Causes For An Enlarged Kidney
18 December, 2018
Enlarged kidneys are uncommon and are usually related to a few specific disorders that are caused by birth defects, structural abnormalities, infection, pregnancy, blockage and injury. An enlarged kidney can only be felt occasionally during an examination, usually when the patient is an infant, a child or a thin adult, according to the Merck Manual Online Medical Library. Other symptoms of kidney disease are usually identified first.
What Causes Urinary Tract Dilation
As with most birth defects, the cause of urinary tract dilation is unknown. The condition appears to run in some families, so itâs not unusual for a parent, sibling, or cousin to have had urinary tract dilation or some other kidney issue in childhood. In rare instances, urinary track dilation is due to a genetic or chromosomal condition, such as Down syndrome . Most cases of urinary tract dilation develop in otherwise healthy babies, however.
Your Childs Treatment Team
Your childs care team should include:
- a paediatric nephrologist, wholl monitor your childs kidney health and can provide treatment
- a paediatric hepatologist, wholl monitor your childs liver health and can provide treatment
Depending on your childs needs, additional specialists involved in his or her care could include:
- a perinatalogist and neonatalogist, who provide monitoring, care and advice before and after birth
- a paediatric gastroenterologist, who can help to treat any problems with your childs gut or digestion
- a geneticist or genetics counsellor, who can provide information, advice and counselling on inherited diseases
- a feeding specialist or dietitian, who can help to ensure your child gets the nutrients they need
- a psychologist or psychiatrist, who can help with behavioural or psychological problems your child may develop
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Other Considerations Warnings And Precautions
Because kidney enlargement often causes no symptoms, it is often discovered incidentally on an imaging study such as an an abdominal ultrasound, x-ray or CT scan. Although oversized kidneys often signal a medical problem, this is not always the case. For example, some people are born with only one kidney which grows larger than usual to compensate for lack of a second kidney. Similarly, when one kidney is damaged, the other might enlarge to compensate.
Kidney enlargement must be investigated to determine the underlying cause.Often the enlargement is temporary and does not cause permanent organ damage, such as with a kidney infection or urinary stone. If a chronic kidney disorder is diagnosed, your doctor will advise you about how best to preserve your kidney function.
Seek urgent medical attention if you experience any warning signs or symptoms, including:
- Severe or worsening flank or abdominal pain
- Fever or chills
- Sudden decrease in urine production or lack of urination
Reviewed and revised by: Tina M. St. John, M.D.
- Because kidney enlargement often causes no symptoms, it is often discovered incidentally on an imaging study such as an an abdominal ultrasound, x-ray or CT scan.
- Often the enlargement is temporary and does not cause permanent organ damage, such as with a kidney infection or urinary stone.
Transitioning To Adult Services
- As your child approaches adulthood, theyll need to transition from child to adult health services. This can be an unclear time, but can also give your child more ownership of their care. For more information on transition, see Transition from childrens to adults services what you should expect, from the National Institute for Health and care Excellence.
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Testing And Treatment Following Birth
Your baby may be placed on a low-dose, once-a-day antibiotic to prevent urinary tract infection.
Since an ultrasound performed in the first few days after your baby is born may underestimate the degree of this condition, the first ultrasound is usually conducted following discharge from the hospital.
However, there are circumstances when an ultrasound will be conducted prior to your babys discharge. This may be necessary because of:
- bilateral dilation
How Are Foetal Kidney Problems Detected During Pregnancy
Here are some parameters that your doctor may use to identify if your unborn baby suffers from any kidney-related ailments:
- Any deformities or abnormalities in your unborn babys kidneys can be detected during your routine prenatal ultrasound. Around 20th;week of pregnancy, your doctor might be able to determine if there is any kidney-related problem in your baby.
- Foetal multicystic dysplastic can be detected during an ultrasound exam.
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What Is An Enlarged Kidney
An enlarged kidney is a condition in which a kidney is larger than its normal size. Generally, kidney enlargement is a symptom of an underlying disease or disorder of the kidneys. Some common illnesses that may cause this to occur include polycystic kidney syndrome, a kidney stone and unilateral hydronephrosis. Most of the time, the enlarged kidney is treated by treating the underlying cause of this condition.
The kidneys are vital to human survival. Most people are born with two of these bean shaped organs, which are located in the middle portion of the back. Kidneys function by removing excessive water and waste from the bloodstream. This waste eventually becomes urine, which is passed through tubes, known as ureters, into the bladder where it is eventually released from the body.
Polycystic kidney syndrome is a condition in which multiple cysts grow within the kidneys. The water-filled cysts are typically benign or noncancerous growths that can vary in size. An enlarged kidney is generally a symptom of this syndrome, as the cysts will cause the kidneys to expand. Other common symptoms may include abdominal swelling, back pain, headache, frequent urination and high blood pressure. If left untreated, high blood pressure can lead to other serious health problems, such as stroke, heart attack and kidney failure.
