor advises to observe for an year. no medical or diet intervention...
want to know -- possibility of renal recovery... Please explain in detail..
Thanks.
keep this private to me. NO public sharing.
Asked by Me , Thu, 27 Jun 2013
I was not asked to choose nephrologist.. Please forward it to nephrology specialist.
thanks.
Asked by Me , Thu, 27 Jun 2013
Doctor's reply to your question above...
Hello
Thanks for your query.Based on the facts that you have posted it appears that your baby has Congenital Posterior Urethral Valve detected during routine ultrasound scanning done in antenatal check up.
He had undergone fulguration of the valves two weeks after birth.
His creatinine levels which were high before fulguration are coming down gradually and he is gaining wait which is good sign of recovery.
Normally in most of the cases Kidney function becomes normal (100%) over a period of one year.
Do not worry your baby will be absolutely fine in one years time.
Hope I have answered your query. If you have any more questions please feel free to ask me I shall be happy to help you
Dr XXXXXXX
Replied by Dr. P. T. XXXXXXX , Thu, 27 Jun 2013
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thanks Doctor.
The worry factors are
Fluctuating creatine and high blood acidity and ph (it was 10 last week leek)
But wait gain is good 25gms avg per day.
Do you expect still he will become normal.
I read kidneys can not be recovered. Is it not all true.
Thanks.
Asked by Me , Thu, 27 Jun 2013
Doctor's reply to your question above...
Hello
Thanks for follow up.Fluctuating creatinine levels and blood acidity are to be worried about.
creatinine will almost near normal range 1.2 mg within 6 months time.
Nephrons (Kidney tissue) has potential power to regenerate hence Renal damage due to any obstructive pathology recovers completely once that obstruction is removed without scarring ..
I again assure you that your baby will be absolutely normal and fine within a year.
Thanks and Regards.
Dr XXXXXXX
This is follow up question. Below I pasted the previous conversation.
summary : pre term baby with PUV grade 5 ... fulgaration done. creatine from 3.5 to 1.5 after 4 weeks.
Now its 5 months old. weight : 4kgs. We all tests done. blood creatinine up to 1.8. Vitamin D suppliments. urine reflux found because of bladder neck fat. there is only 20ml space supposed to be 80ml. doctors say no treatment is suggested until one year. They are expecting the boy's kidney function will deteriorate. survival chances are very minimum. suggests wait and watch. we have 2 blood transfer in last 30 days. do you see any +ve for this boy.. how its going to be.. how long (months/days) he can live.. Please explain.
hi, please review the below and give your impression.
pre term baby bladder obstruction... grade 5... high creatinine 3.80 and potassium weight : 1.5g.
puv fulgaration done 2 weeks post birth. - weight 1.6kg.
after 4 weeks surgery .. creatinine 1.6 potassium normal
after 8 weeks scan result : .. right kidney 48% left kidney 52% function, moderate renal insufficiency
after 15 weeks current: creatinine 1.6.. high ph ... medicine for blood acidity.. weight 3kg. avg 25-30g per day.
doctor advises to observe for an year. no medical or diet intervention...
want to know -- possibility of renal recovery... Please explain in detail..
Thanks.
keep this private to me. NO public sharing.
Asked by Me , Thu, 27 Jun 2013
I was not asked to choose nephrologist.. Please forward it to nephrology specialist.
thanks.
Asked by Me , Thu, 27 Jun 2013
Doctor's reply to your question above...
Hello
Thanks for your query.Based on the facts that you have posted it appears that your baby has Congenital Posterior Urethral Valve detected during routine ultrasound scanning done in antenatal check up.
He had undergone fulguration of the valves two weeks after birth.
His creatinine levels which were high before fulguration are coming down gradually and he is gaining wait which is good sign of recovery.
Normally in most of the cases Kidney function becomes normal (100%) over a period of one year.
Do not worry your baby will be absolutely fine in one years time.
