Primary VUR presenting in Adulthood
· 30 Y, M
· LUTS: since 2-3 months: Urine stream is weak, intermittency, straining, post void dribbling, sense of incomplete void, frequency D: 3-4, N: 01
· AUA score is 16/35
· Right abdominal pain sometime since 2 months
· H/o fever 15 days back, no nausea, no vomiting, no haematuria
· Appetite good, no constipation.
· H/O Ayurvedic medicine for stone disease, doubtful h/o passing stone .
· Past History: No h/s/o recurrent fever in childhood, On repeated asking no h/s/o recurrent UTI Asked the senior members of his family, He was hospitalized twice in childhood. Of which once was for jaundice and the other time no details
· BP 155/91, P75
· PA: soft, no lump ,no tenderness, bladder is not palpable, penis: NAD, no renal angle tenderness.
· PR: Prostate is flat tone good, no tenderness, perianal sensation are normal
Lab and Imaging
· HB: 13.7, TLC: 6,800, N: 56, L: 41, PL: 2,49,000,
· Urea: 38, SrCr: 1.94, SrCr 2.58
· Urine r/m 1-2 PC,
· Urine c/s: No growth (he had received antibiotics before)
· Ultrasound: Both kidneys are normal in size with raised renal CMD, RK PCS fullness, dilated upper ureter on right side, on bladder plate both the lower ureters are seen dilated, Prevoid 289, Postvoid Nil
· Plain CT KUB: Bilateral renal cortical scarring, LK: 9.1x5.2 RK: 9.9x 4.8, Mild to mod HN RK, Mild prominence of lower ureters on both side, mild dilatation of bilateral distal ureter is noted
· The bladder is smooth
· The picture is s/o Primary reflux
· He has bilateral dilating reflux
· Creat is deranged
· Do we reimplant? Will it help?