My daughter just had a renal ultrasound as a remedial due to surgery she had on her kidney as a baby. She had a clean bill of health at 11 months and has not needed any follow-up since then. The ultrasound showed hydronephrosis on her right kidney even though she has ZERO symptoms. The doctor reading her scans casually mentioned that it is most likely caused by scarring from the previous surgery. Other than saying he would have to report the hydronephrosis, the doctor didn't seem concerned at all. He did say that further testing could be done to test the function, but he didn't actually tell us we should get the tests done. Now that I'm reading more at home, it looks like at the very least that she should have her kidney drained. First, I'm concerned that my daughter's chances at a SA are done. But second, I'm trying to figure out what we should do on our own. If this is simply a case of scar tissue needing to be removed, can that be done soon and then could she possibly be waived? We will almost certainly follow-up on our own if DODMERB does not ask for it, but if she has any chance of a waiver then we want to wait to see what course of action they want her to take. Any thoughts on whether she has any chance of a waiver (we are assuming this will be a DQ)? Has anybody had anything similar? Has anyone had surgery as a result of something from a remedial and still been waived? If it makes a difference, although she haven't received it, she was called about 10 days ago and told that she should expect to receive a LOA (this was separate from any medical).
Current hydronephrosis
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Dadx4
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It's good to hear that she is asymptomatic and her doctor wasn't concerned. I'm a Navy Medical Officer. I'm fairly certain that Current Hydronephrosis is DQ and not typically waiverable, but each circumstance is unique. I would do the right thing medically or surgically (whatever is recommended), then let the DODMERB process play out. Wishing the best for your daughter.
The doctor who read her ultrasound just returned my call because I wanted more information and had been so surprised in the office that I didn't ask any. He said that although she shows hydronephrosis his guess is that it is simply a chronic symptom as a result of the problems she had as a baby. He described her collecting system as "baggy" since it had been stretched as a baby, but said his bet is that the kidney is fully functional and that nothing needs to be done. No surgery. No drainage. He said he thinks it simply will be that way as a result of the issues she had as a baby. He said in his report he suggested getting a CT IVP dye test done to test functionality. Even if DODMERB doesn't request this, we will likely have it done on our own to just confirm she is fine.
Based on this additional information, if the dye test showed her kidney is functioning normal, do you think there is a chance of a waiver?
Dadx4
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Definitely a chance, because now she's leaning more towards a history of hydronephrosis, which IS typically waiverable if stable and normal function documented. My DD went through the waiver process for an unrelated condition, which started 3 days before REPORTING! We sure were glad when DODMERB asked for all of the medical records and that she had followed through with all the recommendations of her doctors!
That gives us some hope. We should get a copy of the report in the mail in a few days, so we'll plan to schedule the dye test after that on our own so we can have the results available to submit if (hopefully) a waiver is requested on her behalf.
GoCubbies
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She probably has a chance for a waiver if a renal scan shows normal kidney function. Are all her kidney labs normal?
GoCubbies
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The surgery was to fix a uteropelvic junction obstruction, correct?
ACatSLP
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Just sent you a PM. My DS went through the exact same thing.
The remedial only asked for an ultrasound so far. They didn't ask for any labwork on her kidney. The doctor who did the scan is recommending a CT IVP dye test, but I guess that is up to DODMERB. We plan to do it either way and submit the results since we'll hope for a waiver.
No, she did not have a uteropelvic junction obstruction. She had a duplicate system, so the doctor removed the "extra" part that wasn't working, leaving her with a fully functioning "normal" kidney. This was done at 5 months and she hasn't had any issues since then. She is super athletic and doesn't have any pain or issues. We were shocked today to see she currently has some hydronephrosis. Although, as I said above, the doctor seems to think that is just normal for her based on her history. We're just praying that DODMERB asks for the additional functional tests that the doctor says he recommended instead of DQing her automatically and that those test results are good.
GoCubbies
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Did she have 2 ureters coming out of one kidney?
Yes, as a baby. That ureter actually didn't connect to the bladder and was removed. Apparently having a duplicate system isn't that uncommon.
She was just DQ'd. DODMERB didn't bother to request a renal scan or an IVP dye test to test functionality. Hoping for a waiver now. We are going to go ahead and have one of these tests done on our own but we first have to find a urologist closer to us who can see her and write the order for the tests.
Dadx4
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She expected the DQ. Now I recommend following through with all of the testing recommended by her doctors to (1) make sure she's ok, and (2) to assemble the best waiver package possible if it becomes an option. Hang in there. Again, wishing her the best!
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Try to find a urologist with a military background (retired flight surgeon etc.). These folks understand the nomenclature that DoDMERB is looking for and best know how to phrase things in an accurate yet favorable way. Non-MIL docs may overstate conditions (in an attempt to be cautious) and unintentionally open cans of worms.
You can find a former military doc by reviewing their biography or calling a local VA hospital for a referral.
Thank you. That is good advice. I will try to do that. We do plan to get the scan done on our own.
GoCubbies
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Does she have a surgical scar on her side or lower abdomen?
Mention to the urologist to consider lasix MAG3 renal scan.
There’s a good chance she’ll need a voiding cystourethrogram to rule out vesicoureteral reflux.
Yes, she has a scar on her side (~4 inches maybe). I know that the follow-up testing after her surgery showed no evidence of reflux (that is in the report we have from 2002/2003), but I guess that could have changed over the years. She has no pain or discomfort at all, which usually would be the case for anything like that, but it would be good to rule anything out.
GoCubbies
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A scar on the side suggests the surgeons took out the upper part of her kidney. Is that your understanding of the procedure?
A MAG3 renal scan can confirm/demonstrate good drainage. Without knowing all the data, I can’t ask you to demand from the urologist a MAG3 renal scan. I’d ask nicely of the urologist if it’s something he/she can consider though.
If the scan is normal, recent VUR shows no reflux, global renal function is normal, and hydronephrosis goes away, then I think your DD has a fighting chance for a waiver. No promises though. You never know how the govt will decide on these things on a year-to-year basis.
I sent you a separate message.