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How can the swelling and duplex kidney be treated in a child?

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Practicing since : 1994
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my three year daughter had an us yesterday.its shows she has extra tissues suspect of duplex shows some fluid in the kindey.and there is some swelling it a serious problem?what can i do for my baby.she had utiurine was positive for e coli. .treated with suprax.again urine culture came positive for diffent organism ,entrococus.she was on bactrim for 10 days
Sun, 6 May 2012 in Kidney Conditions
Answered by Dr. Sree Bhushan Raju 19 hours later

Thanks for the query.

Duplex kidney is a normal variant which is seen 2-5% of the human beings. Kidney alone or in association with the urine collecting tubular system looks as if there are 2 different entities within the kidney. It is absolutely normal without any major clinical implications. However a small group of people will develop UTI(due to stagnation of urine within the dilated pelvi calyceal system(a structure from which the urine passes first after filtering in the kidney). As your child has got recurrent UTI's we need to rule out underlying vesicoureteric reflux(VUR). Your doctor should be aware of this and hence should be doing Ultrasound scans.

Sometimes a dilated system of urinary tract might mimic, duplex moiety. It is very important to rule out VUR. She needs to continue antibiotic prophylaxis. Later, its important to get DMSA scan to look for any scar formation within the kidney.

Hope this answers your query. If you have any further queries please reply back and I shall be glad to reply you.
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Follow-up: How can the swelling and duplex kidney be treated in a child? 6 hours later
Hi Doctor,
Thanks for the fast reply.VCUG was done.It was normal and there was no reflux. US report says duplicated left kidney with pelviectasis and the right kidney measured 7.5 and left kidney 8.5. We had consulted her primary doctor yesterday and she said that the inflammation in the left and right kidney plus the fluid collection in her left kidney was due to infection she has before. She said that was she was not much concerned about this now as there was no relux or obstruction but she wanted us to take the second opinion of a urologist next week.Will she have any problems with hypertension in future?
As the VCUG was normal she was taken off Bactrim and was told to call her doctor if she gets fever or dysuria.
Answered by Dr. Sree Bhushan Raju 17 hours later

Good to hear from you again.

As I had already mentioned in my previous post that duplex kidney (or duplex pelivis or duplex ureter ) is a normal anatomical variant and as there is no VUR, you really dont have to worry about the recurrent UTI. Girls are prone for recurrent UTI's. Usually they subside as the child grows.

Duplex kidney alone doesn't produce Hypertension but the functionality of the Kidneys do matter along with if any structural changes in the kidney in future and if multiple adrenal glands are present; it might lead to Hypertension.

She can undergo a DMSA scan and check whether there is any scar formation. She doesn't require any antibiotic prophylaxis. She can be treated with antibiotics as and when required, according to culture reports.

It is most important to prevent further UTI's. This can be done by the following measures:
1. Avoid constipation, to do that give her lot of XXXXXXX leafy vegetables, fruits.
2. Ask her to drink good amount of fluids like water and fruit juices
3. Avoid dehydration
4. Maintain personal hygiene after passing stools.

Hope this answers your query.

Wish your child a good health.
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