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Medical Forum / General / General / January 20053.5 year old girl with kidney infection
My 3.5 year old daughter has been diagnosed with her second kidney infection. I'm hoping to find some ideas as to the cause of these infections and maybe some advice on getting the most out of her doctors. The first infection was at 1.5 years old and was thoroughly analyzed...VCUG, multiple static ultrasounds at the local hospital with consultations with a pediatric specialist at Stanford...then a final video ultrasound/consultation at Stanford. They determined there was no reflux, no deformities, good kidney growth over the following year...no clue as to what may have caused the first infection and no permanent damage sustained. Due to the absence of reflux, she was not required to go on antibiotics. She has had no further problems until now. She has never had (that we know of) a UTI, pain while urinating, etc. She's a very healthy child otherwise. She has had some difficulties with constipation at various times and we gave her Miralax (via prescription) to keep her regular. This was mostly an issue prior to potty-training and over the last year has not been a consistent problem. This most recent incident was not preceded by a constipation problem. Although, interestingly, it was the exact same time of year - to the day - as the first incident (spent new year's in the hospital almost twice now). And in both cases, we went on a trip to see relatives that required an 8 hour car ride. In the first incident, she did have constipation issues in the few days prior to the infection. We were originally assured that, although the constipation was a problem, it was not related to the kidney infection...although they did not actually have a reason. The doc who has saw her this second time (not her regular doc) suggested that there is anecdotal evidence that there is a relationship between constipation and kidney infections. Given the lack of other sources, I'm wondering if this is such a case? If it's not constipation, or deformities, or reflux...what else could it be? She's had all the recommended vaccines and is seen regularly, whether she's sick or not. Is there something more insidious that might be at work here? Cancer? She just had a vaccination about four months ago...is there a chance there's a vaccine that doesn't agree with her somehow? Cipro has taken this thing down in a day, so we're on the mend. We hope to meet with her regular doc tomorrow. We're guessing this will trigger a whole new round of ultrasounds, etc. I'd like to be more educated this time, if possible. I don't want to just go through another year of painful/invasive testing to get the same useless answer. Thanks in advance for any help. We're really worried and frustrated. I had a kidney infection once and it occurred (I believe) as a result of "pulling a muscle" while helping my husband change a tire on our vehicle. I twisted my back which resulted in pain which did not go away after a few days. It eventually got worse and one day I had pain on the other side also. So I went to the doctor and was diagnosed with kidney infection in both kidneys. It is possible, I suppose that the long trip resulted in unusual muscular stress which could have caused an injury leading to the infection. When you go on a long trip, do you make frequent stops, or does she stay in the same position for too long a time. Just a thought. Ora >My 3.5 year old daughter has been diagnosed with her second kidney >infection. I'm hoping to find some ideas as to the cause of these [quoted text clipped - 43 lines] >answer. >Thanks in advance for any help. We're really worried and frustrated. My father has also said his kidneys get sore with days of driving. I think there's something to be said for the idea. It might also be that she's going from full-sprint-preschooler mode to sedentary mode so suddenly. But we do keep the legs of the trip under three hours and she often sleeps in a comfortable car seat. It seems that we'd have lots more kids out there with kidney infections, if this were a real cause, but then again maybe she has a predisposition to infection due to her prior incident? Thanks for the thoughts! Korby > My father has also said his kidneys get sore with days of driving. Most people have no idea where their kidneys are. If he gets lower back pain, chances are it's not his kidneys that are hurting. > I > think there's something to be said for the idea. It might also be that > she's going from full-sprint-preschooler mode to sedentary mode so > suddenly. But we do keep the legs of the trip under three hours and > she often sleeps in a comfortable car seat. It seems that we'd have > lots more kids out there with kidney infections, This is one of the dumbest theories I've ever heard for recurrent kidney infections. I'm an adult with recurrent kidney infections, but I've been getting them since I was a child (and am now in kidney failure), and never was "sitting" given as the cause. >if this were a real > cause, but then again maybe she has a predisposition to infection due > to her prior incident? Has she ever had strep? Childhood strep infections have been linked to kidney problems. Is her immune system normal?  