undergone DMSA scan showed right kidney 33% and left kidney 67%. Recovery through medication?
Thanks for writing to XXXXXXX
I can understand that your baby was operated for VUR on the right side for grade IV which is high grade VUR, and that his recent DMSA show evidence of decreased function on the right side . The report I understand says that out of 100% function 33% is done by your son's right kidney and 67% ( the rest ) by his left kidney, which does mean his left kidney is compensating for right kidneys decreased function. Below 15 % is only considered as non functioning.
So be assured. Your son's right kidney is still working moderately .
There is every chance that this function will improve if you do yearly DMSA scans as advised by your pediatric urologist and continue antibiotic prophylaxis and investigations as recommended on a routine basis.
There is no special medicine to improve his current function, but it can improve as he grows .
But be careful about these points
1) Toilet training, make sure he empties his bladder and and bowel completely each time
2) Make sure your kid is taking his antibiotic prophylaxis without fail
3) Consult your doctor immediately if he has fever, because any further urinary infections will increase the damage
Hope I answered your queries. Let me know if you need clarifications.
Thanking you for your kind advise.
But the condition cannot be improved with medication is a bad news for us.
We are already trying to give him proper toilet training.
For your information he is ALREADY resistent to
2.Niftrans---Prophylactic antiboitic(which we came to know recntly after his fever in XXXXXXX 2013)
3.Presently he is on Sporidex 125mg/5ml Syrup.(5ml daily at bedtime)
His Nephrologist has suggested for a repeat MCU to understand the reflux grade.Please suggest whether we should opt for open surgery once again depending on the MCU result or keep him on medicine(Prophylactic antibiotic.)
In Kolkata there is no Pediatric Urologist available.
The Urologist who did his surgery was not Pediatric surgeon and we understand that the Operation did not go well, otherwise he should not have been affected with UTI again as his basic problem is VUR for which the operation was done at 7months.
Looking forward to your valuable comment once again.
1) I very well understand shotage of pediatric urologists in India. But do consult with a XXXXXXX pediatric surgeon who should have plenty of surgical experience with VUR.
2) Lower Antibiotic prophylaxis is becoming difficult nowadays because of increasing drug resistance. This is an universal problem more so in India because of unregulated use of antibiotics in the open market.
Persistent VUR despite surgery ( if your kids MCU scan shows that ) , may need re surgery depending on the grade of residual VUR.
Do consult with both your nephrologist and pediatric surgeon before concluding on re surgery.
3) I meant that no direct medicines are available to improve your kids kidney function. But do remember, there are many kids who live normal life even with one kidney.
And MORE IMPORTANTLY, as time progresses his kidney functions could improve as he is still young and growing.
WIshing your kid good health
Thanking you once again for your advise and guidance.To complete my discussion I had attached the following reports for your study and comment.
1.DTPA scan report done in September 2011.
2.USG KUB report done in July 2012
3.USG KUB report done in April 2013
4.DMSA scan report done in XXXXXXX 2013.
Kindly go through the same and give your opinion as till now you had advised without any reports in hand just on basis of the data provided by me.
I can confirm whatever you had said in your question is true in the report
But be positive, your son is growing ,there is every possibility that his right renal function would improve as the USG in April 2013 still is not adverse.
DO follow regular checkups and investigations as per your nephrologist
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