Copilul a fost bolnav

Sergiu s-a nascut in iunie 2010.

Din saptamana 20-22 de sarcina descoperisem ca bazinetele renale ii sunt vizibile la ecografie, ceea ce nu era normal. Am facut apoi in fiecare luna cate o ecografie si usor-usor imaginea bazinetului renal din stanga s-a estompat, intrand in normal. Dreptul a ramas dilatat pana la nastere. Shock.

In august am inceput primele analize. Am crezut ca nu-i mare lucru, un caz de supra-analizare: poate ca si noi ne nascuseram la fel, dar nu existau ecografii pe atunci. Si am crescut bine mersi, fara nici o problema la rinichi. Denial.

Prima si ultima ecografie la Dr. Ulmeanu, la Sanador - nu a prea folosit la nimic. Pentru ca rapotul a fost unul descriptiv - poetic, fara masuratori exacte care sa serveasca drept reper. Pentru ca, asa cum aveam sa aflam mai tarziu, e importanta evolutia. Si analize de pipi, care au iesit foarte bine. La o saptamana Sergiu a facut febra (si rosu in gat), iar pe 3 septembrie ne-am dus cu el la spitalul Grigore Alexandrescu, la doctorita Laura Topor. Repetat urocultura la 2 laboratoare (Gr. Alexandrescu: a iesit sterila; la Synevo a iesit E-coli). Ceftriaxon intravenos. Copilul meu de 5kg si un pic a avut branula vreme de 10 zile. Anger.

Diagnosticul cronic a fost Hidronefroza la rinichiul drept. De gradul 3. Diagnosticul a fost confirmat de ecografie, iar spre sfarsitul tratamentului i-au facut doua analize grele care au aratat la fel.
Urografia reprezinta o serie de radiografii facute la intervale mici, inainte de si imediat dupa ce copilului i s-a injectat prin branula o substanta de contrast. Radiografiile facute la 1 minut, 7 minute, 14 minute si 1 ora de la injectare au confiramt faptul ca urina se elimina prea incet din rinichiul drept.
Cistografia este o analiza care verifica daca este prezent refluxul vezico-ureteral. O sonda introdusa prin penis elibereaza un lichid ce forteaza mictiunea sub radiografie. Imaginile au aratat ca nu exista reflux. Baiatul meu a luat un microb in urma acestei proceduri - dar sa nu anticipez.

Bargaining. Am umblat pe la mai multi doctori. Ne-a lamurit un urolog de adulti, care ne-a explicat ce inseamna exact, fizic, ce se intampla cu rinichiul baiatului. Si doctorita Topor, care a avut bunatatea si energia de a purta cu mine discutii lungi in care sa-mi explice de ce face fiecare miscare. Doctorita ne-a spus ca planul este sa ii urmareasca (ecografic si clinic) evolutia, iar la 1 an sa ia decizia daca il opereaza sau nu. Prefera sa nu opereze copii mai mici de un an (fiindca sunt prea mici si mainile lor, instrumentele lor, prea mari, iar ureterele sunt ca niste fire de ata). Dar se poate ca prin crestere lucrurile sa se regleze si sa nu fie nevoie de operatie. Doctorul celalalt ne-a spus ca astfel de cazuri se trateaza cu operatie, dar momentul si tipul interventiei il decide un medic care are experienta multor astfel de cazuri. Ne-a trimis la Viena, la AKH.

Cum era rinichiul lui Sergiu: (presupunerea initiala a medicilor care a fost 100% corecta) un vas de sange puternic s-a rasucit in jurul ureterului drept si a impiedicat eliminarea urinii, in proportie de circa 60%. Urina ce nu se putea scurge baltea in rinichi, in bazinetul renal ce se umfla. Doua probleme: tesutul renal era presat si suferea. Si daca urina nu curgea continuu lasa timp microbilor sa se inmulteasca. Asta inseamna diminuarea functiei renale in timp si mediu propice pentru infectii urinare.

Am sa mai povestesc. Mai jos copiez mesajul pe care l-am trimis unui medic din Linz, de la clinica de urologie pediatrica, si apoi unor doctori din Viena, de la Spitalul de copii Sf. Ana si de la AKH. Am tradus toti termenii medicali cu ajutorul internetului, mi-a luat ceva vreme. Am trimis mai apoi copii dupa toate pozele de la radiografii si ecografii.

Good afternoon dear Professor Riccabona,

My name is Miruna Grigorescu. I am writing to you to kindly ask you to treat my son Sergiu. We have considered the great experience of your clinic of Pediatric Urology and we would kindly ask you to cure him.

Sergiu was born on June 13, 2010. He is diagnosed with hydronephrosis of 3rd degree at the right kidney due to ureteropelvic junction obstruction. The left kidney seems to be working normaly.
Our son is treated now by Dr. Laura Topor (surgeon), at Children's Hospital Grigore Alexandrescu in Bucharest. The childrens' doctor that sees him is Dr. Gina Palicari.

Please find below a description of the health condition of our son and a list of investigations and tests we have done. At your request, we can send scans of the results of the tests and we can come to Linz.

1. Health condition:

Sergiu developed a Urinary Tract Infection at the beginning of September (he was running a fever during the night, we sent urine for test and the tests showed that the urine is infected with E-coli). He was treated with Cefort for 10 days (injected in the vein) and after that the doctor prescribed 1.5ml Cedax (Ceftilbuten) every 24 hours. We are repeating the urine tests every 10 days (they all came back sterile after beginning the treatment). The same day he was diagnosed with the UTI, the doctor that examined him noticed that his throat was red. In the next days, his nose was a little stuffed, but this went away by itself. He did not develop any fever since then.

Sergiu has a small umbilical hernia.

Sergiu was checked by the doctor for fimosis and he does not have it.
Sergiu was born with 3.650kg. He is now 15 weeks old and has 5.500kg. He was growing slowly in the begining, being breastfed and with 1 meal a day of formula. He started growing very well at 11 weeks, when I started giving him 4 meals a day of formula. Since he started taking Cedax 14 days ago he gained only 200g, and he is spitting up a lot of milk.

2. Tests
During my pregnancy, in week 22, at a routine sonogram the doctor discovered that both my son kidneys have their basinets larger than normal. Until birth (in week 39) I had a sonogram every month that showed that the left kidney become normal and the right one remained enlarged.

After our son was born, we had the following tests: 3 echographies of the urinary tract; 1 Intravenous polygram (on september 15; showing a larger right kidney, with late excretion on the right kidney. The contrast agent was not present anymore at 3 hours) and 1 Voiding cystourethrogram (on september 16; showing no reverse flow of urine).

The echographic examinations were done as follows: (I) at age 5 weeks by Dr. Ulmeanu; (II) at age 11 weeks by Dr. Nedelcu and (III) at age 15 weeks by Dr. Nedelcu. Sergiu is scheduled for new sonograms on October 25th and November 23rd (with Dr. Nedelcu). The conclusion of echography III (most recent one) was: "For the right kidney: The renal basinet is smaller after urination, compared to the previous examination. The shape of the renal basinet has a different shape, compared to the previous examination. Smaller dilatation of the rod, no elements indicating reverse flow of urine".

We would appreciate if you take this under consideration and guide us for solving our son's problem. We want to do all that is needed for having him healthy as soon as possible.

Thank you,