HYDRONEPHROSIS

share
Last Updated : 1/14/2010
Font-size :  
Kumud P Mehta
More..
Approach to

Unilateral hydronephrosis

- If a unilateral hydronephrosis is detected, USG should be repeated after 3-7 days when dilatation becomes more evident.

- If ureter is dilated - MCU should be done to detect VUR.

- If ureter is not seen- Tc99DTPA renal scan with diuretic renography should be done to detect PUJ obstruction and its severity so that surgery is planned.

Approach to Bilateral mild to moderate

HDN

Same as above + S.creatine/BUN to diagnose renal insufficiency

Aims of systematic evaluation of hydronephrosis is to detect obstructive lesions which may require surgery in asymptomatic stage to prevent progressive renal damage for e.g.
- Recurrent UTI leading to reflux nephropathy and CRF;
- Obstructive nephropathy leading to CRF / ESRD, hypertension, growth failure, anemia and urolithiasis.

Indications of

surgery in HDN

PUJ obstruction
At initial diagnosis:
* Symptomatic HDN (UTI, renal mass, growth failure),
* Solitary kidney with impaired function,
* Bilateral severe HDN
* Relative renal function of obstructive kidney <30%.
On follow up:
* 10% decline in relative renal function on DTPA renal scan when repeated after 6-12 weeks
* Increasing HDN
* Post urethral valves, ureteroceles
* VUR Grade IV-V persisting beyond infancy
* New renal scars or recurrent UTI despite antibiotic prophylaxis

Management of Hydronephrosis
In asymptomatic HDN or HDN which is mild to moderate and stable after USG within 3-7 days, with no obstruction (Hydronephrosis due to ?VUR)
- Antibiotic prophylaxis (amoxycillin /cephalexin for 3 months and then oral cotrimoxazole / nitrofurantoin single night dose for 6 months - 2 years to prevent UTI.
- Urine cultures may be necessary if fever occurs.
- Diuretic renography, MCU are recommended at 1-2 months after antibiotics
- USG after a year.

If VUR is detected,
- DMSA renal scan to detect renal scars
- Surgery may needed if scars are present or there is presence of Grade IV-V VUR.
- Repeat MCU/diuretic venography at 2 years to decide about resolution of VUR.
- DMSA renal scan should be done every 2-3 yearly if scars are persistent or to detect presence of new scars.
- BP; growth monitoring; S. Creatine / BUN, USG should be done yearly till 15-20 years.



Contributor Information and Disclosures Kumud P Mehta
Consultant Pediatrician & Pediatric Nephrologist, Jaslok Hospital & Research Centre, Bai Jerbai Wadia Hospital for children, Mumbai, India


First Created : 1/10/2001
References
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.