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What Do These Following Lab Reports Indicate?

Posted on Wed, 28 Oct 2015

Question: My son is 2 months old and diagnosed with UTI at 6 weeks.
Baby currently under Trimethoprim antibiotics.
Three tests prescribed by Pediatric consultant:
1) MCUG (Micturating cystourethrogram) test done - Negative results(No issues)
2) Ultrasound result: both kidneys are normal in size
On the left the collecting system is very mildly dilated and there is mild dilation of the renal pelvis which measures 8 mm.slight prominence of the upper left ureter is noted. No cortical scarring is seen. Bladder looks normal and no lower ureteric dilation seen.
Very mild left pelvicalyceal dilation noted.
3) DMSA scan due in january
Please help on what's the treatment options and impacts and reasons for this condition?

Answered by Dr. Matthew J. Mangat (53 minutes later)

Brief Answer:
No indication for antibiotic or further tests.

Detailed Answer:
Hello XXXXXXX and welcome to HCM.
As an Urologist, let me confirm,if UTI at 6 months was diagnosed after culture test.
Was there a second episode of UTI , before MCUG was done.(UTI on urine culture).
If U/S scan is normal as reported, and MCUG is also normal, there's no indication for proceeding with Isotope scan( DMSA)., unless child is symptomatic.
As your son has no fever, there's no indication for continuous trimethoprim.
You can clarify this with the Pediatrician.
Scarring of kidneys suggests infection and calls for further tests and antibiotics.
Wishing your child remains in good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Matthew J. Mangat (3 hours later)

Hi Doctor XXXXXXX

My son is now 11 weeks old and he got UTI when he was 6 weeks old and he is on antibiotics since then.

MCUG came as negative, all good.

But ultrasound found some dilation: Results of Ultrasound below:

Ultrasound result: both kidneys are normal in size. On the left the collecting system is very mildly dilated and there is mild dilation of the renal pelvis which measures 8 mm.slight prominence of the upper left ureter is noted. No cortical scarring is seen. Bladder looks normal and no lower ureteric dilation seen.

Answered by Dr. Matthew J. Mangat (11 minutes later)

Brief Answer:
No tests for normal kidneys on scan and MCUG.

Detailed Answer:
Hi again.
The minimal dilatation of the left kidney pelvis and upper ureter, can be ignored.
Only if it affects the kidney, does one need to worry about it, and find a cause for it.
Hope your doubt is cleared.
Wishing him well.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Matthew J. Mangat (7 minutes later)

Thanks for your prompt reply doctor XXXXXXX Do you know why this dilation might have occurred like due to a birth defect or due to some other reason?

do you think that this dilation will cure by itself and there is no treatment needed for this?

Thanks,
XXXX

Answered by Dr. Matthew J. Mangat (13 minutes later)

Brief Answer:
May be only a variant.

Detailed Answer:
Hi XXXXXXX
Such dilatation, is a variant of normal anatomy in majority.
Only if it affects kidneys in any way, do we pursue it with the tests mentioned.
You get the U/S-KUB repeated after 6 months.
It may be seen as normal by then.
As long as both kidneys are normal, ignore a minimal dilatation of the ureter.
Similarly, repeat urine culture after 6 months.
Wishing him well.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar