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Infant suffering from weight loss, urine infection, low blood platelets count. Diagnosed with mild hydronephrosis. Suggest course of treatment

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My 3.5 months old son was born with low weight(1.995 kilos) through normal delivery 39th week of pregnancy. He got urine infection within 2 weeks of birth and suffered weight loss, his blood platelets count had fallen to 50 and weight was down to 1.3 kilos. He was underfed for a while after birth as he was being switched to breast milk. The pediatrician immediately gave him intravenous antibiotics shot and advised frequent formula feeding so as to gain weight immediately. Currently he is 4.3 kilos at 3.5 months. As a follow-up to the urine infection the ped asked for USG scan on his kidneys. The scan was done 2 days back and showed "Slightly prominent pelvicalyeceal system in left kidney". Right kidney is normal and measures 4.9 x 2.1 cms. Left kidney measures 5.3 x 2.4 cms. The radiologist who conducted the USG scan has said it could be due to PUJ narrowing or reflux and MCU tests may need to be carried on my son to determine what exactly is the issue. The pediatrician has referred us to a pediatrician nephrologist whom we are scheduled to visit in 3 days time.
I want to know from you what do you think may be the problem and what should be the correct course of treatment with all the probable possibilities
Posted Fri, 3 May 2013 in Kidney Conditions
Answered by Dr. Ravi Bansal 9 hours later

Thanks for letting us know your concern.

Mild hydronephrosis on sonography can be due to, PUJ obstruction or reflux disease. In both the cases, the way to manage is as follows.

- Prophylactic antibiotic for preventing recurrence of UTI (DTPA scan to rule out PUJ obstruction.

Further treatment is guided by the exact diagnosis.

Hope I could clarify your doubts. If you have any further questions, please ask. Also please do inform about the latest urine routine and serum creatinine report.

Thanks and Regards
Above answer was peer-reviewed by
Follow-up: Infant suffering from weight loss, urine infection, low blood platelets count. Diagnosed with mild hydronephrosis. Suggest course of treatment 4 hours later
1. Should the prophylactic antibiotic be started immediately even before the reports of MCU test and DTPA scan are available. Should it be applied through intravenous route ? What are the commercial names of such antibiotics available in the market ?
2.What are the courses of treatment that are recommended for infants of similar age in case of reflux disease or PUJ obstruction, or both

Thanks & Regards
Answered by Dr. Ravi Bansal 14 minutes later
prophylactic antibiotic should be started after the episode of UTI has been treated and continued till a definitive management plan has been made.

it is in form of oral syrup trimethoprim-sulphamethoxasole (TMP/SMX), nitrofurantoin, and penicillin derivatives . Treatment should be taken under guidance of your doctor.

I think as your tests are planned over next one week, we should wait for the results. if there is excessive crying at time of urination and fever and non-acceptance of feed then we should actively investigate for urine infection and start antibiotic.

Kindly inform me the reports once done. Don’t be impatient, let the tests be done.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Infant suffering from weight loss, urine infection, low blood platelets count. Diagnosed with mild hydronephrosis. Suggest course of treatment 11 hours later
Not sure if I could explain my questions to you clearly but sounds like there is a communication gap.
My son had caught UTI 3 months back when he was 2 weeks old. He had undergone treatment then and was given antibiotics by injection. He had recovered then and the antibiotics were stopped after his recovery. Our pediatrician has recommended the sonography on his kidney recently as a follow-up investigation to the UTI that had occurred then. Currently my son does not have UTI, however our pediatrician has asked us to visit a specialist doctor(pediatrician-nephrologist) to carry further investigation related to his kidney. In this context I want to know from you if the prophylactic antibiotics should be started immediately to prevent any further re-occurence of UTI ?
I do not know what tests/reports you are talking about - only if the specialist doctor asks for further tests I shall get that done. As an opinion-seeker I want to know from you if the MCU test and DTPA scan that you have mentioned in the first reply can be carried out safely on my son as he is only 3.5 months old. Are there any other precautionary measures that you would recommend at this moment ?
Answered by Dr. Ravi Bansal 6 hours later

Don't worry, I have understood your query. Since the episode of UTI occurred 3 months back, after the treatment, a prophylactic antibiotic may have been started by your doctor. Now since 3 months have passed and no repeat UTI episode has occurred, there is no need to start antibiotic at present. In case there is a second episode of UTI, then it should be treated with full doses of antibiotics for the recommended duration and then started on low dose prophylactic antibiotic for longer duration. I think that clarifies your doubt on antibiotic usage.

Regarding the tests, these should include kidney function tests, urine routine examination, which are generally done for patients having this disease. As you mentioned, the specialist you are consulting may advise for the tests.

There is no risk for doing the tests like MCU test and DTPA scan. Since you are visiting a specialist soon, he may advise you for the same. There are no other preventive measures you can do at present. Please be reassured. Let us wait for a proper evaluation by the specialist.

Hope this clarifies your doubts. Best wishes.
Above answer was peer-reviewed by
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