Hydronephrosis

Hydronephrosis, while not a specific disease, is a finding that shows that urine is filling the kidney more than normally seen and is commonly found on an ultrasound. Hydronephrosis may be unilateral (affecting just one kidney) or bilateral (affecting both kidneys). In children with mild hydronephrosis, the condition often resolves on its own. Hydronephrosis is a relatively common congenital condition (a condition a baby is born with) that occurs in both boys and girls.

 

Causes of Hydronephrosis

Hydronephrosis is not a disease but may be caused by an underlying condition including:

  • A partial obstruction - a blockage is preventing the urine from draining completely out of the kidney.
  • Reflux - where urine comes back up the ureter into the kidney (think of acid reflux). Reflux of urine back into the kidney(s) can occur for a variety of reasons and needs an evaluation to determine the cause. 

 

Diagnosing Hydronephrosis

Thanks to advances in imaging technology, diagnosis of certain urologic conditions such as hydronephrosis can begin in the womb either through routine or specially ordered ultrasound exams on the expecting mother, typically around the fourth month of pregnancy or later. Dr. Robert Mevorach can consult on conditions diagnosed on screening sonogram examinations during pregnancy such as hydronephrosis and other kidney concerns.

If hydronephrosis is suspected in a prenatal ultrasound, the condition of the baby's kidneys will be monitored throughout the remainder of your pregnancy. Upon delivery of your baby, Dr. Mevorach can further evaluate the condition. Your doctor may order imaging tests such as:

  • A renal ultrasound - provides a clear picture of the extent of the hydronephrosis
  • A voiding cystourethrogram (VCUG) - a special x-ray that can show reflux or if there is a urethral obstruction, two common causes of hydronephrosis

 

If the condition is not seen on a prenatal ultrasound, it's important to note that most babies and young children with the condition may have few or no symptoms. In mild and even moderate cases, the issue often resolves on its own with no intervention necessary. 

Children with more severe hydronephrosis may experience one or more of the following symptoms:

  • Discomfort in the side or flank
  • Abdominal pain or discomfort
  • Hematuria, or blood in the urine

 

Treatment of Hydronephrosis

Upon learning more about your child's hydronephrosis and its cause, your pediatric urologist will go over the results of your child's diagnostic tests and develop a treatment plan that meets your child's specific needs. Our pediatric specialists understand that any time there is a health issue with a child, it can be a very stressful and scary time for the parents. That is why we will walk you through every step and involve you in every decision about your child's treatment and healthcare. 

In most cases of mild to moderate hydronephrosis, the condition often resolves on its own with no further issues.  

  • Observation - In most cases, your doctor will observe the child's kidney over time, performing renal ultrasounds periodically. Most cases of hydronephrosis clear up on their own. 

  • Surgery - In rare cases, your pediatric urologist may recommend surgery to correct the cause of your child's hydronephrosis, especially if the condition is affecting the function of the kidney. 

    A common surgical procedure for hydronephrosis is pyeloplasty that is used to repair an obstruction in the drainage portion of the kidney. Children often stay in the hospital and the procedure has a very high success rate.