Young Child's PUV Diagnosis & Management

Um, I think their, um, other one about the management during the first months of life. So, one of the other questions with, um, the least PUV and kidney dysfunction during the first years of life or first couple of months of life are really trying to understand where the kidney function's going to fall out. Um, like I said, during the 1st 2 years of life, it's really challenging to stage kidney disease, um, or chronic kidney disease by severity. Um, because what we do know is that during those 1st 2 years of life, your kidney function can naturally kind of fall in what we call nadir or go down to its kind of baseline state. Um, and so during that time, we do, again, a lot of just more, um, routine assessments, um, to really understand what the kidney function is, but also can your child grow. What I will say is in the end, your child has to grow. And so if they're not growing well, that can sometimes be the biggest um predictor that maybe their kidney function is not um as good. Um, and so, again, we have to understand, is that a feeding problem or is that a true kidney problem? And a lot of that is, again, just really close ongoing observation by a pediatric nephrologist. And the management during the first few months of life, um, as we've discussed previously, is first confirm the diagnosis of valves. 2, if there are valves, when the child is stable enough to go to the operating room, the urologist will take that child to the operating room and incise. Where we just, um, if you imagine a sail on a sailing boat, when it's intact, it can cut the wind and move the ship forward, but if you just put a cut in that sail, it can't, uh, hold the wind anymore. In the same manner, we don't remove the valves. All we have to do is just make a cut in the valve and it can no longer obstruct the flow of urine. So that's what we do. And the reason why we've gone from removing the valves to actually just incising or cutting the valves is that when we used to remove all that valve tissue, we would then create a lot of scar tissue. Which would then be another reason for obstruction. So once the valves have been incised, then we have to monitor the baby's bladder and say, is the baby's bladder emptying, and does the baby have reflux. If the baby has reflux, we would start the baby on an antibiotic once a day to reduce the risk of infections. If the baby's bladder is not emptying completely, then we would consider starting the baby on a catheterization program where the parents are taught to use a small tube. They put the tube in the baby's bladder, allow the bladder to empty, and then take the catheter out, and they do that 3 or 4 times a day when the baby's younger. Our hope is that this is a form of physical therapy for the bladder, and if the bladder is capable of recovering, that the bladder will recover and start emptying more completely. If not, then the catheterization will be more of a chronic intervention. And then we reassess the baby's bladder and kidney function constantly, as Dr. Clay mentioned, during the 1st 2 years of life, there's a lot of changes happening in the baby's body. They're going to triple their birth weight, they're going to double their length. And so with all this metabolic demand going on, the kidney is helping manage that. And so we want to make sure that the kidneys are growing well and are functioning at the appropriate level to ensure that the baby can continue to grow and develop properly. At the same time, about a year of life, we will start to reassess the bladder function again, and if the baby's bladder is working better, we can stop the antibiotics, we can stop the catheterization. If not, that's when we might consider some sort of surgical interventions.