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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What Is Antenatal Hydronephrosis
Antenatal hydronephrosis can be detected in a fetus by ultrasound as early as the first trimester of a pregnancy. During pregnancy, this condition is identified in 1 percent of males and 0.5 percent of females. Typically, this condition is not associated with abnormalities in other organ systems.
Prenatal intervention is almost never required, and amniotic fluid is usually normal. Depending upon the abnormality, ultrasound imaging may be needed throughout pregnancy and after a baby is born. In most cases, this diagnosis does not affect when, where or how a baby is delivered. Surgery is required in a small percentage of children during infancy and childhood.
Why Texas Childrens Fetal Center
- A single location for expert maternal, fetal and pediatric care. At Texas Childrens Hospital, you and your baby receive the specialized care required for the diagnosis and treatment of fetal hydronephrosis all in one location, including immediate access to our level IV NICU, avoiding the need to transport a critically ill newborn.
- A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, fetal imaging experts, neonatologists, pediatric urologists and pediatric nephrologists who work in concert to care for you and your baby every step of the way, using proven protocols weve developed over the years. With their combined expertise and unified approach, this team offers the best possible care for babies with hydronephrosis.
- We care for your childs needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues throughout your childs delivery, postnatal care, and childhood, as needed, thanks to one of the nations leading teams of fetal and pediatric specialists.
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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.
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.
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What Care To Take For Enlarged Kidneys In Fetus
During the pregnancy there is a need to constantly monitor the progression of the condition. Regularly performing parental scanning is mandatory. In some cases amniocentesis or chorionic Villus Sampling may be performed to rule out genetic deformities like Downs syndrome.
In addition the mother should ensure that she consumes adequate amount of water, to avoid shortage of amniotic fluid. Once the baby is born, the child should be immediately examined by a pediatric urologist. Surgical intervention may be required in cases of obstructions or other conditions.
What Will Need To Be Done After The Baby Is Born
After delivery, your doctor will examine your baby carefully and request certain tests to find out more about your babys condition. The babys blood pressure will be measured using an infant blood pressure cuff. Often, ultrasound of the babys kidneys and bladder will be done to get a closer look at your babys kidneys and bladder than is possible before delivery.
Another test that is often done is called a voiding cystourethrogram. In this test, a thin tube called a catheter is inserted into your babys bladder through the urethra, and the bladder is filled with x-ray dye. The catheter is then removed and x-rays are taken as the baby urinates. This test evaluates the babys bladder and urethra, and also determines if reflux is present.
In babies who have hydronephrosis, a type of x-ray called a renal scan is often done. In this test, a small amount of radioactive tracer is injected into a vein. This tracer is removed from the blood and excreted by the kidneys. By measuring the time the kidneys take to remove this tracer, the doctor can tell how well the kidneys function and whether there is something preventing them from emptying properly. Renal scans are often done several weeks after birth so that the infants kidneys have time to begin functioning outside the uterus.
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Enlarged Kidney: Causes Symptoms And Treatment
Enlarged kidneys are relatively uncommon, with only a few select disorders leading to the condition. The kidneys are responsible for filtering the blood from harmful metabolites and ensuring proper volume status that affects our blood pressure. Having an enlarged kidney will likely compromise all of its function.
How Does Fetal Hydronephrosis Affect My Baby
Hydronephrosis can range from mild to severe. In most cases, the condition is mild and typically has little or no effect on the fetus or newborn baby. More serious cases may require surgery after birth to repair an obstruction or reflux.
In severe cases, hydronephrosis can cause serious complications, including:
- Too little amniotic fluid, a condition known as oligohydramnios. Fetal urine is the main component of amniotic fluid. If hydronephrosis limits the flow of fetal urine enough to reduce the amniotic fluid below a safe level, it can lead to serious pregnancy complications including underdeveloped lungs and breathing difficulties at birth and deformities of the face and extremities .
- Kidney damage and loss of kidney function. The backup of urine puts pressure on the fetal kidneys. This can cause progressive, permanent damage and the risk of kidney failure or rupture.
Hydronephrosis is sometimes graded on a scale of zero to four, zero being no hydronephrosis present and four being the most severe form of the condition.
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Will I Be Able To Help Care For My Baby
Yes. Your baby will more than likely go to the newborn nursery and be treated there if hydronephrosis is his or her only problem. The urologist/nephrologist may see him or her in the hospital if you deliver at Froedtert & The Medical College of Wisconsin Froedtert Hospital Campus. If you do not deliver at Froedtert or the urologist/nephrologist does not see your baby before you go home, please call to set up a follow-up appointment soon after you take your baby home.
After birth and before your appointment with a pediatric urologist, an ultrasound of the kidneys will be done to look at the structures. This is also to compare the pictures taken before your baby was born.
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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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What Are The Symptoms Of Hydronephrosis
Normally, urine flows through the urinary tract with minimal pressure. Pressure can build up if theres an obstruction in the urinary tract. After urine builds up for an extended period, your kidney can enlarge.
Your kidney may become so engorged with urine that it starts to press on nearby organs. If its left untreated for too long, this pressure can cause your kidneys to lose function permanently.
Mild symptoms of hydronephrosis include urinating more frequently and an increased urge to urinate. Other potentially severe symptoms you may experience are:
- pain in the abdomen or flank
If you see signs of hydronephrosis, schedule an appointment with your doctor to talk about your symptoms. Untreated UTIs may lead to more serious conditions such as pyelonephritis, an infection of the kidney, and , an infection in the bloodstream or blood poisoning.
What Are The Causes Of Hydronephrosis
Two types of problems cause hydronephrosis. One is obstruction, where urine is physically prevented from draining out of the kidney. The obstruction, or blockage, can occur at any point in the urinary system from the kidney down to the urethra. The second is reflux, in which urine flows back up into the kidney.
