What Are the Treatments for Neonatal Hydronephrosis?

Neonatal hydronephrosis is a condition that occurs when a kidney is obstructed or descended and swollen due to a blocked or narrow ureter.

Facts

• Four main organs work during urination: the kidneys, bladder, ureters, and urethra. According to Penn State Health, urine is formed in the kidneys where it then moves through the ureters into the bladder where it is stored. The bladder then "voids" through the urethra as you urinate. When this doesn't happen correctly, hydronephrosis may be diagnosed. The Children's Hospital in Boston reports that "it is unknown why some babies are born with the kinds of anomalies that lead to hydronephrosis. Neither hydronephrosis nor its causes have ever been linked to anything the parents did during pregnancy."

Significance

• This condition is four to five times more common in males and can occur in one or both kidneys. Whereas once doctors didn't discover the condition until the child was three to four years old, a heightened awareness of this rather common condition has resulted in an increasing number of children receiving prenatal diagnoses and swift treatment.

Types

• Hydronephrosis is gauged on a level of 1 to 4, 4 being the most severe. The three main causes for this condition may also demand treatment and include Vesicoureteral Reflux, present with "the abnormal backflow of urine from the bladder into the ureter and up to the kidney;" Non-Obstructive Hydronephrosis, present when the swollen kidney has no effect on kidney function; and Ureteropelvic Junction (UPJ) Obstruction, present when "the ureter is 'kinked' or narrow where it joins the kidney."

Tests

• The specialist will order one or more tests to keep tabs on progression or response to treatment. A renal---or kidney---ultrasound provides pictures to determine size and shape of the kidney and if any abnormalities exist. The Voiding cystourethrogram consists of placing a catheter in the child's urethra and filling the full bladder with liquid dye, which provides a visual path the urine takes as it attempts to void. An Intravenous polygram may also be ordered, which "involves injection of a contrast agent that fills the urinary tract on the x-ray and helps the doctor to see the organs," according to Children's Hospital in Boston. The fourth test is a renal scan used to "identify and assess the degree of blockage."

Treatment

• For all cases, doctors will prescribe antibiotics to prevent any urinary tract, bladder, or kidney infections. The length of this treatment depends on the severity of the condition and the individual child. Most children will additionally be placed on a "watch and wait" basis as most nonsevere cases correct themselves. Children with grade 4 hydronephrosis, however, will likely require surgery. Treatment may also mean placing a nephrosomy tube into the afflicted kidney to keep the swelling down until the specialist can surgically treat the condition. Surgery serves to unblock or remove offending parts of the kidney and/or ureter. The doctor will then want to watch the child using the aforementioned tests for a period of time following surgery to ensure the condition is resolved.