How Likely Will It Be That My Baby Will Be Induced Early Due to Very Dialated Kidney
Prenatal program UCSF Pediatric Urology
The fetal diagnosis and treatment center at UCSF is a leader in prenatal diagnosis having performed the first successful prenatal surgery on the urinary tract. The prenatal diagnosis center is a multidisciplinary team with a medical manager (Larry Rand, Medico.) consisting of perinatologist, genetic counseling, pediatric surgical subspecialist including the pediatric urology kinesthesia, obstetricians and radiologist and a nurse coordinator. The pediatric urology subspecialist routinely counsel pregnant women with prenatal urologic diagnosis.
What is hydronephrosis?
Hydronephrosis is dilation of the kidney, specifically the renal pelvis (place where urine is stored after its production). This tin can exist the consequence of an anatomic abnormality in the urinary tract or can be a variant of normal. Hydronephrosis secondary to obstruction is typically at the level of the kidney (uretero-pelvic junction obstruction, or UPJ) or the bladder (uretero-vesical junction obstruction or megaureter). Delight meet Figure i. Rarely, hydronephrosis is caused by a blockage in the urethra below the bladder from a condition called posterior urethral valves.
How is hydronephrosis diagnosed?
Hydronephrosis is normally diagnosed in one of two ways.
i) A prenatal ultrasound (ultrasound during pregnancy) may reveal a fetus with dilated kidneys. This occurs in 1 per 100 pregnancies.
two) An ultrasound done as a routine evaluation for another medical problem, such as a urinary tract infection or incontinence, may also reveal hydronephrosis. Once hydronephrosis is noted, whether it is during pregnancy or later, additional tests are often required in club to find out the significance of the hydronephrosis. These tests are important considering children with hydronephrosis may have an anatomic abnormality or urinary tract blockage. Early diagnosis and treatment of a potential urologic abnormality can prevent urinary tract infections and permanent kidney damage or scarring.
What, if any, other test should exist done?
· VCUG (voiding cystourethrogram): This report gives us important information regarding the shape and size of the float, the float cervix (or opening) and the tubes that drain the urine from the kidneys into the bladder, called ureters. It allows usa to diagnose reflux (the abnormal back-flow of urine from the bladder into the ureter and up to the kidney). Information technology besides gives u.s. boosted anatomic information about the urethra (urine tube which takes urine from the bladdder outside the body) to make sure no blockage is present (posterior urethral valves).
· Kidney (Renal) Scan: This test may be done depending on the history of urinary tract infection(south), result of VCUG, and/or the severity of the hydronephrosis. It is used to better demonstrate the actual function and/or drainage of the kidneys. A kidney scan can also show if there is kidney harm and/or scarring that may take resulted from a previous urinary tract infection or long-standing hydronephrosis. Two types of renal scans are typically performed depending on the diagnosis.
1. Lasix Renogram or Magazine-Three diuretic renogram to examination for significant blockage in the urinary tract, OR
2. DMSA renal scan to examination for scarring or damage to the renal tissue (more common in patients with vesico-ureteral reflux).
When should these tests be performed if a prenatal ultrasound showed hydronephrosis?
The decision to perform these tests depends on several factors including the severity of the hydronephrosis. If the hydronephrosis is mild and only on one side, a repeat renal ultrasound can be performed in the start month of two of life and a VCUG or renal scan may not be needed at all. If the hydronephrosis is severe and/or on both sides, a renal ultrasound is generally performed afterwards the first 24-48 hours of life just within the beginning week of life. It is normal for a newborn to exist dehydrated, and brand less urine, on the first day of life, then information technology may falsely appear that hydronephosis has gone if done likewise early. For severe hydronephrosis; a VCUG will be performed adjacent, within the side by side several weeks of life. A renal browse will exist performed if necessary.
Certain conditions seen on the ultrasound may warrant a more than expeditious piece of work-up and we will let you know if this is necessary (for case, in the event of astringent hydronephrosis in both kidneys or a dilated bladder).
How is hydronephrosis graded and why is this important?
Why does hydronephrosis occur?
There are numerous reasons why hydronephrosis occurs. Please see the list of potential diagnoses below:
i) Vesicoureteral reflux
ii) Non-obstructive hydronephrosis
3) Ureteropelvic junction (UPJ) obstruction
iv) Ureterocele
5) Posterior urethral valves
6) Ureterovesical junction (UVJ) obstruction
7) Megaureter
eight) Multicystic Dysplastic Kidney
ix) Ectopic ureter
10) Neurogenic/nonneurogenic bladder
This listing is quite extensive, but most often the cause of the hydronephrosis is from one of the first iii (in bold) diagnoses.
The special x-ray tests mentioned previously will aid us to find the cause of the hydronephrosis.
Will my child require any medication to assist in treating the hydronephrosis?
The conclusion to treat children with hydronephrosis with prophylactic antibiotics is affected by several factors but mainly the severity of the hydronephrosis. If prophylactic antibiotics are used, your kid volition receive antiobiotics in a depression dose and on a daily basis. The types of antibiotics are very specific for the urinary tract and take very few, if any, side effects. The specific blazon of antiobitics will depend upon your child'due south age, weight and allergies. The goal of antibiotics is to prevent kidney infections that may occur every bit a result of the hydronephrosis. Often times, in one case the special ten-ray tests take been completed, we will be able to estimate the total time of antibiotic treatment.
Will the hydronephrosis go away or will my child crave surgery?
Typically, non-obstructive hydronephrosis (ie, hydronephrosis secondary to dilation at the ureterovesical junction, the place where the ureter meets the float; please encounter Effigy 1) and grade 1 to three hydronephrosis secondary to uretero-pelvic junction type hydronephrosis do not need surgical intervention and resolve over time. The timing of resolution depends on the severity of the hydronephrosis and is different for each child. Children diagnosed with dilation from uretervesical junction abnormalities called megaureters rarely need surgical repair. Patients with form Iv hydronephrosis (severe) are the most likely to require surgery to forbid renal damage and recurrent infection.
The vast bulk of children with hydronephrosis grow upwardly healthy and lead normal lives even if they require surgery to fix an abnormality.
Source: https://urology.ucsf.edu/patient-care/children/Hydronephrosis
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