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Why is my daughter's kidney reflux not resolving?

Q: My daughter is 3 years old and has been diagnosed with stage 2 reflux. She has been on antibiotics for a year and her most recent VCUG indicated that she was still at level 2. Her urologist recommended that we proceed with the deflux procedure. My concern is about the long term effects of this procedure. I also have concerns about continuing the antibiotics for another year, as the doctor said that he would not suggest antibiotics for more than two years. This procedure is now an option and there is only a 20% chance each year of the reflux improving. There hasn't been any further infection since the initial diagnosis. Please advise.

A:It is good that she had not had any infection episodes since initiating antibiotic prophylaxis. Options now would be to continue on similar prophylaxis till the age of 6 years, or do some intervention like deflux or incontinence surgery. Usual indications for intervention are - 1. Persisting bacteriuria while on prophylaxis, as evident by periodic urine cultures 2. Break-through infection / pyelonephritic episode, despite prophylaxis 3. A new renal scar formation on a DMSA scan, which is done routinely every year in these children during follow-up 4. Non-resolving reflux in a female child beyond the age of 6 years has to treated by an intervention, whether deflux or surgery, as spontaneous resolution after this age is unlikely. Reflux in females cannot be allowed to continue during adulthood, as it is a risk during pregnancies.

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