Hydronephrosis—Child
En Español (Spanish Version)

Definition
Hydronephrosis is when one or both kidneys swell with backed up urine. This swelling can lead to kidney infection or kidney damage.

Hydronephrosis is not a condition but a symptom of another condition.

Urinary Tract System

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Causes
Hydronephrosis is caused by urinary tract problems that makes it difficult for urine to leave the kidneys. Urine may be slowed or blocked by:

  • An obstruction, bulge, or narrowing in the tube that carries urine from the kidney to the bladder
  • In boys, flaps of tissue obstructing the tube that carries urine out of the body or narrowing of the tip of the penis
Other conditions that may cause problems with urine flow include:

  • The backwards flow of urine from the bladder into the kidneys
  • Problems with the tube that carries urine to the bladder or in the way that it connects
Occasionally it is from an abnormal kidney

In most cases, the child is born with one of these conditions that affect the urinary tract. For some, the condition develops later on.

Sometimes the cause of hydronephrosis is not known.

Risk Factors
Male babies are more likely to have this condition than females.

Symptoms
If severe, hydronephrosis may case excess amniotic fluid during pregnancy.

In mild cases, there may not be any symptoms. If the condition is more severe, symptoms may include:

  • Pain in the back, sides, abdomen, or groin
  • Blood in the urine
  • Trouble feeding
  • Poor growth
  • Symptoms of urinary tract infection
Diagnosis
Most often hydronephrosis is diagnosed during pregnancy during a maternal ultrasound.

After birth you will be asked about your child’s symptoms and medical history. A physical exam will be done. Your doctor may be able to feel the swollen kidney during the physical exam.

Your child's bodily fluids may be tested. This can be done with:

  • Urine tests
  • Blood tests
Your child's bodily structures may need to be viewed. This can be done with:

  • Ultrasound—may be done before and/or after birth
  • Voiding cystourethrogram—x-rays of the bladder and urethra taken during urination
    • Note: This test is only done if there is hydronephrosis still present after birth.
  • MRI scan
  • CT scan
  • Cystoscopy
Treatment
Hydronephrosis that develops before birth will often resolve on its own without kidney damage, either before or after birth. Your child's kidneys will be monitored until the swelling has gone away.

When necessary, the condition causing the back up of urine will be treated. Treatment options may include:

Medication
Medications may include:

  • Over-the-counter medication to reduce pain and/or fever
  • Antibiotics to prevent or treat infection
Surgery
If the hydronephrosis is causing painful symptoms, there are signs of kidney damage, and there is a correctable lesion that will not get better on its own surgery may need to be done to allow urine to flow properly. The type of surgery that is done depends on the cause of your child's hydronephrosis. In rare cases, surgery may need to be done before birth.

Prevention
There is no known way to prevent hydronephrosis.




RESOURCES:
American Kidney Fund

National Kidney Foundation

CANADIAN RESOURCES:
BC Children’s Hospital

The Kidney Foundation of Canada

References:
Herz D, Merguerian P, et al. Continuous antibiotic prophylaxis reduces the risk of febrile UTI in children with asymptomatic antenatal hydronephrosis with either ureteral dilation, high-grade vesicoureteral reflux, or ureterovesical junction obstruction. J Pediatr Urol. Published online July 22, 2014. Available at: http://www.jpurol.com/article/S1477-5131%2814%2900178-8/fulltext. Accessed August 13, 2014.

Hydronephrosis. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/health-topics/conditions/hydronephrosis. Accessed August 13, 2014.

Hydronephrosis. University of California Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/urology/downloads/kurzrock_handouts_PDF/Hydronephrosis.pdf. Accessed August 13, 2014.

Hydronephrosis. University of California San Francisco Benioff Children's Hospital website. Available at: http://www.ucsfbenioffchildrens.org/conditions/hydronephrosis/index.html. Accessed August 13, 2014.

Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 30, 2014. Accessed August 13, 2014.
4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed August 13, 2014.

Last Reviewed August 2014



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