How can my daughter’s kidney problem be treated?

Q: My 7 years old daughter is having recurring urinary tract infection (UTI) for the last 3.5 years and is treated with crocin and appropriate antibiotic medicine as and when the fever comes. Recently, MCUG test was done and reflux of grade III was found on the left side. DMSA tests suggested that 22% left and 78% right kidney is functioning and also there are lot of scar marks on the left kidney. However, right kidney is reported as normal. Two months back the doctor advised prophylactic medicine for the next 2 years and he asked us to wait as he says such refluxes gets automatically ok as the child grows. We followed his advice and immediately put her on Septran 480 mg daily. In between these 2 months, we sent the same urine sample for testing to 2 different labs for urine routine and culture. Report from lab 1 - WBC - 8-10, epith cells 3-4 and growth of E. coli in excess of 1 million. Report from lab 2 - WBC - 5-7, epith cells ++ (in fair number) and growth of E. coli around 10,000. She is also getting mild fever in between. What should we do now? As recurring UTI and non-sterile urine reflux may be causing further damage to the kidney. I have read somewhere that endoscopic and open surgery options are available nowadays. What is the success rate? Which hospital in Delhi provides this treatment? Please advise.

A:The treatment approach of prophylactic antibiotic for your daughter with left sided grade III vesicoureteral reflux (VUR) disease seems to be an appropriate one since it intends to minimise the chances of progressive damage to left kidney including ongoing scarring of the kidney. It is also based on the fact that most VUR do tend to resolve spontaneously. The ongoing reflux of sterile urine while she is on antibiotic (before the spontaneous resolution of the reflux disease) does not cause further scarring. However, if she continues to have recurrent infection of urinary tract including left kidney called pyelonephritis, it would be advisable to seek an opinion of Urologist for surgical intervention. As part of further investigation, she would also require study of voiding dysfunction, which is sometimes associated with VUR. Any ongoing medical therapy as in her case or future surgical correction of the VUR would be rendered ineffective if voiding dysfunction is not addressed. There are private hospitals in Delhi with expertise in dealing with VUR surgically and I would advise you to seek paediatrician’s referral to an appropriate specialist.