MJ seemed intermittently more herself last night, after a long nap. But it seems we may not be done with this for a while, even if her blood test looks good today. Apparently the protocol for follow-up care of a severe UTI in infants is rather aggressive. It seems that having had such an infection prior to six months of age is a significant risk factor for serious kidney disease later on.
After dinner last night Mark sent the boys downstairs to watch a video, made us a pot of herb tea, and turned on the computer. We read medical websites until my eyes started to cross and I had to go to bed. He promised to do more research at work, where he has full access to most major medical journals. I have access to them too, because no one at the University has yet realized that I am no longer an active member of the staff (shhhh), but I probably won’t have a lot of time to devote to it this morning.
We’ve learned a few things already. She’ll have to be checked for urological abnormalities that might have made her more susceptible to infection. We’ll certainly have her screened for reflux, the condition in which bladder pressure drives urine up the ureter to the kidney. Reflux is pretty common in kids, which doesn’t surprise me; as far as I know, only gravity sends urine to the bladder, and that can be overcome by just a little pressure (e.g. "holding it"). One school of thought among urology researchers is that a UTI is more dangerous when reflux is present.
But this is apparently a point of controversy. Some researchers seem to think that the reflux is not as important a marker as the age of the child. For this reason, even if she does not appear to have reflux, even if the infection clears up right away (something we’re still not done with) we will choose a follow-up care regimen that will probably last a few years.
That’s what we know so far. What Mark’s diving into today is the state of the research regarding the nature of the follow-up care. The existing protocol is this: continuous, prophylactic, low-dose antibiotics to prevent recurrent infection.
This also the subject of some controversy: as far as I can tell from what I’ve read, the evidence is still being gathered to determine (a) whether prophylactic antibiotics really prevent recurrent infection, (b) whether prevention of recurrent infection reduces renal scarring, (c) how to identify the children for whom -a- and -b- are most likely to be true.
So we’ll probably need to decide, in scarcity of evidence, whether to accept for her a treatment regime that is theoretically preventative of a serious disease. Antibiotics are not free of side effects, after all.
Other parts of the follow-up will include being excruciatingly careful from this point forward about her diaper hygiene, bathing, etc.; probably immediately ruling out UTI when she has a fever in the future; and some kind of regular screening.
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