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Testing And Diagnosis Of Hydronephrosis
Renal bladder ultrasound
This procedure uses sound waves to outline the kidneys and bladder. It will enable us to see the degree of hydronephrosis.
Images from the ultrasound are used to evaluate the size and appearance of the collecting system , and the appearance of the renal parenchyma, ureter and bladder.
In a voiding cystourethrogram , a catheter is placed through your childs urethra into the bladder. The tube will be used to slowly fill the bladder with a contrast solution and pictures will be taken.
While the bladder is being filled, a special machine is used to take pictures. If special ultrasound contrast is used, these pictures can be taken with an ultrasound machine . The radiologist looks to see if any of the solution is going back up into the kidneys. This study confirms the diagnosis of VUR.
Additional pictures are taken while your child is urinating. The radiologist will look at the urethra while urine is passing to be sure there is no blockage noted .
MAG III renal scan
MRI is a radiation-free diagnostic procedure that uses a combination of a large magnet, radiofrequencies and a computer to produce detailed images of the body.
Who Will Be On My Care Team
At Midwest Fetal Care Center, a collaboration between Childrenâs Minnesota and Allina Health, we specialize in individual attention that starts with you having your own personal care coordinator to help you navigate your babyâs treatment process. We use a comprehensive team approach to urinary tract dilation and any associated conditions. That way, you are assured of getting the best possible information by some of the most experienced physicians in the country. For urinary tract dilation, your care team will include a maternal-fetal specialist, a pediatric urologist, a neonatologist, a geneticist, a nurse specialist care coordinator, and several other technical specialists. This entire team will follow you and your baby closely through the evaluation process, and will be responsible for designing and carrying out your complete care plan.
How Is Fetal Hydronephrosis Treated
Treatment of fetal hydronephrosis is usually postponed until after delivery. Only in the most severe cases is intrauterine surgery attempted during the pregnancy. In these most severe cases, an attempt is made to place a drain through the babys back into the kidney to allow passage of urine and relief of the pressure in the kidney.
This is done with endoscopic instruments inserted through mothers abdomen into the uterus itself. Because of the risks of preterm labor, infection, injury to baby or mother, and poor outcome, this procedure is reserved for the most severe cases.
At Lurie Childrens, fetal hydronephrosis is treated by The Chicago Institute for Fetal Health team. Learn more.
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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What Does It Mean When Fetus Kidneys Are Enlarged
Fetal hydronephrosis is swelling of a babys kidney caused by a buildup of urine. This can happen while the baby is still in the mothers uterus. Doctors often find the problem when a woman has a fetal ultrasound during pregnancy. Urine normally travels from the kidney down a narrow tube to the bladder.
What Are The Chances I Could Have Another Baby With Hydronephrosis
Minimal hydronephrosis is not genetic and is not hereditary. However, hydronephrosis may coincidentally occur in future pregnancies. If UPJ obstruction is determined to be the cause of the hydronephrosis, the chances for future children with the same obstruction may be as high as 50 percent.
In addition, certain genetic conditions can cause the kidneys to have cysts and generally carry a 25 percent chance for future children to have the same condition. Regardless of the cause, you should have a prenatal ultrasound examination in the second trimester with all future pregnancies to check the developing kidneys and bladder.
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Causes Of Enlarged Kidney In Fetus
There are two things that cause enlarged kidney. The first is an obstruction of the urine flow in the urethra or kidney. This keeps the urine from going through to the bladder and out of the body. The second cause is reflux, which occurs when the urine does flow out of the kidney and then back up into the kidney.
Types of Obstruction
- Posterior Urethral Valve Obstruction This happens to boys when the tissue that forms the urethra has an abnormality. This obstructs the urine flow in the bladder.
- Ureteropelvic Junction Obstruction This happens high up at the point where the ureter and the kidney unite. The ureter at this point can become too narrow to allow urine to pass.
- Ureterocele This happens when a part of the ureter develops a bulge. It can affect both the bladder and the kidney.
- Ureterovesical Junction Obstruction This obstruction happens lower at the point of the urethra and the bladder entrance.
Vesicoureteral reflux happens as the bladder fills and empties. The muscles connected to the urethra and bladder squeeze the urine back up into the kidney.
Other Reasons for Enlarged Kidney in a Fetus
- Ectopic Ureter This is a rare birth defect in which a ureter is connected to the bladder in the wrong place.
- Cause Not Known In most cases, there is no cause found and the condition goes away on its own with no complications.
How Is Urinary Tract Dilation Managed Before Birth
Urinary tract dilation is not treated before birth if the amniotic fluid level remains normal. After the condition is diagnosed, however â usually as a result of the ultrasound done routinely at the 20th week of pregnancy â we may continue to monitor your baby with high-resolution fetal ultrasonography at intervals throughout the pregnancy.
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What Causes Hydronephrosis
Hydronephrosis isnt a disease. Instead, it can be due to internal and external conditions that affect the kidney and the urinary collecting system.
One of the most common causes of hydronephrosis is acute unilateral obstructive uropathy. This is the sudden development of an obstruction in one of your ureters, which are the tubes that connect your kidneys to your bladder.
A blocked ureter can cause urine to go back up into the kidney, which causes swelling. This backflow of urine is known as vesicoureteral reflux .
Other potential causes of a blockage include:
- a kink in the ureteropelvic junction, which is where the ureter meets the pelvis of the kidney
- an enlarged prostate gland in men, which can be due to benign prostatic hyperplasia or prostatitis
- pregnancy, which causes a compression due to a growing fetus
- tumors in or near the ureter
- a narrowing of the ureter from an injury or birth defect
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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