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather >> My father has also said his kidneys get sore with days of driving. > >Most people have no idea where their kidneys are. If he gets lower back >pain, chances are it's not his kidneys that are hurting. Agreed. >> I >> think there's something to be said for the idea. It might also be that [quoted text clipped - 7 lines] >getting them since I was a child (and am now in kidney failure), and >never was "sitting" given as the cause. While I agree that pain in the lumbar musculature from back strain and pain from a kidney infection are entire separate matters, you don't have to be so mean about it. Often pain from medical conditions such as juvenile arthritis, renal colic, and others are erroneously believed initially to be from a recent injury. This type of red herring can delay diagnosis. "Pulling a muscle" in the back does not cause one to get an ascending bacterial infection of a solid retroperitoneal organ. The pain from the "pulled muscle" may very well have been the renal pain from the infection which was mistakenly attributed to physical activity. It's kind of like when a child has his first seizure while sitting in a chair and, naturally, he falls out of the chair and hits his head. It seems that 9 times out of 10 the parent is convinced that the child somehow fell out of the chair first and hit his head, and this is what caused the seizure (and all subsequent seizures, even if the child is shown by EEG to have epilepsy). >>if this were a real >> cause, but then again maybe she has a predisposition to infection due [quoted text clipped - 4 lines] > >Is her immune system normal? OK, as someone attacking someone else's "dumb" theory, you should now be embarrassed to have demonstrated that you don't know the difference between a bacterial urinary tract infection and post-streptococcal glomerulonephritis, which is an immune-complex-mediated disorder, not an infection. Completely different matter. PF > >> My father has also said his kidneys get sore with days of driving. > > [quoted text clipped - 18 lines] > pain from a kidney infection are entire separate matters, you don't > have to be so mean about it. "So mean"? Please. That was hardly mean at all. > >Has she ever had strep? Childhood strep infections have been linked to > >kidney problems. [quoted text clipped - 3 lines] > OK, as someone attacking someone else's "dumb" theory, you should now > be embarrassed Not embarassed - better educated. And you've got to admit, it *is* better than guessing "prolonged sitting." > to have demonstrated that you don't know the difference > between a bacterial urinary tract infection and post-streptococcal > glomerulonephritis, which is an immune-complex-mediated disorder, not > an infection. Completely different matter. My nephrologist speculated that it might be the cause of my legion of renal problems; obviously I misunderstood which one. Must've been sitting too long. Though doesn't glomerulonephritis/glomerulosclerosis of any etiology make one generally more vulnerable to bacterial renal infection, or is that true if the GN/GS is caused by a disease like diabetes, which mucks up the immune system in general? Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather > My 3.5 year old daughter has been diagnosed with her second kidney > infection. I'm hoping to find some ideas as to the cause of these [quoted text clipped - 43 lines] > answer. > Thanks in advance for any help. We're really worried and frustrated. If it happened twice, both times after a holiday visit, and involved constipation and kidney problems, I would suspect: 1. allergies. 2. sexual molestation by a relative > My 3.5 year old daughter has been diagnosed with her second kidney > infection. I'm hoping to find some ideas as to the cause of these [quoted text clipped - 43 lines] > answer. > Thanks in advance for any help. We're really worried and frustrated. Since there have been no answers as of yet from physicians, I'll just say that from what I've heard and read this is a pretty common problem in young girls, esp. if hygiene isn't very good. Our daughter had a uti at age 2, she had a VCUG as well, which was normal. It sounds like you are getting good care for her--if the doctors aren't too worried you probably shouldn't be either. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >My 3.5 year old daughter has been diagnosed with her second kidney >infection. I'm hoping to find some ideas as to the cause of these [quoted text clipped - 12 lines] > >She has never had (that we know of) a UTI, pain while urinating, etc. Just to clarify: A kidney infection IS a UTI. >[...] In the first incident, she >did have constipation issues in the few days prior to the infection. [quoted text clipped - 4 lines] >there is a relationship between constipation and kidney infections. >Given the lack of other sources, I'm wondering if this is such a case? It is. "Elimination dysfunction" is a general term for the spectrum of disordered voiding and stooling habits in kids, more commonly girls. The spectrum starts with constipation (poop problems) and progresses to dysfunctional voiding (pee problems) over time. Dysfunctional voiding predisposes to urinary infections. There are multiple simplistic and possibly incorrect explanations for what's really going on with elimination dysfunction. For what it's worth, here's mine: Commonly constipation is due to retentive behavior, i.e., the child has a painful stool or two for whatever reason, and decides she's not going to do THAT again. With the next urge, she holds it, which naturally makes the stools harder, larger, and ultimately more painful to pass. Toddlers with this type of behavior will often go several days without a bowel movement, ultimately hiding somewhere to finally pass the stool. Parents who observe this often believe the toddler is trying very hard to get the stool out when in fact she is trying her darndest to keep it in. And certainly shaming a potty-training child for stooling in the diaper instead of