Grade Two Kidney Reflux in Seven Year Old Female

Patient

Q: History: My daughter (birthdate 2-1-05) developed her first diagnosed UTI shortly after she turned 5 years old. She had no symptoms other than high fever for four days. She was treated successfully and did not have another UTI until she was almost 6. Over the course of about 6 months, she had 4 more UTIs. She had an ultrasound and VCUG when she was 6.5 (July 2011). It was determined that her kidneys looked fine on the ultrasound but she has Grade 2 Kidney Reflux on both sides. Her pediatrician did feel that it was unusual for a diagnosis at this age and that we would wait to put her on prophylactic antibiotics until we knew if she was going to continue to get UTIs. She did have one UTI in the fall that cleared up quickly after they got her on the right antibiotic. Three weeks ago, she had a high fever with no other symptoms and our suspicion of a UTI was correct. She was started on Bactrim but the sensitivity test showed E. Coli so they switched her antibiotic. Her fever cleared up and we took a repeat Urine samlpe in 48 hours after her last dose of antibiotic. It showed she still had a lot of blood and nitrates and so they started her on Augmentin and sent the sample away for another sensitivity test. This test also showed E. Coli so what she on it effective. She is now on day 5 of the antibiotic.

These are my concerns... with the kidney reflux, this infection has been free-flowing between her bladder and kidneys for over 2 weeks. What are the chances that this will cause kidney damage? Can it cause the uterers to scar which would mean a higher grade of reflux? Given that she was 6 at the age of diagnosis, what are the chances that it will correct itself since most children are diagnosed within the first couple years of life and it is resolved by the time they are school-age? What would be the recommended treatment at this point? Prophylactic antibiotics (even though she continues to have UTIs while on antibiotics) and wait to recheck her or is surgery the better option?

Thank you!

Doctor

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