Definition: Swelling of the kidney as a result of
obstruction to the flow of urine.
1. What caused this condition?
Hydronephrosis in most babies is a minor condition that goes away on
its own. It likely represents increased urine production by the fetus
prior to delivery that goes away with time. Occasionally, hydronephrosis may be due to an obstruction that is caused
by abnormal development of the ureter (the tube that carries the urine from
the kidney to the bladder). Hydronephrosis may also represent the backwash
of urine from the bladder to the kidney known as vesicoureteral reflux.
2. What tests are needed to further define the
disorder?
In most cases, ultrasound imaging is used to discover kidneys that are
hydronephrotic. Once a kidney has been determined to be
hydronephrotic, depending on the age and gender of the baby, a bladder
X ray should be performed to look for backwash of urine up to the kidney (vesicoureteral reflux) or blockage in the urethra if the child is male. In other instances where the condition is quite severe, a nuclear medi-
cine renal scan should be performed to rule out obstruction of the kidney.
An obstruction might require surgical intervention to preserve the kidney.
If the hydronephrosis involves both kidneys, then further evaluation with a standard blood test should be performed in the hospital or office to make sure that kidney function is normal.
3. Is this condition causing my baby any pain or
discomfort?
If the kidney is significantly swollen (dilated) or it is obstructed, the baby
may have pain, nausea or vomiting, or even blood in the urine. However,
most degrees of hydronephrosis do not cause any pain or discomfort.
4. Is it correctable, and will surgery be necessary?
Most hydronephrosis is minor and will resolve or improve on its own
as the baby gets bigger. However, if the dilation is significant or
severe, then this may represent an obstruction of the kidney that will
require surgery to resolve the obstruction. If the dilation of the kidney
is related to vesicoureteral reflux, and if the reflux does not resolve as
the baby gets older, then correction of the reflux may be necessary.
Blockage of the male urethra must be corrected with surgery.
5. Will it predispose my baby to kidney disease or
infection in the future?
Most hydronephrosis does not predispose the kidney to disease or infection;
however, if the dilation is related to vesicoureteral reflux, reflux is a risk
factor for developing both bladder and kidney infections. If the dilation is
severe and involves both kidneys, then kidney disease is a possibility.
6. Do we need to consult a urologist and, if so, when?
Once the diagnosis of hydronephrosis is made, the urologist should be
consulted to review the X rays, perform a complete history and physical examination of the baby and then determine if any other further
studies are necessary. While this is generally not an urgent condition,
if the child is having pain, significant infections, or it involves both
kidneys, then the urologist should see the child immediately.
7. How will the condition be monitored following
discharge from the hospital, and what tests will
need to be done?
An ultrasound and further studies are usually recommended approximately four to six weeks following discharge. Depending on whether
or not the hydronephrosis is severe, a renal scan may need to be
performed. If the hydronephrosis involves both kidneys, then a stan-
dard blood test would need to be performed to determine kidney function. If the child has not had an evaluation for vesicoureteral reflux,
then a bladder X ray test would be necessary.
8. What danger signs should we look for after leaving
the hospital that would indicate that the kidney
problem might be getting worse?
The most common symptoms associated with severe hydronephrosis
or an obstructed kidney is abdominal, side, or back pain and vomiting.
Fever may represent a urinary infection.
9. After discharge from the hospital, when do you
wish to see my baby again?
After the child is discharged, we will normally see the child back in
our office for an ultrasound and further studies approximately four to
six weeks later. See question #7 for details.
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