Birmingham Update

Nephrology visit was yesterday, Thursday, 9/12 and Karla is happy. 👍

Mini Mayhem's iron supplement had to be increased due to her anemia and one of her anti-rejection meds was decreased due to a slightly elevated level. We will recheck the level here locally in a month. 

She had her routine; echocardiogram, it was normal, and she won't need another for 3 years!

Then she went for a renal ultrasound. I took a CD of the USs done at LB in July and August for them to compare (as they had requested). 

Thankfully, we were worked in to see Urology on the same day and only had to wait two hours. I thought that was pretty ok.  

At LB in July, we were told there was hydronephrosis. Hydronephrosis occurs when one or both kidneys swell due to a buildup of urine. One cause of this is a UTI which we know MM has had two, one in July and one in August. When she had the US at LB in August, I was told the hydronephrosis was resolved. Well, guess what....IT IS NOT RESOLVED. The Urologist said the US done that day showed some urinary tract dilation. The plan: continue the antibiotic that Nephrology had suggested she start on, he just changed it from a liquid to having me open a capsule and add the granules to her last feeding of the day, she will start a probiotic and a cranberry supplement and he will schedule a VCUG in 6 weeks. 

What is a VCUG? "A voiding cystourethrogram (VCUG) is when the bladder is filled with a liquid called contrast material. Then, images of the bladder and kidneys are taken as the bladder fills and also while the patient urinates. An X-ray exam that uses a small amount of radiation to create images of the urinary system. It's a minimally invasive procedure that's often used to diagnose problems with the bladder, urethra, and ureters."

It can show the size and shape of the bladder, check for blockages or abnormalities in the urethra, the tube that connects the bladder to the outside of the body, check the ureters, the tubes that connect the kidneys to the bladder and can help diagnose vesicoureteral reflux, a condition where urine flows backward from the bladder to the kidneys.

They typically do not use sedation for this because the child needs to be awake to cooperate. Welllllllllllllllllll, since I don't have the most cooperative child, she may have hers done under light sedation by way of something like Versed. She won't be put to sleep (no general anesthesia) but it will prevent her from fighting the process. The Urologist was going to speak with radiology and determine the best option. This is almost always done as an outpatient procedure, but Nephrology was going to speak with Urology to see if she should be admitted the night before and go home the next day or the following day considering her medical history. If we DO go home after the procedure, I will be choosing to stay overnight in Birmingham. The last thing I would want to happen is for us to get home and need to go back! 

If the test does show reflux, there are options for that, but nothing will be done the same day of the test.