Upate: Anna's kidneys

On Wednesday of this week Anna underwent a renal ultrasound to evaluate the size, condition and functionality of her kidneys. Immediately following the ultrasound she had a Voiding cystourethrography (VCUG) performed to observe the operation of her bladder and check for Vesicoureteral reflux (VUR).

Kidney to bladder path

Typically urine travels from the kidneys through ureters (normally a one-way valve) and remains in the bladder until the body voids it. With kidney reflux, urine travels back up one or both of the ureters to the kidneys (called back washing) upon voiding the bladder. The danger in this is the risk of recurrent urinary tract infections and damage/scarring of the kidneys.

For a child who is normally very unhappy about going to the doctor's office for any reason, she was really brave and did exceptionally well through both tests for her age. Mark and I were both able to remain in the room for both tests and assist in comforting her. The staff at Children's Hospital were all wonderful and did their best to make Anna's experience less traumatic.

Grade III reflux - urine (blue)
travels back up into kidney.

The ultrasound part of our visit was quite easy. She resisted getting on the exam table but once Melanie, the friendly ultrasound tech, started talking to her she calmed down and was very cooperative. Anna even got to push the button repeatedly to 'help' Melanie print each image she took of Anna's kidneys. She loved getting to mess with the computer and push buttons!


We then traveled downstairs for the VCUG. Again, the staff did a wonderful job of helping Anna feel comfortable and minimize her fear. Her two female nurses brought out various toys and books and even a music player for her to play with during the procedure. Mark and I were able to remain in the room and stay right at the head of the exam table, holding Anna's hand and talking to her the whole time. Anna cried during most of that procedure but it wasn't out of discomfort but fear. Because of her age and the fact that they needed very clear images of her body's internal operation, she wore a toddler sized hospital gown and was put on a stabilizing board complete with straps around her legs to keep her as still as possible. At one point they had to tilt the board to a 45 degree angle in order to get complete images of her left and right kidney/bladder function. She didn't like being tilted on that board but after a few times she realized she was safe and didn't fuss much. Our strong-willed little girl did not want to void her bladder with a catheter in place and every trick the nurses had failed. After we told them that although Anna is not potty trained she will hold her bladder for long periods if she is uncomfortable, the radiologist decided to remove the catheter to see if Anna would urinate on her own and it worked. Within moments of the catheter being removed, she emptied her overly-full bladder and the techs got the images they needed to clearly diagnose her issues. We were immediately able to see up on the screen that she did indeed have reflux and the radiologist told us it was on both sides (bilateral). They would evaluate all the images from both tests and contact us in a day or two with the specific results.

After it was all over she got to pick a few stickers and a prize - she chose a bright colored bounce ball. She was so proud of getting rewards and showed everyone on the way out of the hospital. Poor little thing fell asleep as soon as we got in the car and continued to sleep in her bed for several hours after the procedures. She was wiped out....physically and mentally.

On Friday afternoon we received a call from the pediatrician that Anna had Grade III bilateral Vesicoureteral reflux. The grading system goes from I - V with five being the most severe. So Anna is being referred to a pediatric urologist at Children's who will thoroughly evaluate the findings and recommend treatment. The known treatments range from a once-daily antibiotic that she would take for one year, to a surgical procedure to correct the 'two-way' issue within her ureters.

More info to come after we meet with the urologist.