Child with Vesicoureteral Reflux (VUR) suffers kidney damage, scar. Can kidney be normal without surgery as child grows?
Patient: My son has been diagonised with unilateral grade 3-4 VUR & his left kidnsy has scarred , its 36 % working.now he is on antibiotics .should we need surgery or will he outgrew it ? he had UTI at 6 months old.now he is 2 yrs 3 months.Is there any chance of resolving it.Will the affected kidney shrink again if there is no infection hereafter Doctor: Hello and welcome toHCM  In vesicoureteral reflux the direction of urine flow is reversed.Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys It is classified into Five grades depending on the severity. Grade I –Grade V. Medical treatment is low dose antibiotic prophylaxis until resolution of VUR occurs. The goal of treatment is to minimize infections, as it is the infection that cause renal scarring and not the vesicoureteral reflux.   Medical management is recommended in children with Grade I-III VUR as most cases will resolve spontaneously.  A trial of medical treatment is indicated in patients with Grade IV  VUR especially in younger patients or those with unilateral disease.  For Grade V VUR  surgery is the only option. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scaring then surgery may be necessary.  Surgery is necessary in cases where infection recurs despite prophylaxis with antibiotics, if the VUR is severe (Grade IV & V)and if there is failure of renal growth, formation of new scars and renal deterioration. Since your child had only 1 episode of UTI and he is on regular prophylaxis we can continue with medical management .Urine cultures should be performed every 3 monthly to exclude any new infection. Get a repeat radiological examination to see if the working of kidney function is deteriorating.  Good perineal hygiene, and timed and double voiding should be done to decrease the reflux. But still i will suggest you to consult a good urologist to help take a wise and timely decision for surgery. Hope I have answered all your queries.  wish you good health for your son.