You are probably wondering why I am writing this post about duplex kidneys and how that even relates to an LGBTQ parenting blog. As I had mentioned in an earlier post, our first year of parenthood had been riddled with sickness. Many of those sicknesses were UTIs as a result of complications from a birth defect called duplex kidney. Over the past year we have become very aware of this condition, the symptoms, and the treatment for it.
When my daughter was around six months old, we got a phone call from daycare saying our daughter had a 103 fever underarm. We brought her to the doctor and they would not do anything for a couple days to see if the fever subsided, but on the third day we brought her back in and they had her tested for a UTI. We had to wait an additional two days for the results. At this point our daughter was lethargic and barely eating. When the results finally came back, we were informed that not only did she have a UTI but it had traveled to her kidneys. We had to put her immediately on antibiotics that night or she would need to be admitted to the hospital.
I cannot begin to explain, the terror, the frustration, and heartbreak we felt watching our daughter suffer for five days. All the tears, all the hallucinations from the high fevers, all the sleepless nights where all she wanted was to cuddle and be held through it all. I want to make it clear that we have no ill feelings towards our pediatricians. In many cases fevers do go away on their own after a couple days and there was no reason to suspect there was anything else going on. And despite it being her first UTI, and it being relatively common in baby girls, they sent us to a urologist immediately to get her assessed. It is a good thing we did because we found that she has what is called duplex kidney which is what has caused her now numerous UTIs.
In this post today, in hopes of spreading awareness, I will explain what a duplex kidney or double ureter is, the symptoms and treatment for it based on what I have researched and information received from our pediatric urologist.
Disclaimer: I am not a medical professional; I am writing based on our personal experiences, research, and information provided from our pediatrician and pediatric urologist.
What is Duplex Kidney?
Duplex kidney also called double ureter is where there are two ureters connected to one kidney. A normal kidney has a single ureter that drains urine from it, but in the case of an individual with a double ureter, there are two ureters draining urine from a single kidney. This is a birth defect that is not preventable and occurs more in females than in males. Duplex kidney is diagnosed through ultrasound imaging. This usually does not require treatment because a person grows out of it.
Symptoms
In most cases there are usually no medical problems or symptoms that are associated with duplex kidneys. However, there are some instances where the extra ureter causes Vesicoureteral Reflux (VUR). This means that when urine is being drained from the kidneys it goes back up into the kidney where bacteria from the urine can then cause infections. This presents itself as a UTI, which is very difficult to identify in babies and toddlers.
According to Nationwide Children's article, "Urinary Tract Infections In Babies," the most common symptoms of UTIs in infants and toddlers are the following:
Fever (100.4 and higher)
Crying or discomfort when urinating
Cloudy or foul smelling urine
Irritability
Loss of appetite
Vomiting
With our daughter the main symptoms we noticed were fever, foul smelling urine (almost resembled cat pee), and touching her privates or gyrating on the ground. In most cases, fever and irritability are the only symptoms of a UTI that presents itself in infants.
Remember to call your pediatrician if you have any questions or concerns about your child.
If your child has frequent UTIs then further diagnosis and treatment may be required to see if the duplex kidney is causing further complications. Please be aware that not all UTI's are a result of this condition.
Further Diagnosis and Treatment
As I mentioned earlier, most instances of a duplex kidney do not cause any medical problems so they do not require treatment. However, in my daughter's case we had to do additional testing because of the number of UTIs she had in such a short amount of time.
My daughter was required to be tested for Vesicoureteral Reflux (VUR). In order to be assessed for this condition, the doctors preformed a voiding cystourethrogram (VCUG) test. For this test, a thin tube is inserted into the urethra and the bladder is filled with contrast which allows the doctors to see the path the urine travels upon urination with an x-ray machine. With this they can see if urine travels back up the ureters and then into the kidneys. If reflux is occurring, then they will decide on treatment depending on the severity of the reflux.
Treatment for Lower Grade VUR (grades I-III)
Antibiotics prophylaxis: babies, toddlers, and older children will be provided a low dose of antibiotics daily in order to limit the growth of bacteria until their is lower risk of reflux.
Toileting habits and hydration: children who are potty-trained should be going to the bathroom every couple of hours (2-3) and should refrain from holding in their urine. Children should also drink plenty of fluids to help limit the growth of bacteria.
Treatment for Higher Grade VUR (grade IV and V)
Surgery: children with higher grade VUR and have multiple UTIs with concerns of damage to the kidneys may require surgery. There are two different types of surgery that would be recommended based on the seriousness of the reflux, whether there is reflux in both ureters, and your child's age and gender.
Two Types of Surgery
Ureteral reimplant: This requires general anesthesia and an incision and recovery in the hospital for a day. There is an incision in the lower abdominal and the ureter is reimplanted to the bladder to correct the urine going back into the ureter.
Endoscopic surgery: this procedure does not require an incision. A tube is inserted into the urethra and a solution is injected into where the ureter enters the bladder which stops urine from going back up into the ureter. This requires general anesthesia and does not require recovery outside the home.
Conclusion
My daughter was lucky enough not to require surgery yet as she had a grade III reflux. Our urologist provided her with a daily low dose of antibiotics and a diet that includes cranberry juice and yogurt. If you notice your child is having any of the symptoms listed above, make sure to contact your pediatrician with your concerns. Most instances of duplex kidney do not cause any medical issues or treatment but in the case that there are multiple UTIs it may require further testing, diagnosis and treatment.
References
The Children’s Hospital of Philadelphia. (2014a, April 25). Duplex kidney. Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/duplex-kidney
The Children’s Hospital of Philadelphia. (2014b, April 29). Vesicoureteral reflux (VUR). Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/vesicoureteral-reflux-vur
Duplex kidney (duplicated ureters): Diagnosis, Cause & Symptoms. Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/diseases/16492-duplex-kidney
Urinary tract infection (UTI) in children. NHS inform. (n.d.). https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/urinary-tract-infection-uti-in-children
Urinary tract infections in babies. Nationwide Children’s Hospital. (n.d.). https://www.nationwidechildrens.org/family-resources-education/700childrens/2013/11/urinary-tract-infections-in-babies
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