Hope I have answered your query. If you have any more questions please feel free to ask me I shall be happy to help you
Dr XXXXXXX
Replied by Dr. P. T. XXXXXXX , Thu, 27 Jun 2013
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thanks Doctor.
The worry factors are
Fluctuating creatine and high blood acidity and ph (it was 10 last week leek)
But wait gain is good 25gms avg per day.
Do you expect still he will become normal.
I read kidneys can not be recovered. Is it not all true.
Thanks.
Asked by Me , Thu, 27 Jun 2013
Doctor's reply to your question above...
Hello
Thanks for follow up.Fluctuating creatinine levels and blood acidity are to be worried about.
creatinine will almost near normal range 1.2 mg within 6 months time.
Nephrons (Kidney tissue) has potential power to regenerate hence Renal damage due to any obstructive pathology recovers completely once that obstruction is removed without scarring ..
I again assure you that your baby will be absolutely normal and fine within a year.
Thanks and Regards.
Dr XXXXXXX
Hello
Thanks for follow up.Recent serum creatinine levels are stable at 1.6 mg and your son is gaining weight.
Have you done his urine tests to know level of proteinuria which indicates whether there is damage to renal paranchyma.
Renal paranchyma (Nephrons ) have high potency to regenerate to near normal level after releasing the obstruction(PUV) provided there is no infection or associated Vesico Ureteric Reflux(VUR)
Please repeat his MCU to rule out VUR and to assess results of surgery (Fulguration)
With my experience of 40 years I can say that there are good chances of recovery and to have near normal kidney function .
Please ensure to follow following regime .
1) Get his routine urine test done every month.
2) Give him prophylactic antibiotics as per advice of Paediatrician to prevent UTI.
3) Repeat his DMSA scan after six months to rule our any scarring or infection of the renal paranchyma.
4) Give him high protein diet with Vitamins.
Please feel free to ask if you have more questions I shall be happy to help you.
Thanks and Regards.
Dr.Patil.
Thanks for follow up.Recent serum creatinine levels are stable at 1.6 mg and your son is gaining weight.
Have you done his urine tests to know level of proteinuria which indicates whether there is damage to renal paranchyma.
Renal paranchyma (Nephrons ) have high potency to regenerate to near normal level after releasing the obstruction(PUV) provided there is no infection or associated Vesico Ureteric Reflux(VUR)
Please repeat his MCU to rule out VUR and to assess results of surgery (Fulguration)
With my experience of 40 years I can say that there are good chances of recovery and to have near normal kidney function .
Please ensure to follow following regime .
1) Get his routine urine test done every month.
2) Give him prophylactic antibiotics as per advice of Paediatrician to prevent UTI.
3) Repeat his DMSA scan after six months to rule our any scarring or infection of the renal paranchyma.
4) Give him high protein diet with Vitamins.
Please feel free to ask if you have more questions I shall be happy to help you.
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello sir,
More details.. Creatinine levels are fluctuating.. they are in betweek 1.6 and 1.8. its 1.8 today. its 1.48 two month ago. Pottassium is at 5. No Urine infection. he is given sonamint 2 times a day and sporadex antibiotic 2 times a day.
They found Reflux due to bladder neck fat. valves are clear. They suggested very minimal dose of oxsispas to relax his bladder muscles. He is passing urine as stream. Avg 1 to 2 times/day he cries before urine. There found scarring in kidneys. we are giving protein diet and required vitamins. he is gaining weight avg 20g/day. As they explained there is only 20ml space instead of 80ml for his age. actually this is new found... They expected this bladder fat and space to be fixed after puv fulgeration. We consulted surgin, nephrolist.. due to high creatine and current reflux (which can not be fixed) they say the boy's survival or recovery chances are very less..
More details.. Creatinine levels are fluctuating.. they are in betweek 1.6 and 1.8. its 1.8 today. its 1.48 two month ago. Pottassium is at 5. No Urine infection. he is given sonamint 2 times a day and sporadex antibiotic 2 times a day.
