
Dr. Anil Takvani
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24 Nov 2024 01:27:43 PMAsymptomatic high grade VUR with hypo plastic/dysplastic right kidney in 7 year boy
Case Summary:
A 7-year-old boy, asymptomatic, underwent an abdominal ultrasound (USG) 4 months ago for left hydrocele. The USG findings revealed:
• A smaller-sized right kidney
• Mild to moderate right hydronephrosis (HUN)
• Maintained corticomedullary differentiation
Clinical Details:
• No history of UTI
• No voiding complaints
• No constipation
• Circumcision was performed 4 months ago
• Normal spine examination
• Normal BP
• Weight and height are less compared to peers of the same age
Investigations:
• Urine culture: Sterile
• Serum creatinine: 0.43 mg/dL
• Recent VCUG and DMSA scan images will follow
Management Query:
Please discuss the management of this case with reasoning.
Thanks



Comments(12)
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Ravindra Sabnis
25 Nov 2024 08:26:11 AMI feel in asymptomatic primary vur whatever is grade - no role of surgery. In this case constipation should be treated. As it may add element of dysfunctional voiding which may complicate the matter
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Rajesh Kukreja
25 Nov 2024 08:27:05 AMWould manage conservative as of now. Asymptomatic, no UTI. Bladder appears normal and no PVR. The right kidney maybe taking the brunt of reflux and protecting the left kidney as a pop off mechanism.
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Dr. Anil Takvani
25 Nov 2024 09:45:06 AMSo a 7 year old boy with bilateral high grade VUR, right > left.Maintained rft with right shrunken kidney and left ? Compensatory hypertrophyPost circumcision.The child has quite a bit of constipation in my opinion in MCU. A scout/plain film would make it more clear sir.Treat the constipation.Plan for Bilateral ureteric reimplantation with tapering.Hydrocele/congenital hernia can be dealt with at same time.From Dr Kaushik from Bangalore -
Dr. Anil Takvani
25 Nov 2024 09:45:51 AMGood morningTreat the BBDBladder diaryConstipationUrotherapyReevaluate after 3 months and then proceed for surgeryYes all can be done the same timeFrom Dr Prasanna, Bangalore -
Dr. Anil Takvani
25 Nov 2024 09:47:17 AMInteresting approach sir. Seems like that thought process is having a lit of traction sir.In the on 2nd thought scientific program recently in bangalore there was a session questioning ir VUR is even a surgical pathology.So a bilateral reflux grade 5 in filling phase doesn't mandate surgery sir? Even sterile reflux can damage the well preserved left side is it not sir?From Dr Kaushik, Banglore -
Dr. Anil Takvani
25 Nov 2024 09:47:53 AMSterile reflux damaging the kidney is being questioned. If no UTI then no damage.Kidney will deteriorate as per amount of dysplasia in kidney. Not is our hand.Even if you do anti reflux surgery, courses of disease will be same.Dr R B Sabnis -
Dr. Anil Takvani
25 Nov 2024 09:50:01 AMEau guidelines 2024 still suggest surgery be offered if reflux persists are lutd treatment sir.
Dr Vinayn Kaushik -
Ritesh Mehta
25 Nov 2024 03:01:18 PMLooks like primary bilateral reflux (Rt<lt) with Lt. Poorly functioning kidney as a result of reflux nephropathy but considerable residual function. In my view, Patient should undergo Rt. Ureteric reimplantation to limit further insult.
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Yaqoub jafar
26 Nov 2024 12:31:02 AMGood morning , it’s interesting case .
The child is asymptomatic , no FUTI .The ultrasound showing right Hydroneohrosis .The VCUG : high grade VUR . Smooth bladder wall .I agree that the child look constipated .This is could be either a congenital High grad VUR discovered accidentally . And according to the evidence , high grade VUR have cortical abnormality ( congenital renal dysplasia ) that could be considered as renal scarring .I would make sure that the child dose not have BBD .I would do the following for the kid :1: bladder calendar2. Urotherapy .3. Treat constipation .4, follow the child if she present with FUTI . I will consider surgery but otherwise I don’t believe it could be beneficial .VUR but itself if asymptomatic and not causing any concern on the child health I will not intervene. -
Dr. Aadil Farooq
27 Nov 2024 11:50:11 AMGood morning,
Respected teachers,Looking at the VCUG,I would like to treat the Constipation first, Bowel program to be explained to parents.Bladder Diary then teach properToilet Training.I always do Uroflowmetry with EMG & PVR in children who can follow the commands.Then Cystoscopy for evaluation of Urethra along with Sphincters.Conservative approach till 6 months keeping the urine sterile. -
Dr. Anil Takvani
28 Nov 2024 02:38:26 PMThe child has a congenital dysplastic kidney with high grade reflux. Usually boys are affected. As long as the child is asymptomatic no invasive therapy is required.Best. MargitFrom Prof Margit ( Germany)
Dr. Anil Takvani
25 Nov 2024 07:22:59 AMAdditional USG information: post void residual 25 to 30 cc