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Is surgery necessary for reflux nephropathy?

Q: Doctor, My husband is 24 years old and has been diagnosed reflux nephropathy. He has never complained of any problem. Early last year, he was feeling very uncomfortable when we got to know that his blood pressure was very high 150/92. His serum creatinine was 2.6, protein 3+ and alkaline phosphatase 295. The volume of urine was normal. We also got his nuclear scan done and the report is: scan DRCG - multiple episodes of abnormal radiotracer activity seen in the region of right middle ureter and during the voiding phase of study. Abnormal radiotracer activity also seen in the region at lower end of the left ureter though no abnormal radio tracer activity seen in the region of kidney on either side during study. Significant post void residual radio tracer activity in the bladder. Images by gamma camera: left kidney appears normal in size, zhape & position with good perfusion and preserved cortical concentration of the radio tracer. There is prompt transit of activity into the collecting system with subsequent sluggish drainage into the bladder. Right kidney is relatively smaller in size with good perfusion and mildly impaired cortical concentration of the radio tracer. There is a rapid transit of activity into the collecting system with subsequent drainage into the bladder Relative function: Left Kidney-59.3; right kidney-40.7; total-100.0 GFR (ml/min)- left kidney 44.4; right kidney 30.4; total 74.8 Captopril study- left kidney 57.9%; right kidney 42.1% GFR (ml/min)- left kidney 46.6; right kidney 34; total 80.6 His ECG report is normal. I have referred 3 doctors - one says the condition is not critical and has prescribed Odoxyl 125 mg, Listril 5mg & Covance 50. The other says that we should go for recanaling surgery. I am confused - is the surgery really required as doctors say that the surgery is successful only in small children. My husband is taking lot of precautions- takes less salt, non-veg, milk, and all proteins & fats. Now with medicines his BP is around 120/80 and the maximum it has gone to in 3 months is 130/90. His latest report shows that protein is nil but creatinine is 3.4 (can this be because he had 150 ml of alcohol the night before the test)? CAN CREATININE LEVELS BE DECREASED WITH DIET and MEDICINES? What grade of reflux nephropathy is this and will he ever live a normallife? What diet should he follow? Please help as I am very confused?

A:You should investigate him for outflow obstruction as your reports say that there is significant residual urine. Get a uroflowmetry done and ultrasound for residual urine. Also I need to know whether there is any hydronephrosis in kidneys on ultrasound. Then you need an MCU to actually grade the reflux which is shown by DRCG. Surgery cant be done without MCU. If there is reflux till kidney, then surgery may stop further progression of disease which is a real concern. Dont take it lightly. If he develops kidney failure, he will require surgery as major as a renal transplant after few years - so try your best to avoid such a situation. If there is evidence of outflow obstruction it can be treated more easily. His creatinine should not be rising so fast. Temporary catherization may show a fall in creatinine if there is obstructive problem. Do tell me if there is anything wrong with the way he passes urine, and whether he has any back bone problem?


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