They found Reflux due to bladder neck fat. valves are clear. They suggested very minimal dose of oxsispas to relax his bladder muscles. He is passing urine as stream. Avg 1 to 2 times/day he cries before urine. There found scarring in kidneys. we are giving protein diet and required vitamins. he is gaining weight avg 20g/day. As they explained there is only 20ml space instead of 80ml for his age. actually this is new found... They expected this bladder fat and space to be fixed after puv fulgeration. We consulted surgin, nephrolist.. due to high creatine and current reflux (which can not be fixed) they say the boy's survival or recovery chances are very less..
Hello
Thanks for fresh query.With fresh information that you have posted I think he has PU valve with congenital bladder neck obstruction.
It is rather confusing that his bladder capacity is just 20 c.c, because with this low capacity bladder he should pass urine very frequently at least 5-6 times in a day.Hence it need to be confirmed .
I think you should evaluate him thoroughly on following lines.
1) Get his Cystoscopic examination done preferably by a Paediatric Urologist.to assess his bladder capacity and to confirm bladder neck obstruction.
2) Viediocysourethrogram with Urodynamic study to study entire urinary passage and to confirm bladder neck stenosis.
Please consult qualified Paediatric Urologist for detail clinical evaluation.and to establish final diagnosis.
Tanks and Regards.
Dr.Patil.
Thanks for fresh query.With fresh information that you have posted I think he has PU valve with congenital bladder neck obstruction.
It is rather confusing that his bladder capacity is just 20 c.c, because with this low capacity bladder he should pass urine very frequently at least 5-6 times in a day.Hence it need to be confirmed .
I think you should evaluate him thoroughly on following lines.
1) Get his Cystoscopic examination done preferably by a Paediatric Urologist.to assess his bladder capacity and to confirm bladder neck obstruction.
2) Viediocysourethrogram with Urodynamic study to study entire urinary passage and to confirm bladder neck stenosis.
Please consult qualified Paediatric Urologist for detail clinical evaluation.and to establish final diagnosis.
Tanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The boy is reviewed by Paediatric Urologist and nephrologist and other surgeon.
cystoscopic examination is done. Baby at 4months. Doctors suggest wait and watch.. Hints survival or recovery chances are very minimum considering current creatnine 1.8 and reflux. They see cyst and scars in kidneys. fatty bladder. They say nothing left to do on this baby. But baby is doing OK. He is putting weight and taking feeds. he cries one or two times per day before urination.We are giving some medicines for blood acidity, d-vitamin and antibiotics as said.
As doctors says no almost no chances for recovery, how long it will take for completely deterioration and baby to pass away.. Is it going make him painful. Can we expect any miracle here. thanks.
cystoscopic examination is done. Baby at 4months. Doctors suggest wait and watch.. Hints survival or recovery chances are very minimum considering current creatnine 1.8 and reflux. They see cyst and scars in kidneys. fatty bladder. They say nothing left to do on this baby. But baby is doing OK. He is putting weight and taking feeds. he cries one or two times per day before urination.We are giving some medicines for blood acidity, d-vitamin and antibiotics as said.
As doctors says no almost no chances for recovery, how long it will take for completely deterioration and baby to pass away.. Is it going make him painful. Can we expect any miracle here. thanks.
Hello
Thanks for writing again.
I can understand your feelings as a father.In a given complex scenario as the child is recovering well and gaining weight,it is very difficult to predict how long it will take for kidneys to deteriorate or recover .
Please continue the medications as per advice of your Nephrologist and hope and pray God for some miracle to happen.
Thanks and Regards.
Dr.Patil.
Thanks for writing again.
I can understand your feelings as a father.In a given complex scenario as the child is recovering well and gaining weight,it is very difficult to predict how long it will take for kidneys to deteriorate or recover .
Please continue the medications as per advice of your Nephrologist and hope and pray God for some miracle to happen.
Thanks and Regards.
Dr.Patil.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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