the potty makes matters worse. Kids who feel guilty for stooling in the diaper don't decide to go in the potty next time -- they just decide not to go at all. So how does this affect urination? Healthy, well-tuned bladders need to exercise filling all the way and emptying all the way. When your pelvis is occupied by a large cannonball of hard poop accumulated over several days of retention, there isn't much room for bladder expansion. Likewise, when a child tries to void, all the pelvic muscles start to relax and that painful hard poop the kid so desperately wants to keep in tries to come out too, so the child ceases voiding. You've then got a bladder that doesn't get to fill all the way or empty all the way. Bacteria that make their way into the bladder love that. Et voila. Constipation leading ultimately to urinary infections. By the way, a good screening question for dysfunctional voiding is this: Does your child pee first thing in the morning? (Do you? I do.) >If it's not constipation, or deformities, or reflux...what else could >it be? Another possible culprit is just plain old bad luck. It is possible for a child with totally normal elimination habits and a completely healthy, well-built urinary system to get two urinary infections before age 4, but not bloody likely. However, common things being common, the moment I saw you mention MiraLax I knew I'd bet dollars to doughnuts she has dysfunctional voiding. >She's had all the recommended vaccines and is seen regularly, >whether she's sick or not. Is there something more insidious that >might be at work here? Cancer? She just had a vaccination about four >months ago...is there a chance there's a vaccine that doesn't agree >with her somehow? No, no, and no. >Cipro has taken this thing down in a day, so we're on the mend. We >hope to meet with her regular doc tomorrow. We're guessing this will [quoted text clipped - 3 lines] >answer. >Thanks in advance for any help. We're really worried and frustrated. Hopefully they will not see a need to repeat the VCUG, at least. Were she my patient, I would review very carefully her elimination and dietary habits, possibly get an abdominal X-ray to see if the's full of stool, and work on the constipation first and foremost. PF Update... The lab cultures came back negative. Doc says no evidence of infection was found. Also said the 'story' of the fever breaking the first day after starting the Cipro is a little 'too convenient'. In other words, it was really just a nasty stomach flu bug and as a result she had a particularly dirty urine sample. This led to an initial diagnosis of kidney infection based on the 'stick test'. Now I just need some valium to get over stress of the mis-diagnosis. We continue to keep an eye on her urinating/stooling habits. Lately, they've been normal. We're going to follow up with another stick test in a few days, just to make sure she didn't actually have an infection with inaccurate lab work. Thanks very much to all who have contributed. I know it takes time to write thoughtful posts. I've gotten much to think about for our daughter's future care. Korby > Update... > [quoted text clipped - 16 lines] > > Korby Thanks for the update. I'm quite familiar with stress over my daughter's health. ;-) Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Update... > >The lab cultures came back negative. Doc says no evidence of infection >was found. Also said the 'story' of the fever breaking the first day >after starting the Cipro is a little 'too convenient'. I don't know why he said this. One EXPECTS a child to defervesce within a day of proper treatment of a febrile UTI. I'd guess also that the prescribing doctor is a family practitioner, as I don't know any pediatricians who would prescribe ciprofloxacin to a 3-year-old. >In other words, >it was really just a nasty stomach flu bug and as a result she had a >particularly dirty urine sample. This led to an initial diagnosis of >kidney infection based on the 'stick test'. Now I just need some >valium to get over stress of the mis-diagnosis. It is very common practice to begin empiric therapy for suspected UTI after an initial dipstick and/or microscopic urinalysis suggests an infection. As happened with your child, sometimes the culture proves otherwise, whereupon the antibiotic can be stopped. This is well within the standard of care and is prudent medical practice. Would you prefer instead that one await the culture result before starting treatment in a febrile 3-year-old girl with a prior history of febrile UTI who presently has an abnormal urinalysis? If so, what would be the point of the initial urinalysis if the result should be ignored? Would she have been better off or would you have been less stressed were she hospitalized for urosepsis and/or renal abscess because of a delay in treatment had she actually had a UTI? If you really regard this as a "misdiagnosis," who is to blame, then? The one who didn't wipe her properly when obtaining her urinalysis, perhaps? >We continue to keep an eye on her urinating/stooling habits. Lately, >they've been normal. We're going to follow up with another stick test >in a few days, just to make sure she didn't actually have an infection >with inaccurate lab work. This is a good idea: documenting a nice, clear urinalysis after all is said and done. >Thanks very much to all who have contributed. I know it takes time to >write thoughtful posts. I've gotten much to think about for our >daughter's future care. I'm glad to help. I don't wish to sound overly harsh in this message but I do believe there is much more to think about. PF |
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