Violet Kalinowski, 4, crouched on her bedroom floor and peeked under the dresser. She spied her pet bunny, Oreo, and beamed.
“He’s right there!”
Unable to coax him out, Violet pivoted to her bookshelf and focused on her toys. But when Oreo came out of hiding, the preschooler scooped him up, cradling him like a baby.
“They’re buddies,” her mom, Nicole, said. “He tolerates her well.”
The Kalinowskis prize these days of carefree play at their home in Sand Lake, Michigan.
It’s a complete reversal from a year ago, when Violet spent months fighting infections, in and out of the hospital, flattened by fevers.
“We’d see other kids out in the water, riding their bikes, and she just couldn’t. She just lay in our bed,” Nicole said. “One of us always had to stay back and be with Violet while everybody else went to do something.”
Nicole and her husband, Dave, also have two sons, Jack and Colton.
Violet’s symptoms popped up as soon as she became potty trained: Fevers of 103 or higher. Glassy eyes. Lethargy.
Visiting the local med center with her first fever, she tested negative for strep throat. The doctor suspected a virus.
When the fever persisted, Nicole took her daughter to the family’s primary care doctor, Brent Becklin, MD, who came to the same conclusion—virus—but advised that Violet’s urine should be tested if things didn’t improve.
Later that day, Nicole dropped off a urine sample. That’s when she learned Violet had a urinary tract infection.
After a round of antibiotics, all seemed fine. But five days later, the fever returned.
Another urine test, another UTI.
Back-to-back UTIs in a 3-year-old is an unusual situation that calls for a special X-ray of the bladder, called a voiding cystourethrogram, Dr. Becklin said.
He scheduled Violet for this test, plus an ultrasound of her kidneys, at Spectrum Health Helen DeVos Children’s Hospital.
Results showed that Violet had vesicoureteral reflux, an anatomical condition that allows urine to flow back up from the bladder to the kidneys. Violet’s reflux occurred in both ureters, though it was worse on one side than the other.
The family received an immediate referral to David Weatherly, MD, a pediatric urologist at the children’s hospital.
Dr. Weatherly discussed risk factors for bladder infections in kids—including behaviors like waiting too long between trips to the toilet—and explained that having reflux increased Violet’s risk of kidney infections.
“If you’re getting bladder infections and you have reflux, then you’re essentially giving the infection an easy path up to the kidney,” he said. “And we know that recurrent kidney infections definitely lead to kidney damage.”
This makes kidney infections much more serious than bladder infections.
Dr. Weatherly outlined a staged approach to Violet’s care.
First came prevention: putting Violet on a daily antibiotic and having her parents work with her on healthy bladder and bowel behaviors—urinating every two hours and having a bowel movement every day to lower her risk of infection.
If all went well, Violet could ride out this storm and outgrow the reflux.
But despite being on a prophylactic antibiotic, Violet continued to experience high fevers, along with vomiting and flank pain—telltale signs of kidney infection. Twice her symptoms grew so severe she landed in the children’s hospital in need of IV antibiotics and IV fluids.
“It was just discouraging, because you’d think that the daily antibiotic would prevent this,” said Nicole, a nurse at Helen DeVos Children’s Hospital. “But she was always sick.”
After multiple kidney infections, Dr. Weatherly and the Kalinowskis discussed the treatment option they’d hoped to avoid: surgery to correct Violet’s reflux.
“It was a hard decision to say, ‘Yes, we want to do the surgery,’” Dave said. “But she wouldn’t get better, so we thought we might as well take the big step.”
They scheduled the surgery for late September 2018.
The complex procedure, called ureteral reimplantation, created new tunnels for Violet’s two ureters within the bladder wall. The new tunnels extend the length of the ureters on their route to the bladder.
The new tunnels are positioned so they’ll collapse as the bladder fills up, closing off the tubes “so that when she’s peeing, urine can’t go back up toward the kidneys,” Dr. Weatherly said.
“What we’re trying to do … is guarantee that her kidneys are going to be healthy for her in the future.”
The surgery, though scary for Violet’s parents, couldn’t have gone more smoothly. And the results couldn’t have been better.
Not only has Violet been free of kidney infections, but she hasn’t had a single UTI since the surgery.
“It’s crazy. I didn’t expect the results to be like this—I prayed fiercely for her to have relief from kidney infections, but I didn’t expect her not to have another urinary tract infection,” Nicole said.
“I’m just really grateful for Dr. Weatherly and Helen DeVos (Children’s Hospital). They gave us our sweet, healthy girl back.”