Scarlett's Repeat VCUG Testing

As I have posted before, Scarlett has VUR (Vesicoureteral Reflux) which puts her at very high risk for kidney infections. She got her 1st kidney infection at only 3 months old, which is how we realized she had VUR. She has been on daily antibiotic ever since.

The protocol is to repeat the VCUG test yearly until they no longer have the reflux. On Tuesday we went ahead and repeated the test (I wanted to get it done before I find a job and don't have the availability to take her). It was much harder this time with Scarlett being older. 

Before Smiles

They did put numbing medication in her diaper for a few minutes but I promise you she didn't think it worked. A catheter was inserted into her bladder and a contrast solution was injected into her bladder and a series of realtime X-rays were taken. I had to stand at the head of the table and hold her arms above her head. The RN held her feet. Once 60ml were inserted into her bladder the reflux started.

At 3mo old her right kidney only had "minimal reflux" and the left was a grade 2.

 The results this time were that the right kidney was now a grade 2 (so it got worse) and the left kidney didn't show any reflux on the 1st attempt. The Dr. said there was no point in repeating it to see if the left would reflux since she proved to do it on the right. 

Therefore, we have to continue the daily antibiotic for another year. We are increasing her Bactrim dose just slightly to accommodate for her growth but it is still on the low side of being therapeutic. The VCUG will have to be repeated again in 1 year.

The hope is that she "outgrows" this reflux. Her growing should help stretch out her ureters and stop this urine reflux. The pediatrician said most children outgrow this by ages 4-6. I really can't imagine doing this yearly at toddler age ... how do you even try to explain it?! Most children with a grade 2 or less reflux do not require surgery.

We really, really pray she outgrows this & fast!

Scarlett's Kidney Workup

Yesterday was Scarlett's scheduled kidney workup at Methodist Hospital. Cody and I were SO nervous for her knowing what we were about to put her through.  I feel like God planned the timing of my last clinical rotation at Urology San Antonio so that I knew exactly what was happening with Scarlett. I mean what are the odds that I just observed these same procedures last quarter and then had to observe my own daughter go through it?!

We checked into the pediatric radiology unit and were thankful to not have to wait very long. First she had to do the VCUG where they insert a catheter and then inject contrast into her bladder to watch the flow of urine with a series of x-rays. The radiologist and RN were wonderful and said they would tell us immediately if something was wrong and then call our pediatrician so we could discuss it. 

They made her wear a hospital gown

She explained to us that they would do the procedure twice because sometimes kids don't reflux on the 1st attempt but will on the 2nd. And that is exactly what happened to Scarlett. She did not reflux on the 1st attempt but did on the 2nd. 

Vesicoureteral Reflux

You can see the bladder full of contrast (the big dark circle) and then the urine "refluxing" back up to the kidney. Scarlett did this on both sides. The right side had very minimal reflux and the left side was much more dramatic. The radiologist stated it was grade 2 and that less than 5% of children with grade 2 or less require surgery. However, when I spoke with our pediatrician she said that based on the written report (she hasn't seen the images yet) that is sounded like at least a grade 3. We will see what she says once she sees the images.

Then Scarlett had her renal ultrasound to make sure she had 2 kidneys that were the right size. This part was less invasive but she still cried because she didn't want to be touched at that point. I ended up nursing her while they did the ultrasound to calm her down. The results from the ultrasound were perfect.

The radiologist called my pediatrician with us standing right there and gave her the results. Our pediatrician asked to speak to me and discussed the next steps. Scarlett has to begin prophylactic antibiotic (Bactrim) daily to prevent UTIs. She will have to have this test repeated in 6 months. The hope is that she "outgrows" it as her body gets longer and stretches out the ureters. If there is ever a sign that it is getting worse, we will have to discuss surgery. 

We were also informed by the radiologist that siblings under the age of 5 should be tested as well. This really bothers Cody and I because we can't imagine putting two more girls through this procedure and how do you even explain it to a 3 year old who comprehends?! Our pediatrician agrees and is ok with our decision to wait until one of them gets a UTI before testing them. She said we could begin with the ultrasound to be less invasive and would be able to see any kind of kidney damage at their age. Cody and I think the girls are fine as they have not had any past UTIs.

Praying she outgrows this and that our other girls don't have the reflux as well!