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TREATING THE KIDNEY REFLUX (VUR) IN CHILDREN IN ANTALYA, TURKEY?
About 1-3 percent of all babies and children have a condition called vesicoureteral reflux (VUR). Renal reflux is the most common cause of end-stage renal failure in children. Some of the urine escapes back towards the kidneys and can increase the risk of developing a urinary tract infection (UTI). UTIs that reach the kidneys can cause health problems. That is why it is important to diagnose kidney reflux early, monitor it and, if necessary, treat it.
Turkey Medicals member and Medicalpark hospital department, head and Pediatric Urology and Robotic Surgery Prof. Dr. told us about the treatment of kidney reflux in Turkey in children.
What causes kidney reflux in children?
Some of the children are born with VUR, and the reason is unclear. The child’s urinary tract is usually in a one-way flow state. Urine flows down both kidneys through tubes called ureters. The ureters enter the bladder through the tunnel of the muscle, which forms special one-way valves to prevent urine from returning to the kidneys. The urine in the bladder exits the body through another tube called the urethra.
In children with VUR, the tunnel in the bladder for one or both ureters may be too short or its angle may be distorted, which can lead to urinary backflow. VUR can also occur as a result of the bladder not emptying normally. This is a less common cause of VUR.
What are the signs and symptoms of kidney reflux?
The diagnosis of kidney reflux is usually made in two ways. The first is recognized by the enlargement of the kidneys during ultrasound examinations performed in the womb. The other one occurs during examinations when the patient develops a febrile urinary tract infection.
What tests are done to diagnose kidney reflux?
VUR is diagnosed by a test called a voiding cystourethrogram (VCUG). No other test is a substitute for this test. A thin probe is inserted into the children while the VCUG film is being shot. It is usually administered with local anesthesia or sedation. It is important that the child does not move. VCUG is recommended for every child, boy or girl, who has a febrile urinary tract infection.
What to expect during a kidney reflux test?
A thin plastic tube called a catheter is inserted into the urethra, and the bladder is filled with a special liquid that can be seen on the X-ray. The test is not painful, but the child may experience some stress and short-term discomfort when inserting the bladder catheter. When the bladder is full, an X-ray is taken. VUR is diagnosed if the fluid goes the wrong way from the ureter to the kidney.
What other tests can be done for kidney reflux?
Ultrasound: This test uses sound waves to create an image of a child’s kidneys and bladder. It is recommended for all babies and young children after their first UTI with fever. In this sense, it is the first test that should be applied. A normal appearance does not mean that there is no renal reflux. However, if it turns out to be defective, it may require further examinations according to him.
Scintigraphy: Scintigraphy, also known as DMSA screening, is the gold standard method for determining whether there is damage to the kidneys. It may be desirable to do this if the child has a febrile UTI. Its implementation is not difficult. The radiation dose is very low. It is practiced in nuclear medicine clinics.
Blood test: Creatinine measures kidney function. A child with damaged kidneys may have a high creatinine level.
Blood pressure: Blood pressure should be checked at least once a year. Children with kidney problems are at a higher risk for high blood pressure.
Renal reflux is rated 1 (mild) to 5 (worst). The degree depends on how far back the urine goes and how wide the ureter is. Children with lower VUR (1-2) degrees found in early childhood have a chance to overcome this without surgery in 1-5 years.
How is kidney reflux treated?
Treatment for kidney reflux depends on the child’s age, gender, the degree of kidney reflux, and whether it causes any problems, such as a large number of UTIs. In addition, conditions such as damage to the kidneys, bladder dysfunction pose a risk. In most cases, VUR heals on its own with age. But to determine it is the sphere of specialists in pediatric nephrology and pediatric urology.
Treatment approaches include:
Observation: Children with a lower degree of VUR can be safely monitored under the supervision of their doctor (pediatric nephrology-urology). This usually includes regular follow-up appointments. It may include imaging tests to make sure that the kidneys are growing normally. Children with VUR should have their urine tested for infection when they have a fever and the fever has no other cause, such as a cold.
Preventive antibiotics (Prophylaxis): Some children are given low doses of antibiotics every day to reduce the risk of developing UTIS while waiting to see if they have exceeded VUR. The American Academy of Pediatrics (AAP) recommends preventive antibiotics mainly for children with higher-grade VUR (grades 3-5).
Endoscopic injection: A substance is injected into the area where the ureter meets the bladder to prevent the backflow of urine. This condition can be applied to children with recurrent urinary tract infections and low-grade (1-3) reflux despite antibiotic treatment. The success of the procedure varies between 50 80 percent.
Surgery: If the Stroke is severe and does not improve, or if there are recurrent kidney UTIs with fever, the child may benefit from surgery that corrects the lea valve between the bladder and ureter. This operation is called ureteral reimplantation surgery. Traditionally, it can be performed in the form of open surgery. The success of the operation is over 95 percent. After open surgery, it may be necessary to temporarily put a stent in the urinary canal. In this case, the stent should be removed from the urinary tract with a second operation after 2-4 weeks. The duration of stay in the hospital after open surgery is from 3 to days.
Robotic surgery: This is the most modern method of treating VUR. Robotic surgery has a success rate of over 95 percent, just like open surgery. It is done by entering the abdomen through 3 different millimeter points. No muscle incision is made. Therefore, the pain after surgery is much less. The recovery period is short. Patients can be discharged within 1 or 2 days. A cosmetically better look is achieved, since there are no scars left. This treatment is recommended in the European Guidelines for Pediatric Urology as an alternative to open surgery and can be applied in experienced centers.
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Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.
Physician's Resume:
Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.
Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.
In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.
Awards:
Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.
Certificates:
Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .
Professional Members:
American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.
Disclaimer:
Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.