What is hydronephrosis?
Hydronephrosis is the dilation or stretching of the kidneys that occurs when there is an obstruction to the flow of urine at some point along the urinary tract. Normally, urine flows from the kidneys through the ureters and into the bladder. If there is a blockage that prevents the urine from draining properly, urine can back up in the kidneys and hydronephrosis occurs.
Why come to Children's Hospital Colorado for treatment of this condition?
The professionals at Children's Hospital Colorado in Aurora, Colorado are dedicated to caring for kids. The members of the urology team are experts in pediatric urologic conditions and our surgeons are specialized in both pediatrics and urology. We strive to help patients and families feel educated about their condition, prepared for treatment and fully cared for by our urology team.
What are the signs and symptoms?
Children with mild hydronephrosis may have no symptoms at all, or the condition may improve or disappear within the first year of life. In more severe cases, when the kidneys are affected, symptoms may include pain with urination, hematuria (blood in the urine), and infection. Symptoms may not occur until months or years after the hydronephrosis has been detected.
How do you diagnose it?
Hydronephrosis can be detected pre-birth through a routine prenatal ultrasound. Hydronephrosis is not a diagnosis; it is a finding that indicates an obstruction. Once the cause of the obstruction is decided, the appropriate treatment will be determined.
If hydronephrosis is discovered after birth, or if a child develops hydronephrosis, the underlying cause of the obstruction will need to be determined by utilizing one or more of the following tests, depending on the severity of the condition.
- Voiding cystourethrogram (VCUG)
- Renal ultrasound (RUS)
- Renal Scan (MAG 3 with lasix)
- Intravenous pyelogram (IVP)
At some point, your child’s hydronephrosis will be classified as mild, moderate, or severe, unilateral (occurring in one kidney), or bilateral (occurring in both kidneys). Based on these classifications, a mode of treatment will be determined.
How is it treated?
Treatment of hydronephrosis varies depending on the cause and the severity of the condition. In mild cases caused by mild obstruction, the child may only need to be monitored with regular ultrasound scans, as the condition may improve or resolve on its own. In moderate to severe cases of hydronephrosis treatment of severe unilateral hydronephrosis or severe bilateral hydronephrosis may include antibiotics with serial radiologic testing (scans).
Imaging studies are used to decide if surgical treatment is necessary. Surgery is usually necessary to correct the cause in severe unilateral or severe bilateral cases, but may be beneficial in some moderate cases as well.
Who gets it, and can it be prevented?
Most children with hydronephrosis are born with the condition, but occasionally it can occur during childhood. For example, it may develop because of a stone or injury to the urinary tract. Hydronephrosis is more common in males than in females.
There are many different kinds of urinary tract obstructions that can lead to hydronephrosis. The most common type is at the junction where the ureter joins the kidney, called the ureteropelvic junction. This blockage is caused by an abnormal narrowing of the ureter at this location. The next most common site of narrowing is where the ureter meets the bladder, called the ureterovesical junction.
Below are some conditions commonly associated with blockage of the kidneys:
Hydronephrosis cannot be prevented, but it may be prevented from worsening depending on the degree of the condition.
When should I seek medical attention?
If your child experiences any of the symptoms described above, seek medical attention. If your child has already been diagnosed with hydronephrosis, it is important to continue regular follow-up appointments to evaluate if the condition is worsening or improving.