Hydronephrosis

What are the signs and symptoms of hydronephrosis?

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), high blood pressure and infection. Symptoms may not occur until months or years after the hydronephrosis has been detected.

What tests are used to detect hydronephrosis?

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)
• Magnetic resonance imaging (this is rarely needed)

If your child experiences any of the symptoms of hydronephrosis, seek medical attention. If your child has already been diagnosed, it is important to continue regular follow-up appointments to evaluate if the condition is worsening or improving.

How is hydronephrosis treated?

At some point, your child's hydronephrosis will be classified (as mild, moderate or severe) and graded (from 1 to 4, with 4 being the most serious) as unilateral (occurring in one kidney) or bilateral (occurring in both kidneys). Based on these classifications, a treatment plan will be determined.

Treatment of hydronephrosis varies depending on the cause and the severity of the condition. In cases caused by mild obstruction, the child may only need to be monitored with regular ultrasound scans, because the condition may improve or resolve on its own. In moderate-to-severe cases of hydronephrosis, severe unilateral hydronephrosis or severe bilateral hydronephrosis, treatment 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 and bilateral cases, but may be beneficial in some moderate cases as well.

Why choose Children's Hospital Colorado for your child's hydronephrosis treatment?

Our providers have extensive experience in medical management of hydronephrosis, as well as in minimally invasive surgery.

The Urology Department at Children's Colorado is also involved in research efforts to ensure that hydronephrosis treatment practices are as up-to-date and efficient as possible.