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What are the causes and treatment for neonatal hydronephrosis?

Q: During the 9th month of my pregnancy, an ultrasound revealed that my child's left kidney was hydronephrotic. After she was born it was reconfirmed by a subsequent ultrasound. The doctor suggested we take her for a scan every 6 months. Since she did not develop any symptoms, we discontinued her doctor visits. She is 8 years old now and still has no symptoms. What is the outlook on a child with a hydronephrotic kidney?

A:Your child was diagnosed with Neonatal hydronephrosis which is detected during pregnancy by an ultrasound imaging (prenatal ultrasound). Hydronephrosis involves stretching or dilation of the collecting part of the kidney usually resulting from a blockage in the ureter where it joins the kidney that prevents urine from draining into the bladder or may result from an abnormal reflux of urine from the bladder. Both of these result in trapped urine/increased back pressure causing the kidneys to stretch. The severity of hydronephrosis depends on the extent of the blockage and the amount of the stretching of the kidney. Children with a mild to moderate degree of hydronephrosis usually do not have symptoms, the kidneys are minimally affected, and the hydronephrosis may disappear in the first few years of life. Studies have shown that the kidney compensates for the underlying hydronephrosis to maintain normal filtering function in the initial few years of life. Patients with a severe degree of hydronephrosis require a constant monitoring of the underlying kidney function by renal scan and imaging studies since they are prone to a worsening of function and repeated kidney infection. Based on the information provided, your child probably has asymptomatic unilateral (left-sided) hydronephrosis which is a benign condition often known to resolve spontaneously. One would advise a close observation of the underlying kidney function until hydronephrosis resolves or remains stable for a long duration. However, if hydronephrosis is worsening probably from an underlying on-going obstruction of the urinary tract, surgical intervention is recommended. This has to be done under the guidance of your child’s pediatrician in close consultation with an urologist.

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