KIDNEY FOUNDATION FOR CHILDREN

      SAVING YOUNG LIVES

UNILATERAL HYDRONEPHROSIS


The mother of one of your patients comes to your clinic to consult you regarding her second baby who is unborn.Your new patient is a 22 week old fetus..The mother shows you the ultrasound scan which says that there is a left renal pelvis dilatation of 6 mm..She wants your advice .What should you do as a pediatrician?

       SECOND TRIMESTER  CONSULT FOR UNILATERAL     HYDRONEPHROSIS

                   4 Questions that need to be answered

  •   Is this dilatation significant ?                                              Yes.Any dilatation > 4 mm in the second trimester is significant.
  •   .Is the dilatation severe?                                                     No.Only dilatation > 10 mm is considered severe
  •   .Is it unilateral or bilateral?                                                       Unilateral .But the opposite kidney needs to be watched carefully as pregnancy advances.
  •   .Is it an isolated anomaly.

     Can't say unless a fetal anomaly scan has been done.


BILATERAL HYDRONEPHROSIS


A 30 week pregnant mother consults you for her unborn baby..The baby's antenatal USG shows bilateral pelvicalyceal dilatation.Left kidney pelvis AP diameter is 8 mm and the Right kidney pelvis is 15 mm. What is your advice to the parents of your patient.?

 COUNSELLING THE PARENTS


  • .To do a complete fetal anomaly scan
  • .If isolated renal anomaly to repeat USG in third trimester
  • .Favourable neonatal outcome
  • Favourable long term renal outcome

    Provided The opposite kidney has been carefully  

    evaluated and found to be normal


THIRD TRIMESTER CONSULT FOR BILATERAL HYDRONEPHROSIS

                   6 QUESTIONS TO BE ANSWERED

  • Is this dilatation significant ?

    YES. AP Diameter > 7 mm in the third trimester is      

    significant

  • Is the dilatation severe ?

> 15 mm dilatation in third trimester is severe

   Left kidney mild dilatation

   Right kidney severe dilatation

  • Unilateral  or Bilateral

    Bilateral

  • Is the kidney function normal ?

    Look for oligohydramnios- indicator of poor renal function

  • Are the kidneys dysplastic

   Hyperechoic kidneys, cysts in the kidney,Indicators of    

    renal dysplasia

  • Is this an isolated anomaly ?

   Opinion can only be given if a fetal anomaly scan has

   been done.



   COUNSELLING PARENTS.

  • Fetal anomaly scan should be done
  • USG should be monitored 6 weekly for pelvicalyceal dilatation and amniotic fluid index
  • No renal indication for premature delivery
  • No benefit with fetal intervention

 

unilateral hydronephrosis

  • Start antibiotic prophylaxis
  • Amoxycillin 10-20 mg/kg at night
  • Monitor urine output
  • Urine routine exam for UTI
  • Postnatal USG after 72 hours
  • If postnatal USG confirms unilateral involvement no other immediate investigation needed
  • Repeat USG at 2 months of age even if first postnatal USG Normal
  • If unilateral HN with APD , 10 mm monitor 3 monthly USG
  • If APD > 10 mm will require additional investigations such as MCU and /orDTPA scan





bilateral  hydronephrosis

  • Start antibiotic prophylaxis
  • Amoxycillin 10-20 mg/kg at night
  • Monitor voiding pattern and urine output
  • Urine routine exam for UTI
  • If male child postnatal USG on day1 to rule out  post urethral valves
  • If female child USG after 72 hours
  • Repeat USG at  6-8 weeks of age
  • MCU
  • If MCU shows VUR,DMSA SCZN
  • If no VUR ,DTPA scan




postnatal management




antenatally detected  hydronephrosis

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