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Saturday, December 7, 2013
VCUG for Stage1 Hydronephrosis Necessary?
My 2yr old daughter had one urinary tract infection in May and her pediatrician said it was unusual for someone under 5 so she recommended a nephrology referral, VCUG and renal ultrasound. I opted to wait on the VCUG but the ultrasound results were:"mild distention of the right renal pelvis with fluid, no hydronephrosis on left. Slightly small kidneys bilaterally wiht grade 1 hydronephrosis on the right. Bladder was partially distended with fluid and smoothed walled." Because my daughter was on an antibiotic for an ear infection at the time the UTI was detected and she only complained of pain once, her doctor is concerned that she could be having more UTIs "higher up" with little to no symptoms. The septra antibiotic cleared up the UTI in early June and I`ve tested her twice in July with an over the counter UTI test 4wks apart, both negative. Should we go through with the VCUG at this point or wait until she has another UTI? I have a nagging feeling that for a potty training 2 yr old, 1 UTI isn`t a cause for concern and an unnecessary procedure but I can`t explain away the fluid in her right kidney.
Urinary tract infections are common around the age of toilet training. If she had painful urination, strong, malodorous urine, suprapubic pain, or a combination of these symptoms, then she had a bladder infection, or cystitis. On the other hand, if she had a high fever and abdominal, flank, or back pain, then she had clinical pyelonephritis, or a kidney infection. Bladder infections are more common, and generally do not need extensive radiologic evaluation unless they occur repeatedly. Repeated kidney infections, however, can cause kidney damage (also called kidney scarring).
Many clinicians obtain a renal ultrasound after one kidney infection to check for any previously undetected kidney abnormality. Grade 1 hydronephrosis is minimal, and usually is not of any significance. Some would suggest getting a VCUG to determine whether urinary reflux is present. I think a VCUG is reasonable for your child if she had a kidney infection, but if she had a bladder infection, I would not do the VCUG. Instead, I would repeat the renal US in one year to be certain that the kidneys are growing satisfactorily.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University