Effects Of Kidney Problems
The effects of various kidney problems depend on its type and the severity of the condition. The foetal multicystic dysplastic kidney disorder may cause blockage in the kidneys and other complications. Hydronephrosis may lead to pain in the area between the ribs and the hips. PKD or polycystic kidney diseases may lead to fatal complications such as kidney failure. PKD may also cause cysts in other body parts, such as in the brain, pancreas, ovaries, liver, intestines, and spleen. The complications associated with PKD may be mild or severe.
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What Is The Cause Of Hydronephrosis
Hydronephrosis is very commonly seen on antenatal scans. A vast majority of peoples prenatal scans, one kidney can appear larger than normal. Normally this resolves in its own time and is due to alterations in either the flow or anatomy of the kidney.
Hydronephrosis can also be caused by stones or previous surgery and can be caused by other rare conditions.
A small number of children have a narrowing of the tube leading from the kidney. This is called a pelvi ureteric obstruction. There can also be a small kink and blockage of that area or there can be reflux, which allows urine to go back from the bladder to the kidney.
How Is Hydronephrosis Treated
Treatment depends on the cause of the urine backup. It also depends on how bad the problem is. A mild problem may go away on its own without treatment. If the problem was found with prenatal ultrasound, treatment may wait until the baby is born. The goal of treatment is to protect the childs kidneys as he or she grows. Your childs healthcare provider can talk with you about how best to treat your child. Your child may need:
-
Follow-up ultrasounds to monitor kidney health
-
Surgery to improve urine flow if the problem is severe
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Complications Of Swollen Kidney
If left untreated, hydronephrosis can lead to increased pressure within the kidney that will inhibit its ability to perform its function, causing poor removal of waste products from the blood as well as unregulated electrolyte balance in the body. The possibility of infection also increases exponentially, which in some cases can lead to loss of function or even kidney failure.
Upon the onset of hydronephrosis, kidney function will almost certainly decrease, however, it is reversible if the resulting swelling resolves. Typically, the kidneys are able to recover well even if obstruction lasts for up to six weeks.
What Are The Signs And Symptoms Of Kidney Dysplasia
Many babies with kidney dysplasia in only one kidney have no signs of the condition.
- In some patients, the affected kidney may be enlarged at birth and may cause pain.
- The affected kidney may be enlarged at birth.
- Abnormalities in the urinary tract may lead to urinary tract infections.
- Children with kidney dysplasia may develop high blood pressure, but only rarely.
- Children with kidney dysplasia may have a slightly increased risk for kidney cancer.
- Chronic kidney disease and kidney failure may develop if the child has urinary problems that affect the normal kidney.
- Many children with kidney dysplasia in only one kidney have no signs or symptoms.
- muscles and skeleton, or
- other parts of the urinary tract.
A baby may also develop kidney dysplasia if his or her mother takes certain prescription medications during pregnancy, such as some used to treat seizures and high blood pressure. A mothers use of illegal drugs, such as cocaine, during pregnancy may also cause kidney dysplasia in her unborn child.
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How Is Arpkd Diagnosed
ARPKD is diagnosed when typical features and symptoms of the disease are present in the kidneys and liver. These features and symptoms are widely variable and can appear before birth, later in childhood or, more rarely, in adulthood.
If ARPKD is suspected, investigations and tests will be carried out such as blood tests and scans to confirm the diagnosis. The usual type of scan used is an ultrasound. This uses soundwaves to make images of the inside of the body. Using ultrasound, a technician or doctor can spot cysts in the kidney and liver.
Genetic testing can be used to support a diagnosis, although its not routine and is usually only carried out when parents already have a child with ARPKD. There is more information about genetic testing further on in this information sheet.
How Do Health Care Professionals Diagnose Hydronephrosis Before An Infant Is Born
Health care professionals can diagnose hydronephrosis before an infant is born during a prenatal ultrasound. Ultrasound bounces safe, painless sound waves off the fetuss organs to create an image of their structure. An ultrasound can show that parts of the urinary tract are enlarged due to hydronephrosis.
Ultrasounds during pregnancy are part of routine prenatal testing. If a fetus is diagnosed with hydronephrosis, health care professionals may recommend additional ultrasounds to find out if hydronephrosis gets worse or improves over time. Health care professionals may also use ultrasounds or other prenatal tests to try to find the cause of hydronephrosis or check for other health problems.
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How Is It Diagnosed
Presently a vast majority of children are diagnosed with hydronephrosis on fetal scans. At present, the 20 weeks scan can be useful for detecting hydronephrosis and this frequently means there may be further ultrasound scans required in pregnancy. This can occur at approximately 1 2% of all pregnancies. However, hydronephrosis symptoms can also be detected after the baby is born. This usually happens when ultrasound scans are performed to check on the kidneys due to recurring urinary tract infections or other issues.
What Are The Signs And Symptoms Of Hydronephrosis
Most infants with hydronephrosis have no symptoms at all. Older children may also have no symptoms and the condition may disappear without intervention.
If a child has more severe hydronephrosis, they may experience one or more of the following symptoms:
- Abdominal pain with nausea and/or vomiting, especially after large fluid intakes.
- Flank pain .
- Hematuria .
