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Urinary and Genital Disorders (Children)

Renal Scarring Due to VUR

03/23/2009

Question:

My Daughter is 6 years old and has just been diagnosed with grade 4 reflux on the left side. An ultrasound showed that her left kidney is 50% smaller then her right. We are scheduled to have another test to see how the kidney is actually functioning at this point. Her Urologist says she was born with reflux. She had several UTI`s when she was younger, her previous doctors never did any follow up tests to see if reflux was present. Because she is just now starting treatment I am fearful she may have loss of kidney function. She has a loss of energy over the past year, she has always struggled with constipation, she has dark circles under her eyes. Do these signs indicate anything??

Answer:

It sounds like your urologist is planning to perform a kidney scan, which will show how well the left kidney is functioning compared with the right kidney. Many girls this age with reflux also have "dysfunctional elimination syndrome", meaning that their pattern of urination is abnormal; constipation is common with this condition, but it is treatable, and should reduce the risk of having more urinary tract infections in the future. However, if there is grade IV reflux and scarring in the kidney in a 6-year-old girl, surgery often is recommended.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University