Wednesday, June 17, 2009

Another Visit to the Hospital: Mild Bilateral Hydronephrosis

Today Mommy took leave from work to bring Juan Or for routine medical checkup (in HUKM) of his mild bilateral hydronephrosis condition (layman term: mild dilation on both kidneys).



Here are some background information about Juan Or's condition:



Juan Or was first diagnosed with this congenital condition since Mommy was 5 months pregnant. Doctors mentioned that usually mild hydronephrosis resolves by itself. The problem with hydronephrosis is that it makes the baby at higher risk for contracting urinary tract infection (UTI) due to obstruction in the urinary tract which in turn causes symptoms like backflow of the urine. Beause of this, Juan Or has been on antibiotic medication (trimetoprim) as a preventive measure since the day he was born. To date, Juan Or's kidney dilation has shown progress in that the dilation has reduced and his kidneys appear to be growing normally. So far, Juan Or has never experienced high fever not associated with cough/flu (which could be a sign of urinary tract infection) and his urine flow from the penis is of normal gush. Juan Or went for MCUG test (to confirm the source of obstruction and to check for urine backflow) previously but the test had to be aborted because the tube could not be inserted fully through the penis. Because the MCUG test failed, Juan Or has to be on trimetoprim until the condition resolves by itself or until he is 2 years old, whichever is sooner.




So how's the progress of Juan Or's hydronephrosis condition in today's hospital visit? Yay! Good news! Ultrasound scan result concludes that there is 'minimal splitting of both renal pelvis with no evidence of hydronephrosis' (Mommy is quoting directly from the ultrasound scan report!). So what does this mean? It means that the dilation has resolved by itself! There is no more kidney dilation! Yay! Here are the details of the ultrasound scan observation report:



  • BPL right kidney is 6.12 cm and BPL left kidney is 6.18 cm.


  • Both kidneys have normal echogenicity.


  • Minimal splitting of renal pelvis seen. However, no blunting of calyces seen bilaterally.


  • AP diameter of renal pelvis is 0.5 cm bilaterally.


  • No dilated ureter seen bilaterally.


  • Normal bladder. No calculi seen within.


How did Juan Or go through his ultrasound scan session? Well, Juan Or cried a lot (and loudly!) simply because he was rudely awakened from sleep when his turn came and that 'strangers' (the sonographers) had to touch him (Juan Or hates to be touched by strangers!).



Later on, after obtaining the ultrasound scan report, Mommy took Juan Or to the Paediatric Clinic section for consultation. During the waiting period, Mommy took Juan Or to be weighed and his height measured. Before weighing, the nurse instructed Mommy to take off his diaper. Then during the weighing process, Juan Or urinated! Later on, Juan Or dozed off again in the stroller and Mommy had to wake him up when his turn came. Luckily, this time, Juan Or didn't cry when Mommy carried him into the consultation room. Upon reaching the paediatrician's table, Juan Or saw an Incredibles toy figurine and quickly grabbed it. During the consultation, the paediatrician asked Mommy about how strong is Juan Or's urine flow, whether there's any occasion when there's blood in urine, whether Juan Or developed any unexplainable fever, his motor skill development and his weight gain progress. The paediatrician also concluded that Juan Or's weight gain has picked up and is currently at the lower range of the normal percentile. The paediatrician also agreed (with the private-practice paediatrician) that Juan Or should still continue with PediaSure milk. However, for his trimetoprim medication, the paediatrician was a little undecided whether or not to continue with it since the dilation is gone - the only thing of concern is whether the 'minimal splitting of renal pelvis' still poses risk of getting UTI. Because of this, the paediatrician asked about Mommy's preference. So Mommy answered that of course Mommy prefers Juan Or not to be on medication for prolonged period of time unless very necessary, but the possible risk of getting UTI may still be there (which can lead to kidney scarring and subsequent impaired kidney function). So the paediatrician and Mommy finally decided that Juan Or should still continue with trimetoprim until his next checkup at 1 year 7 months old. Mommy also asked the paediatrician whether there's any possibility that taking trimetoprim over a long period of time may have caused his poor weight gain by killing most of the friendly microorganisms in the gut that helps nutrient absorbtion. The paediatrician answered that it is highly unlikely because the dosage is very mild and that trimetoprim is not a broad-spectrum antibiotic.




All in all, Mommy paid RM 47 for the hospital visit: RM20 for ultrasound scan + RM5 for consultation + RM20 for medication + RM2 for parking. Mommy also managed to take some snapshots of Juan Or during the waiting time.










For previous posting of Juan Or's condition, please click here.


As an after-thought, Mommy wondered whether there is any genetic basis to hydronephrosis. A scientific article that Mommy found in the internet indicates that fetal hydronephrosis occurs in 1 of 100 births with at least 20% being clinically significant (luckily Juan Or's is not significant!). The article also mentions that the causes are unknown in most human cases although environmental influence and genetic determinants have been implicated. Genetic basis!? As far as Mommy knows, there are no relatives, both on Mommy's side and Papa's side, who have this condition or who have experienced UTI during toddlerhood or childhood. Could it be spontaneous mutation, then, for Juan Or's case? A further read in the article reveals that spontaneous mutations and targeted genetic modification has been described in a number of animal models to which the genetic defects in most of these naturally occuring mutants are still unknown. Huh!? Juan Or a mutant!? No comments....Perhaps Mommy can consider this a potential research topic for Mommy's final-year research project students - candidate genes for congenital hydronephrosis in human samples. But to do this, Mommy has to network with doctors who are handling such cases to get human DNA samples (Juan Or's DNA sample alone is not enough!). And to do this will involve a substantial amount of protocol (e.g. informed consent from babies' parents and perhaps permission from hospital). Never mind, Mommy will sort that out later....

5 comments:

Mrs Kam said...
This comment has been removed by the author.
Mrs Kam said...

Congratulation that Juan Or is clear of thhe bilateral hydronephrosis now, and that he gained weight!!! Think it's good to continue the antbiotics course for a bit longer. A friend of mine, her son got UTI when he was barely 6 months old or so, very very poor thing, now still on the antibiotics.

Good idea to do a research to find out the candidate genes. Would be interesting.

My son also has congenital disease - he is a G6PD deficient patient. But luckily this has no big impact to his health and development.

Iriene said...

Hi, Tks for visiting my blog. I had just clicked Digi ads on ur blog :D

I also agree with your decision to let Juan Or continue the antibiotics. I had just prayed for him... He will outgrow it, you r an excellent mummy.. take care and do keep in touch :)

Btw, you can read on my blog "The Joy of Love".

http://multiply-88.blogspot.com/2009/05/joy-of-love_17.html

Alice Phua said...

Mrs. Kam and Iriene, thanks for the well-wishes!

MeRy said...

Glad to noe that Juan Or is Ok now...Good news!!