What are the next steps to manage hydronephrosis in kids?

Question

Hello doctor,

There is significant hydronephrosis with a renal pelvis anteroposterior diameter of 24.3 millimeters and preserved average renal parenchymal thickness.

What is the next procedure?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out. I completely understand your concern regarding your child’s medical condition.

Please find below a detailed explanation and guidance:

Diagnosis insight: Your child has been diagnosed with gross hydronephrosis, with a renal pelvis anteroposterior diameter of 24.3 millimeters. This measurement is significantly enlarged for a three-year-old child. It is somewhat reassuring that the average parenchymal thickness is still preserved, which suggests that kidney function may not yet be severely affected. However, if the underlying obstruction continues, there is a risk that kidney function may deteriorate over time.
Probable cause: In children of this age, the most common causes of hydronephrosis include ureteropelvic junction obstruction, vesicoureteral reflux, or other forms of obstructive uropathy. To better understand the cause, further imaging studies are recommended, such as a diethylenetriamine pentaacetate (DTPA) renal scan or a mercaptoacetyltriglycine (MAG3) renal scan. These tests will help assess how well the kidneys are draining and determine the differential renal function.
Recommended procedure: If ureteropelvic junction obstruction is confirmed and there is evidence of impaired or worsening kidney function, the preferred treatment is usually a pyeloplasty, which is a surgical procedure to correct the obstruction. If vesicoureteral reflux is identified, a voiding cystourethrogram (VCUG) will be required to assess the severity, followed by appropriate treatment, either medical management or surgical intervention, depending on the grade and response.
Next steps: It is strongly recommended that you consult a pediatric urologist or pediatric nephrologist without delay. The additional investigations likely to be needed include:

A DTPA or MAG3 renal scan. Urine routine examination and culture. Blood tests for renal function evaluation.

Monitoring: Carefully observe your child for any warning signs such as fever, flank or abdominal pain, poor growth, or urinary tract infections. These may indicate worsening obstruction or progressive damage to the kidney.

We wish your child the best of health and a smooth recovery.

I hope this information has been helpful.