Hydronephrosis In Children: Symptoms And Treatment Options

A] What Is Hydronephrosis?

Hydronephrosis occurs when urine cannot drain properly from the kidney to the bladder, leading to kidney swelling. This condition can affect one kidney (unilateral hydronephrosis) or both kidneys (bilateral hydronephrosis). Hydronephrosis in children can be detected during prenatal ultrasounds or after birth through various symptoms.

Children diagnosed with hydronephrosis before birth usually get well after as the condition disappears spontaneously. Additionally, kids with mild or moderate hydronephrosis may have an unaffected kidney as the condition resolves itself over time after birth. 

The doctor describes this condition as mild, severe, or moderate depending on

• How much is the kidney stretched?
• How disrupted is the urinary flow?

The primary impact of hydronephrosis in children is the potential damage to kidney function. If left untreated, the persistent pressure from urine buildup can cause permanent infant kidney problems, affecting the child’s overall health. That is why it is important ti detect and intervene to prevent such outcomes.

B] Types Of Hydronephrosis

Hydronephrosis is classified into two depending on the number of kidneys impacted:

1. Unilateral

Unilateral hydronephrosis involves the swelling of one kidney. It is more common and can result from various causes such as birth defects in the urinary tract, obstructions from an enlarged uterus, reflux, etc. Although one kidney is affected, the other kidney usually continues to function normally, compensating for the impaired kidney.

It may lead to abdominal mass in children, flank pain, fever, painful urination, etc. Therefore, children will require proper hydronephrosis treatment.

2. Bilateral

This type involves the swelling of both kidneys. It is less common but more serious as it indicates a systemic issue affecting the entire urinary tract. Bilateral hydronephrosis often requires more immediate and comprehensive medical intervention to prevent severe kidney damage and ensure the proper functioning of both kidneys.

When the doctor comprehends the type of hydronephrosis, they can implement an appropriate treatment strategy and predict the potential impact on the child’s health.

C] Causes Of Hydronephrosis In Children

Hydronephrosis in infants can occur due to many factors. However, they may either be present at birth (congenital) or develop after birth (acquired). Find the different causes of hydronephrosis in newborns in detail here:

1. Congenital Causes (Present At Birth)

These causes are present in the child at birth or may happen during pregnancy. If the urinary tract of the baby prenatal is problematic, it may lead to hydronephrosis. These issues include missing or wrongly positioned kidneys, blockage or reflux of urine, etc.

2. Ureteropelvic junction (UPJ) Obstruction

This is the most common congenital cause, where a blockage occurs at the junction where the ureter (the thin tube carrying urine to the bladder) meets the kidney, preventing urine flow. Usually, the top of the ureter is narrow, which may become one of the hydronephrosis causes.

3. Vesicoureteral Reflux (VUR)

This condition involves the backward flow of urine from the bladder into the kidneys. It may lead to swelling and potential kidney damage. Usually, the muscles at the junction of the ureter and bladder don’t work properly, leading to this problem.

4. Posterior Urethral Valves (PUV)

This is a rare condition affecting male infants, where abnormal flaps of tissue in the urethra block urine flow, causing bladder and kidney swelling.

5. Acquired Causes (develop after birth)

The acquired causes of pediatric hydronephrosis develop after birth. These may occur after a disease or event, like a kidney stone or an external mass compressing the urine tube.

6. Kidney Stones

These are hard mineral deposits that can form in the kidneys and obstruct urine flow, leading to hydronephrosis.

7. Tumors Or Cysts

Growths in or around the kidneys can compress the ureters or kidneys, causing a blockage and urine buildup.

8. Urinary Tract Infections (UTIs)

Recurrent UTIs can cause inflammation and scarring, leading to obstruction and subsequent hydronephrosis.

Understanding the underlying causes of hydronephrosis is crucial for developing effective treatment strategies. Each reason may require a different approach, ranging from medical management to surgical intervention. Therefore, you should consider urologic disorder treatment strategies for effective hydronephrosis treatment.

D] Symptoms Of Pediatric Hydronephrosis

Hydronephrosis symptoms in children can vary depending on the severity of the condition. Most babies may have no symptoms. On the other hand, older children with mild or moderate hydronephrosis may see some common symptoms.  

These include:

• Abdominal or flank pain
• Growth of abdominal mass
• Nausea and vomiting
• Urinary tract infections (UTIs)
• Cloudy urine
• Increased frequency or urgency of urination
• Pain while urinating (dysuria)
• Blood in the urine (hematuria)
• Poor growth or weight gain in infants

Early detection of these symptoms can lead to timely diagnosis and treatment, preventing long-term kidney damage. The doctor may run various tests and suggest a urine blockage treatment accordingly.

E] Hydronephrosis Treatment Options

Hydronephrosis in children can be treated after considering the underlying cause and severity of the condition. However, the main treatment options available include the following:

1. Medical Treatments

In mild cases, close monitoring and regular ultrasounds may be sufficient to ensure the condition does not worsen. However, some medical treatments may have to be registered to cure the discomfort and pain. It may include medicinal hydronephrosis treatment.

2. Antibiotics For Infections

If hydronephrosis is associated with UTIs, antibiotics are prescribed to treat and prevent infections. Children usually receive low doses of antibiotics and are constantly kept under observation to keep a check on the issue.

3. Medications

Medications may be used to manage symptoms or underlying conditions contributing to hydronephrosis. These medicines may reduce excess uric acid excretion. Additionally, the medication given may prevent the child from contracting a urinary tract infection. 

4. Surgical Interventions

Surgery may be necessary to correct structural issues causing hydronephrosis. It is usually rare to go down the surgery path but it may be necessary to reduce the swelling and pressure in the kidney as it restores the urine flow.

5. Pyeloplasty For UPJ obstruction

This surgery removes the obstruction or the narrow part at the ureteropelvic junction, allowing urine to flow normally.

6. Endoscopic Surgery For PUV

It is a minimally invasive surgery performed by a pediatric surgeon to remove the obstructive valves in the urethra.

7. Ureteral Reimplantation For Severe VUR

This procedure corrects vesicoureteral reflux by repositioning the ureters to prevent backward urine flow, thus preventing infant kidney problems.

Each treatment option aims to alleviate the urine blockage and protect kidney function. Consulting a pediatric surgeon is crucial to determine the most appropriate urine blockage treatment plan for your child.