Yesterday, we arrived to find out our baby was gone!!!
She apparently was fed up with the noise, found the brake lever on her crib and drove it out of the hospital down the highway, only to be pulled over by a policeman who gave her a ticket for being too small to drive a crib!!
The nurses said no, that wasn't it. She was wheeled down to have a kidney reflux exam. A VCUG. It is where they watch the urine to make sure it doesn't go the wrong way. (More info below.)
How did all this happen? Well, read back in the blog a LONG time ago, and you will remember the time the guy had a hard problem finding the left kidney. Well, they checked it again, and it is a little small. Now they have to figure out why, if it is growing, if it is broke and if it is ok.
That is what we are doing now. We have another test today. It uses diethylenetriaminepentaacetic acid( Technetium DTPA) to radioactivate our blood to scan our kidneys. Cool! She will glow today!! More on the results of all this new worry later. But all indication seem that nothing will be found.
A kidney nuclear medicine scan, or study, is a simple test that involves administering small amounts of radioactive substances, called tracers, into the body and then imaging the kidneys and bladder with a special camera. The images obtained can help in the diagnosis and treatment of certain kidney diseases.
While many tests, such as x rays, ultrasound exams
, or computed tomography scans (CT scans), can reveal the structure of the kidneys (its anatomy), the kidney nuclear medicine scan is unique in that it reveals how the kidneys are functioning. This is valuable information in helping a doctor make a diagnosis. Therefore, the kidney nuclear medicine scan is performed primarily to see how well the kidneys are working and, at the same time, they can identify some of the various structures that make up the kidney.
Our kidney scan we had yesterday was pictures of the urine to check to see if it was going backwards....
Normally the kidneys manufacture urine. This urine is transported through two tubes called ureters, toward the bladder, a muscular sac a bit like a thick-walled water balloon. When you urinate, the urine is excreted from the bladder through an exit tube called the urethra. When the bladder muscle contracts, the openings from the ureters into the bladder are normally squeezed shut, forcing the urine to go one-way, out the urethra. In some children, however, the connection where the ureters enter the bladder muscle allows urine to go back up toward the kidneys as well as down through the urethra when the bladder muscle is contracted. This is called
vesicoureteral reflux.There are three problems associated with vesicoureteral reflux. First, when the bladder contracts, causing urine to be forced upwards, the urine puts pressure on the kidneys that they are not built to handle. This can produce scarring of the kidneys. The kidneys and ureters can become dilated from the back-up, leading to poor function. The second problem is that the urine that squirts backwards quickly returns to the bladder. We depend on the bladder to completely expel the urine in order to get rid of the small
amounts of bacteria that can enter the bladder (especially in girls, who have short, straight urethras connecting the bladder to the outside world). Effective bladder emptying is a major defense against infection.
Kids with reflux get bladder infections more easily. The third problem is that the urine that goes backward can carry the infection found in the bladder past this line of defense, up to the kidney, resulting in serious infections and possible kidney damage.
Thankfully, you getting through this? The great majority of children with reflux outgrow this over the course of several years. Reflux is divided into grades I, II, III, IV, and V. In children with grades I and II, 80% will resolve spontaneously by
school age(we have some time I think, we are like....what a day?)
. Spontaneous resolution is progressively less common in grades III and IV (only about 10% of grade IV involving sides), and rare in grade V. Progress can be followed by using ultrasounds and x-rays (particularly one called a voiding cystourethrogram, or VCUG(yeah that thing), which takes pictures of the bladder contracting and the urine exiting).