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Child got infected with flu. Diagnosed with stage 1 and 2 VUR. Urine analysis done. Prognosis?

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Practicing since : 2001
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Good day! We're russians and I decided to talk to international doctors because russian doctors don't know how to help us. I will explain our situation. My daughter is 3 years old. In September, 2012 she went to the kindergarden, before this kindergarden she was absolutely healthy girl, she made all tests before going there, including CUA (clinical urinate analisys) - everything was ideal. In October, 2012 she got flue, and she had very strong flue with a temperature in a week, she made all tests - in CUA there were all in norm except erythrocytes (it was 25(normally nothing or 1-2 visual fields)), and Nechiporenko analisys was 47 000! ( normally is not under 1000) (In Russia we made this analisys..i don't know about how it's in states...sorry) Doctor said to take antibiotics SUMAMED ((russian antibiotic)it didn't help), then she changed it AMMEKSIKLAV (10 days). Constantly repeated urine analisys, on reception AMMOKSIKLAV erythrocytes it seems as fell, and fell to 1 500 NECHIPORENKO, but to norm to 1 000 didn't come. And still these erythrocytes pursue us in each analyses in different quantities. In November and December daughter was in nursery nephrology. In nephrology hospital they made her a tsitografiya. Found 1 stage left-side vesicoureteral reflux and the 2nd stage pravostoonny vesicoureteral reflux, but her analyses there were never neither protein nor leukocytes and doctors explained our erythrocytes aren't connected in any way with vesicoureteral reflux. Pier if we didn't have this situation with erythrocytes, we even wouldn't know about our VCReflux. Now we treat VR (a course of treatment for a year on VR). As I understood it is not critical, and in a year we will check again its dynamics. What is doesn’t let us sleep well - our erythrocytes!!!. We always have them in different quantities! In CUA they are to 50 visual fielnds, 6-8 visual field, 10-15 visual field, 25-30 visual filend. We took over 100 times of CUA, and this quantity always changes! Also in our analisys she has small amount of salts, either salt ++++++, or moderate quantity of salts. But we keep to the diet appointed by doctors, it is forbidden vitamin C, and the products containing oxalic acid we excluded, she tries to drink much, not always 1,5 liters, as it is difficult to a child of only 3 years to give to drink it violently. We try to eat more products like cabbage, potatoes, well that recommend. But erythrocytes somehow from it doesn't change. The matter is that doctors don't allow daughter to visit a kindergarden, and since october month she sits at home. I can't understand how long we will still more, doctors told to wait while erythrocytes will leave! And I read that it can not leave also for years. In Hospital our nephrology made the accompanying diagnosis - metabolism nephropathy. Soon March, and we stay at home as our doctors are afraid that she can take another virus from and she will have very bad consequences because of erythrocytes. So what should I do! ? We don’t have any pills against erythrocytes! Give me any advice how to clean her Urine Analisyse from these erythrocytes! ! ! ! ! ! ! ! ! ! ! ! ! !
Posted Sun, 3 Mar 2013 in Kidney Conditions
Answered by Dr. Avinash Ignatius 12 hours later

Your doctors are right that the amount of protein and erythrocytes in the urine are unlikely due to VUR. The VUR is only stage 1 and 2 which usually resolves as the child grows.

However an alternative cause forthe protein and RBCs in the Urine needs to be investigated, as it suggests some form of glomerulonephritis.

This is difficult to confirm on blood investigations - but some investigations like
Anti Streptolysin -O (ASO) titre
Anti Neutrophilic Antibodies (ANA0
Complement levels
would help suggest a cause.

If her protein and RBCs in the urine do not subside, she needs a kidney biopsy to confirm the cause.

Warm regards
Above answer was peer-reviewed by
Follow-up: Child got infected with flu. Diagnosed with stage 1 and 2 VUR. Urine analysis done. Prognosis? 23 minutes later
But in her analisys of urine or blood there were never PROTEIN! Never. And no leukocytes.
How this kidney biopsy can be made? Is it avaliable for kids? May be do you know any medical pills or grass to drink to get rid of these erythrocytes?
And do you think as well that we can't go to the kindergarden? Or we can? What's your opinion?
Answered by Dr. Avinash Ignatius 4 hours later

If there is no protein in the Urine and only erythrocytes, then it is likely that these RBCs are related to the reflux. RBCs can be found in the urine of patients with reflux.

A kidney biopsy need not be considered at this stage.

The variation in the RBCs in the urine is due to variation in intake of water, as intake of more water prior to the urine analysis will dilute the urine and show fewer RBCs.

It is a good idea to avoid excessive Vit C and foods with oxalic acid as there is a tendency to form stones in those with reflux.

There is no need to take any additional pills or grass as they don't have any affect.

Just make sure she takes good amount of fluids (1 to 1.5 Lit)every day.

I wouldn't restrict her from going to kindergarten, if general hygiene is good ...

Above answer was peer-reviewed by
Follow-up: Child got infected with flu. Diagnosed with stage 1 and 2 VUR. Urine analysis done. Prognosis? 31 minutes later
Ok, But first you wrote me "erythrocytes in the urine are unlikely due to VUR", then now you write me "then it is likely that these RBCs are related to the reflux" to uderstand it?
I forget to mention that sometimes my daughter has a temperature without any reasons, she doesn't coughe, sneeze or blow her nose and no pain in throat, the T can be 38,5C, right now she has 37,2C, I'm very worried... This temperature can be 2 days and then fell down till 36,5C. How to be with it? WHat to do? Is it because RBCs? Or is it because the Reflux? Or may be some other hidden viruses of urine tracts? Right now she has 37,2...I give her antivirus pills but seems like it doesn't help her....
And another question, can our RBCs can pass by chance one day? without medical treatment?
And have you had a chance to XXXXXXX such occasion as our occasion? Do you have any statistics of such kids with our situation? And how ususally does it resolve with the kids?
Answered by Dr. Avinash Ignatius 8 hours later

Sorry for the confusion! Initially I was under the impression that she had both protein and RBCs in the urine. Once you clarified that there was no protein in the urine my impression changed.

Children with VUR may get fever due to discomfort while passing urine, but should have increased frequency. The only way to be sure is to get a Urine analysis and culture done when she has fever.

If urinary infection is present and is recurrent she would require some form of antibiotic cover as a prophylaxis.

A DMSA scan if available, can tell if there is any previous scarring in the kidneys due to infection. If so then also she would need antibiotic prophylaxis

Since her VUR is mild any form of surgical treatment would not be recommended.

Warm regards and best wishes
Above answer was peer-reviewed by
Follow-up: Child got infected with flu. Diagnosed with stage 1 and 2 VUR. Urine analysis done. Prognosis? 9 hours later
Good day!
You didn't respond me on this question
can our erythrocytes can be over in urine by chance one day? without medical treatment?
We made her ultrasound scan of kidney, absolutely is ok there, but one kidney has twin form (or double form). I think you understand what I mean.
In your experience do you often have kids with such our problem with erythrocytes?
Thanks again, XXXXXXX
Answered by Dr. Avinash Ignatius 2 hours later

Yes the RBCs in the urine can disappear some day. But there is no test to predict in whom they will or when.

From your description I presume that the she has a duplex draining system. such kidneys are prone to VUR and episodes of urinary infection.

Yes I do get children with RBCs in the urine, however it is not very common.

Above answer was peer-reviewed by
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