You would think this is an obvious thing, right? How your kidneys measure and appear on an ultrasound isn’t the same as how they function and process our bodily fluids. Makes sense. Apparently yesterday, I assumed one meant the other. In other words, yesterday’s post claiming “no more reflux” was a lie. All lies.

So here’s what kidney reflux is, in case I haven’t explained it before:

Vesicoureteral reflux is the abnormal flow of urine from the bladder to the upper urinary tract. The urinary tract is the body’s drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. Blood flows through the kidneys, and the kidneys filter out wastes and extra water, making urine. The urine travels down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder.

In VUR, urine may flow back—reflux—into one or both ureters and, in some cases, to one or both kidneys. VUR that affects only one ureter and kidney is called unilateral reflux, and VUR that affects both ureters and kidneys is called bilateral reflux.

(taken from the National Kidney and Urologic Diseases – Information Clearinghouse (NKUDIC))

Colten has bilateral reflux. It is classified in severity by grades 1 through 4, with 1 being most severe and 4 being least severe – Colten’s is grade 2. I swear at some point I read it was 3/4 but apparently I’m just full of lies these days because the last two documents I just double-checked say “grade 2”. It is something he may outgrow over time, although they will not retest him for it until about one year of age. Silly me – I thought the renal ultrasound was the check, but that’s only part of it. The ultrasound did show that his ureters are continuing to grow and develop, and that they are not being negatively impacted by the reflux at this point. To check if the reflux is still occurring, a VCUG, or voiding cystourethrogram, must be done.

VCUG is an x-ray image of the bladder and urethra taken during urination, also called voiding. The bladder and urethra are filled with a special dye, called contrast medium, to make the urethra clearly visible. The x-ray machine captures a video of the contrast medium when the child urinates. The procedure is performed in a health care provider’s office, outpatient center, or hospital by an x-ray technician supervised by a radiologist—a doctor who specializes in medical imaging—who then interprets the images. Anesthesia is not needed, but sedation may be used for some children. This test can show abnormalities of the inside of the urethra and bladder.

(taken from the National Kidney and Urologic Diseases – Information Clearinghouse (NKUDIC))

Reading more on the website linked above though, an abdominal ultrasound can also be used to test for reflux so you can be sure I’ll ask for that over the x-ray when the time comes. One of you will remind me, right?!

This all started came to light when I called the nurse line today to ask if we could take him off his meds since the reflux was gone. The nurse was quite confused as to where I got that information from. And it was the same woman that had attempted to cath him yesterday. So I’m sure she thinks I’m a bumbling idiot for 1-not being able to console my child and 2-making up what the doctor told me. She informed me that Colten does need to continue his daily preventative dose of antibiotics to keep the UTIs away. From what the NKUDIC site says, “When a child with VUR gets a UTI, bacteria can move into the kidney and lead to scarring. Scarring of the kidney can be associated with high blood pressure and kidney failure. However, most children with VUR who get a UTI recover without long-term complications.” She also informed me that maybe for his next cystometrogram, I can try to wait a bit to feed him and then feed him on the exam table, if I’m comfortable with that. Yes, I believe I’m comfortable with that!

We still go back in three months to attempt the cystometrogram again that they couldn’t do yesterday, and he’ll get a VCUG (or ultrasound instead!?) at around one year of age.

Sorry for the lies yesterday – I blame it on the crying kid. I think my head was in a fog because of that and I just heard what I wanted to hear! Colten and his chaos. Maybe THAT should have been the name of this blog. Hm. Not very nice, no. We’ll leave it as is.