Tuesday, February 9, 2016

B's Kidney Update (@ 1 month old)

Last Friday we went to Children's Healthcare of Atlanta for Bridget to have a renal ultrasound and a VCUG. Last night her pediatric urologist gave us the run down of what these tests revealed. So here's the skinny:

Good news first. Her ultrasound showed a healthy appearing RIGHT kidney. (Yay! Yay! Yay!)  Her doctor does suspect that the right kidney has a ureteral duplication (but uncomplicated), which means two ureters are draining from the RIGHT kidney to the bladder.  “Uncomplicated” means no reflux (no urine washing backwards up to the kidney as sometimes occurs) and no obstruction (blockage).  Uncomplicated also means there is no adverse consequence of having this anatomy. (Woohoo! At least one good kidney is what we've been praying for!)

The less than good news, but better than we were expecting news: As suspected from my prenatal ultrasounds, the LEFT kidney also has a ureteral duplication, but it's complicated. The ureter from the upper portion of the kidney (i.e. the “upper pole ureter”) ends in a ureterocele. Ureterocele means that the last part of the ureter as it enters the bladder is dilated, expanded, ballooned.  This is associated with obstruction of the upper pole portion of the kidney. (This was all what we expected from my prenatal ultrasounds.)

B's Left Kidney - all those dark spots are not present in a normal kidney

Because the upper pole ureter pushes on the lower pole ureter the lower pole ureter which does not end in a ureterocele and does not reflux is also partially, but only partially obstructed. While that sounds scary, it is not an emergency because apparently the lower pole of the left kidney can tolerate this situation for some time.  And, here's more good news, the upper pole is a small segment in its overall contribution to renal function- given its ultrasound features it may not offer any real significant kidney function. Bridget's urologist expects her overall kidney function now and in the future to be normal. (Great!!!)

So what is next? Apparently, the management of ureteroceles is very individualized and a key detail in decision making is the level of function in the upper pole and the impact of the left upper pole on the left lower pole function and drainage.  So B needs another test called a MAG3 renal scan. So looks like we're going nuclear.  Kind of scary, but some fellow kidney-moms I've met thanks to the magic of Facebook, have assured me it is tolerable.  The doctors prefer to obtain this study at 6 weeks of age due to the way that neonatal kidney handles the contrast.  B will be six weeks old next Thursday, so the test should be scheduled in the coming weeks. Once the doctor has the results from this scan he'll be able to decide what procedure she needs and when she'll need it. So while we don't have the game plan in place yet, we feel very optimistic and have been able to breathe a little easier today.  Of course I don't love that B will need surgery, but I'm thankful that her long term prognosis is looking good for now!

Thanks for the continued prayers and thoughts! We are loving our little lady and feel so lucky to have her in our family!

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