Hydronephrosis means the kidneys are abnormally large or overfilled with urine. Hydronephrosis can be seen in one or both kidneys. Hydronephrosis occurs in about 1 out of every 100 babies. In today's Turkey, an average of 30,000 babies with hydronephrosis are born annually.
Most hydronephrosis detected by ultrasound in the womb is temporary. However, it can also be caused by a blockage in a part of the urinary tract or reflux of urine (reflux of urine from the bladder). It can also be due to abnormal development or formation of the kidney in the absence of obstruction or reflux.
There are three main categories of hydronephrosis:
- Idiopathic hydronephrosis with no obvious cause and usually resolves spontaneously before or after birth.)
- Vesicoureteral reflux is a condition in which urine cannot flow properly from the kidneys to the bladder, but instead, urine flows back abnormally into the ureter (the channel connecting the kidneys to the bladder) in the bladder.
- Congestion occurring in four possible locations;
- Where the kidney meets the ureter (ureteropelvic junction-UPJ)
- Where the ureter meets the bladder (ureterovesical junction-UVJ)
- Inside the urethra (the tube that carries urine from the body to the bladder, occurring only in men) (posterior urethral valves-PUV)
- Improper attachment of the ureter to the bladder (ectopic ureter or ureterocele)
Newborns and infants with hydronephrosis often show few or no symptoms. Older children with moderate to severe cases may experience abdominal and flank pain and blood in the urine. Urinary tract infection (UTI) may sometimes be the only symptom in all hydronephrosis patients. Therefore, it is a good example of why it should be investigated in infants or children with urinary tract infections.
There are four main options for treatment, depending on the severity of hydronephrosis in your baby:
- Close observation with ultrasound before and after birth for mild or moderate cases.
- Use of antibiotics after the baby is born to prevent infection when infection may be more likely to occur.
- Surgical treatment to repair any urinary tract obstruction in more severe cases.
- Fetal surgery to insert a drainage tube into your baby's bladder in the most severe cases.
In about half of patients diagnosed with hydronephrosis, the condition resolves on its own.
Patients should be followed according to their grades or followed up with an appropriate treatment method. If hydronephrosis, which is advanced or does not go away for a very long time, is left untreated, it can cause serious damage, such as loss of the kidney or both kidneys. Because the kidney functions are impaired and the kidney cannot perform its function. Therefore, severe hydronephrosis should be investigated and treated without delay.