Hydronephrosis in Children

Overview

Hydronephrosis is a condition in which one or both kidneys become swollen due to a buildup of urine. This occurs when the normal flow of urine is obstructed or impaired, causing the kidneys to stretch and swell. Hydronephrosis can affect children of any age, but it is often diagnosed during prenatal ultrasounds. In many cases, the condition resolves on its own, but severe or prolonged hydronephrosis may lead to kidney damage if not properly treated. The key to managing hydronephrosis is early diagnosis and appropriate treatment to prevent long-term complications.

Symptoms

Hydronephrosis may not always cause noticeable symptoms, especially in mild cases. When symptoms do occur, they can include:

  • Pain in the abdomen or back: Children may complain of discomfort or pain in the lower back or sides, particularly if the obstruction is sudden or severe.
  • Blood in urine 
  • Urinary tract infections (UTIs): Frequent or recurring UTIs are a common symptom, especially in young children, and may cause fever, pain during urination, a strong urge to use the washroom or foul-smelling urine.
  • Changes in urination: Children may experience difficulty urinating, urinate less frequently, or have a weak urine stream.
  • Nausea and vomiting: In severe cases, children may feel nauseous or vomit due to pressure on the kidneys.
  • Failure to thrive: Infants and young children may show signs of poor growth or weight gain if hydronephrosis affects their kidney function.

Causes

Hydronephrosis is usually the result of abnormal development in the upper part of the urinary system. It can also occur due to a blockage somewhere in the urinary tract or from urine flowing backward from the bladder, known as reflux. In some cases, hydronephrosis can be linked to genetic factors or occur alongside other conditions in the baby.

The three main causes of hydronephrosis are:

  1. Idiopathic Hydronephrosis: This form has no clear cause and often resolves on its own, either before or after birth.
  2. Vesicoureteral Reflux (VUR): This occurs when urine flows backward from the bladder into the ureter, instead of moving correctly from the kidneys to the bladder.
  3. Blockage/Obstruction: This can happen at four different points:
    • Ureteropelvic Junction (UPJ) Obstruction: Where the kidney connects to the ureter.
    • Ureterovesical Junction (UVJ) Obstruction: Where the ureter connects to the bladder.
    • Posterior Urethral Valves (PUV): Blockage within the urethra, seen only in males.
    • Ectopic Ureter or Ureterocele: Incorrect attachment or abnormal structure of the ureter as it connects to the bladder.

Diagnosis

Hydronephrosis is often diagnosed through imaging tests that allow doctors to visualize the kidneys and urinary tract. The diagnostic process may include:

  • Prenatal ultrasound: 
    • Hydronephrosis is frequently detected during prenatal ultrasounds, where swelling in the kidneys is observed.
  • Postnatal ultrasound: 
    • After birth, an ultrasound may be used to confirm the presence of hydronephrosis and assess its severity.
  • Voiding cystourethrogram (VCUG): 
    • This imaging test involves inserting a catheter into the bladder and filling it with contrast dye to visualize the flow of urine and detect any backflow (VUR) or blockages.
  • Renal scan: 
    • A nuclear medicine scan can help evaluate kidney function and determine how well the kidneys are draining urine.
  • Blood and urine tests: 
    • These tests may be performed to check for signs of kidney damage, infection, or other complications.

Treatment Options

The treatment for hydronephrosis in children depends on the cause, severity, and whether the condition is causing any symptoms or complications. At Gertrude’s Children’s Hospital, we provide a range of treatment options to manage hydronephrosis, including:

  • Observation:
    • In mild cases, especially when diagnosed prenatally, hydronephrosis may resolve on its own as the child grows. 
    • Regular monitoring with ultrasounds and checkups is important to ensure that the condition improves and does not cause kidney damage.
  • Antibiotic prophylaxis:
    • In cases where hydronephrosis is caused by vesicoureteral reflux (VUR) or increases the risk of urinary tract infections, low-dose antibiotics may be prescribed to prevent infections and reduce the risk of kidney damage.
  • Surgical intervention:
    For more severe cases or when there is a significant obstruction, surgery may be necessary to correct the problem. Surgical options include:

    • Pyeloplasty: This is the most common surgery for correcting ureteropelvic junction (UPJ) obstruction. It involves removing the blocked portion of the ureter and reattaching the healthy part to ensure proper drainage.
    • Endoscopic surgery: In cases of posterior urethral valves, an endoscopic procedure can be performed to remove the tissue causing the blockage.
    • Ureteral reimplantation: For children with vesicoureteral reflux (VUR), surgery may be performed to reposition the ureters so that urine flows properly from the bladder into the ureters without reflux.
  • Kidney stone removal:
    • If hydronephrosis is caused by kidney stones, treatment may involve shock wave lithotripsy (breaking up the stones with sound waves) or surgical removal to restore proper urine flow.
  • Management of associated conditions:
    • In some cases, hydronephrosis may be associated with other conditions, such as neurogenic bladder or urinary tract anomalies. Treatment for these conditions may be necessary to prevent complications related to hydronephrosis.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Hydronephrosis. Here’s why families trust us:

“Our child was diagnosed with Hydronephrosis, and we didn't know where to turn. The team at Gertrude's Children's Hospital was amazing - they worked with us to develop a personalized treatment plan that helped our child manage their symptoms and thrive.”

Emilyparent of a child with Hydronephrosis

Hydronephrosis in Children

Yes, in mild cases, especially when detected prenatally, hydronephrosis may resolve as the child grows. Regular monitoring is important to track the condition’s progress.

Treatment depends on the severity of the condition and its underlying cause. Options include observation, antibiotics, or surgery to correct any blockages or structural issues.

If left untreated, severe or prolonged hydronephrosis can lead to kidney damage. Early diagnosis and appropriate treatment are key to preventing long-term complications.

Hydronephrosis is diagnosed through imaging tests, such as ultrasounds, voiding cystourethrograms (VCUG), or renal scans, which allow doctors to visualize the kidneys and urinary tract.

While hydronephrosis itself may not be preventable, early detection through prenatal ultrasounds and proper management of urinary tract conditions can reduce the risk of complications.

Contact Us

If your child has been diagnosed with hydronephrosis or is experiencing symptoms such as urinary tract infections or abdominal pain, Gertrude’s Children’s Hospital is here to help. Our team of pediatric urology specialists will provide expert care and develop a personalized treatment plan to ensure your child’s health and well-being.

Contact us today to learn more about our Hydronephrosis in Children treatment options.

Book Appointment