Hydronephrosis

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Hydronephrosis


Currently most pregnant women undergo one or two ultrasound scans during their pregnancy. When the fetus is scanned, kidneys and the urinary tracts are analyzed, In addition the volume of liquor (amniotic fluid) also helps to suspect kidney problems. Of late stretching of the kidney (Hydronephrosis) is detected very frequently.

Kidney Stretching (Hydronephrosis)

During scanning of 100-200 pregnant ladies, one fetus is found to have this abnormality. This usually happens because of a blockage in the urinary tract. Before proceeding further it is essential to describe the normal arrangement of the kidneys.

Conditions

In human body there are two kidneys, one on either side of belly. From each kidney urine drains out via a tube called ‘ureter’ into a common urinary bladder. The bladder is located in the lower most part of belly. Once enough urine accumulates, it empties via a tube called ‘urethra’. Whenever there is a block in any of these tubes, kidney stretching results.


What are the symptoms of hydronephrosis?


  1. Detected before birth (Antenatal Scans): The condition should not cause the mother to have any symptoms. Hydronephrosis should not cause the baby to have any problems before birth, but he or she needs close monitoring after birth to keep an eye on the condition.
  2. Colic or Pain abdomen: This can be a feature in older children. This is because of the urine in the kidney trying to push and overcome the blockage.
  3. Urinary Infection (UTI) Whenever there is any blockage to urine flow, the system can easily catch infection. These children may have fever, frequent painful urination etc.

How is hydronephrosis diagnosed


  1. Ultrasound Scan: Hydronephrosis is diagnosed using an ultrasound scan. It helps to determine the severity of blockage; reflected by the amount of dilatation.
  2. Nuclear Scan: For this test a small dose of medicine is injected in to the vein; pictures are taken with a gamma camera (like x-ray) every few minutes; this shows how fast the kidneys take up the medicine and how fast it leaves the kidney. When there is a blockage, the medicine stays in kidney for a long time. When the kidney function is poor; very little medicine is taken up by the kidney.
  3. MCU: This is mainly to exclude problems like reflux or a valve.

How can hydronephrosis be treated?


  1. If the hydronephrosis is diagnosed during pregnancy, early treatment will consist of monitoring with ultrasound, to check that the baby is growing normally and the kidneys are not getting too large. The baby will usually be born by a routine delivery.
  2. After the baby is born, the hydronephrosis will be monitored using ultrasound scans and Nuclear scans.
  3. When the hydronephrosis is getting worse or the kidney function is reducing surgery called pyeloplasty is recommended.