My daughter just got over a case of acute pyelonephritis
associated with a urinary tract infection.  Now the Doctor
wants her to get a renal ultrasound, voiding cystourethrogram,
and a radionucleide scan.

Has anyone out there gone through this.  She is 32 months old,
and we're wondering what she's going to have to go through.
Will (can?) the hospital do anything to help calm her fears?

Any information would be helpful!

--
Doug Bank                       Secure Design Center

708-576-8207                    Schaumburg, Illinois

He had the ultrasound while in our local Children's Hospital for IV
antibiotics treatment ....which was required because of his age, apparently.
The ultrasound was pretty simple & quick. It happened to be Take Your
Daughter To Work Day, and the technician's daughter was even there to
"help."

As for the VCUG, which was just a couple weeks ago, done as an outpatient
procedure, they actually allowed us to stay with Torin. I understand this is
a hospital-by-hospital decision, though. He was strapped to a sort of board
beneath a very big ceiling-suspended X-ray machine, swabbed, catheterized.
The X-ray visible "dye" was actually a clear liquid. Didn't take long to drip in
and fill his bladder...they watched from a nearby monitor. We were given
lead aprons & allowed to hold his hands/arms to help comfort him, from
right beside the table. Once the bladder was filled, the voiding only took a
few more minutes. I'd say we were in the room maybe half an hour max.
A technician & radiologist attended. They gave us encouraging preliminary
results ("nothing obvious") that were verified by our pediatrician the next
day. Torin suffered no ill effects...although we were freaked out by something
that won't apply to your daughter...he is uncircumcised and they retracted
his foreskin for the procedure, something we understood was not to be done
for an "intact" boy before 1 year of age...but apparently it IS done for a
"prolonged" catheterization. Anyway, I know there'll be a difference since
your daughter is also much older, but if you have any other questions, feel
free to e-mail me.

t.r., mom to Torin, 2/13/96

As far as the ultrasound goes, that has been a piece of cake for her.  The
biggest help is the guy (technician) who does the ultrasound is great with
her.  He explains things so she can understand, uses funky colors on his
monitor for her and even draws her a computer picture when he is all done for
her to take home.

If you'd like to discuss this further, please email me

Irene
Mom to Jillian 1/24/92 and Valerie 12/20/95

Ron

: An under-utilized exam is the radionuclide VCUG. This study holds particular
: value in patients who are followed and repeatedly need evaluation of
: vesical-ureteral reflux. Instead of using x-rays, it uses a radiotracer in the
: nuclear medicine department. It offers the advantages of less radiation (want
: to be in the room, Mom?)and letting the patient Sit while voiding which is
: more natural. Additionally, the test is More sensitive.
: Ron
-----------------------------
To original poster: urinary tract infections in children and {*filter*}s are more
common in females. Only in elderly is the incidence roughly equal. In a
child of your daughter's age, the most likely cause is reflux from the
bladder up the ureter, to the kidney. In many cases, this is transient, and
as the junctions of the ureter with the bladder "matures," the reflux
ceases. If she has reflux, she does need to be monitored until it goes away,
mainly to ensure that the kidney does not develop scarring, which can occur
with infected, or even uninfected urine. Kidney ultrasound, or a nuclear
scan called DMSA is used for this purpose. The contrast VCUG (using xray)
should be the first imaging test performed. In addition the reflux, there
may be structural abnormalities, such as duplication of the urinary
collecting system, or baloon-like structures called ureterocoeles at the
junction of the bladder or urethra. There are others as well. Both of these
predispose to UTI, and are more common in girls. The VCUG is a more anatomic
examination. The radionuclide cystogram/VGUG mentioned by the poster above
does indeed cause less radiation dose, about 1% of an xray VCUG. It is more
sensetive than xray VCUG in detecting reflux. However it is insensetive in
detecting the anatomic/structural abnormalities which may cause urinary
infections. It is best used to follow up patients with known reflux, and
should never be used as the initial study.

Your child may have completely normal radiologic evaluation. In spite of the
stressful nature of these exams on children, the value lies in detecting
correctable/treatable conditions, before any permanent loss of function
occurs. In this case, it lies in the detection of scarring of the kidney,
which can lead to loss of kidney function. Be assured, as other posters have
noted, all radiology departments which care for children, whether in dedicated
children's hospitals or not, know how to devote special attention to the
needs of children and their parents. It should go pretty smoothly.

Alan

While I'm not the original poster of this message, I want to say thank you for
the information you presented.  My 4 year old daughter has this problem and
I'm always interested in learning more.

Thank you,

Mom to Jillian-1/24/92 and Valerie-12/20/95

I'm sure that it will go smoothly, then again, our daughter can get
very, very scared at trivial things.  I tried to remove a splinter
and she was freaked out by the tweezers.  I don't want to see her
strapped to a table screaming.  Are any anti-anxiety {*filter*} available
for this type of procedure?

Also, let's say they do find scarring in the kidney (when they do the
DMSA in a month) with or without reflux.  What then?  I know that
reflux can be fixed or can go away on it's own, but the implications
of kidney scarring are never really discussed.

--
Doug Bank                       Secure Design Center

708-576-8207                    Schaumburg, Illinois

Your daughter has had a kidney infection and she is scheduled for a renal ultrasound, a
voiding cystourethrogram and a nuclear scan.

The reason her doctor has booked these tests is to be certain that she doesn't have
residual infection, or a condition that will predispose her to kidney failure in the
future.

The renal ultrasound is a safe test that looks at the structure of the kidneys and
urinary collecting system. It will rule out any gross abnormalities (such as a single
kidney or grossly deformed kidneys). The voiding cystourethrogram(VCU)is a test that
ensures that there is no reflux of urine from the bladder to the kidneys on voiding.
That sort of activity (reflux) can scar kidneys and aggravate kidney disease. The scan
simply looks for present scarring and for any active infection.

This may seem like a lot of activity for what might seem like a problem that's already
been treated. All I can tell you is that it's much better to go through this than to put
up with years of dialysis for kidney failure.

I don't know what the protocol is in your community, but in our hospital, we sedate
children for ultrasound and for scans, but not for VCUs. A supportive parent will do
more to calm a child's fears than any medical person will.

Hope this helps,

Jon Slater MD FRCPC
http://www.mwsolutions.com/jslater/

If given a choice go to a children's hospital.  My daughter had
these tests done several years ago.  It was not a big deal at
the children's hospital.  They asked her to void lying down on
the xray table.  When she didn't (30 seconds of waiting) they
rotated the table up, put a potty under her and got the
pictures they needed.  

---
- Ginny