- Urinary tract infections
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What Are The Complications Of Kidney Dysplasia
The complications of kidney dysplasia can include
- hydronephrosis of the working kidney. A baby with kidney dysplasia in only one kidney might have other urinary tract defects. When other defects in the urinary tract block the flow of urine, the urine backs up and causes the kidneys and ureters to swell, a condition called hydronephrosis. If left untreated, hydronephrosis can damage the working kidney and reduce its ability to filter blood. Kidney damage may lead to chronic kidney disease and kidney failure.
- a urinary tract infection . A urine blockage may increase a babys chance of developing a UTI. Recurring UTIs can also lead to kidney damage.
How Is Hydronephrosis Detected During Pregnancy
Ultrasound can detect the fetal kidneys and bladder by 14 or 15 weeks gestation, though 20 weeks of pregnancy is the ideal time to detect hydronephrosis as the fetus is larger and the kidneys are producing urine. When a UPJ obstruction is identified, the kidneys are closely examined for other findings more common with UPJ, such as cysts or an abnormal shape .
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How The Kidneys Work
Urine is a mixture of waste from your blood and water. Its processed in the kidneys, flows down a thin tube and deposits into the bladder. You have two ureters and each one leads from each kidney into each side of the bladder.;Hydronephrosis;is when this system doesnt work properly and urine builds up in the kidney, causing it to swell.
How Is Fetal Hydronephrosis Diagnosed
Hydronephrosis is diagnosed prenatally using ultrasound examination. After the baby is born, ultrasound or other tests may be necessary to determine the cause and severity of the hydronephrosis. Tests may include intravenous pyelogram , voiding cystourethrogram , renal scan or magnetic resonance imaging .
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How Is Arpkd Treated
Treatment is aimed at each childs symptoms and should be managed by a specialist centre with expertise in ARPKD. Different treatments carry different potential risks, and doctors should always explain clearly to you the benefits and possible drawbacks of each option. Specialists will also monitor your childs health carefully. You may need to travel to specialist units for some appointments, for example for dialysis.
Unfortunately, there are no proven treatments that can slow the progression of ARPKD. Its possible that controlling blood pressure carefully might help to delay damage to the kidneys, but experts are not yet sure. This has been shown for patients with chronic kidney disease in general, but not for children with ARPKD in particular.
How Common Is Hydronephrosis And What Causes It
Some studies show that as many as 2 percent of all prenatal ultrasound examinations reveal some degree of hydronephrosis, making it one of the most commonly detected abnormalities in pregnancy. Why the ureter becomes blocked during development is unclear. Hydronephrosis is more often seen in males than females.Some studies show that as many as 2 percent of all prenatal ultrasound examinations reveal some degree of hydronephrosis, making it one of the most commonly detected abnormalities in pregnancy. Why the ureter becomes blocked during development is unclear. Hydronephrosis is more often seen in males than females.
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Specialists Youll Have To See During Pregnancy
Your doctor likely will refer you to a maternal-fetal medicine specialist .;
Other specialists you may see during pregnancy include a pediatric urologist or nephrologist and a neonatologist . They will make recommendations for follow-up care during your pregnancy as well as follow-up care for your baby once he or she is born.
Testing And Treatment During Pregnancy
In nearly all instances of antenatal hydronephrosis, ultrasound monitoring is all that is necessary. For most cases, a pregnancy is not affected, and a normal delivery can be performed. In the rare fetus with severe obstruction of both kidneys and insufficient amniotic fluid, prenatal intervention to relieve the obstruction is a consideration. Evaluation for possible intervention requires multiple specialties such as neonatology, pediatric urology and maternal-fetal medicine.
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When Your Child Has Hydronephrosis
One or more of your childs kidneys is enlarged because of urine backup. This is called hydronephrosis. The problem may have been diagnosed before your child was even born. Often, the condition is not serious. In fact, in many children the problem goes away with time. In some cases, treatment is needed. Your childs healthcare provider can tell you about treatment options. Your child may see a pediatric urologist. This is a doctor who manages problems of the urinary tract in children.
Your Child Has Hydronephrosis
In recent years, better ultrasound machines have allowed your doctor to see your baby’s kidneys more clearly during pregnancy. Different types of problems can be found including absence of one or both kidneys, abnormal position of a kidney, hydronephrosis , fluid-filled cysts and tumors.
The following overview of the urinary tract will help you understand the problems your baby may have.
What does the urinary tract do?The main function of the urinary tract is to remove wastes and fluid from the body. The urinary tract has four parts: the kidneys, the ureters, the bladder and the urethra. The urine is formed when the kidneys filter blood and remove excess waste materials and fluid. The urine collects into a part of the kidney called the renal pelvis. From the renal pelvis, the urine travels down a narrow tube called the ureter into the bladder. The bladder slowly fills up with urine, which empties from the body through another small tube called the urethra.
During pregnancy, the baby floats in the amniotic fluid within the mother’s womb. This fluid is composed mostly of urine made by the baby. If not enough urine is being produced, there may not be enough amniotic fluid.
What types of problems can happen to the urinary tract in the baby?Birth defects can occur in any part of the urinary tract. For example:
- a bladder x-ray
- a renal scan for function and drainage of the kidneys
COVID-19 patients can become kidney patients.
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