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This section discusses about blockage caused by PUJ obstruction. In this condition there is a blockage of urine at the junction of kidney and the pipe draining (ureter) – pelvi ureteric junction (PUJ). Because of this the kidney stretches. Often it affects one side alone although it can involve both kidneys.

What are the symptoms of hydronephrosis?

  • 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.
  • 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.
  • 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?

  • Ultrasound Scan: THydronephrosis is diagnosed using an ultrasound scan. It helps to determine the severity of blockage; reflected by the amount of dilatation.
  • 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.
  • MCU: This is mainly to exclude problems like reflux or a valve.

How can hydronephrosis be treated?

  • 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.
  • After the baby is born, the hydronephrosis will be monitored using ultrasound scans and Nuclear scans.
  • When the hydronephrosis is getting worse or the kidney function is reducing surgery called pyeloplasty is recommended.

What does a pyeloplasty involve?

Under general anaesthesia, a small cut is made in the kidney region. The blocked portion is removed and reconnected. A small tube called stent may be kept to protect the sutures. It may be kept fully inside (needs removal under a second anaesthesia) or partly out (bedside removal after 7 days). The hospital stay is between 4-8 days. Children recover very well and it is not very painful as medicines will be given to take care of it. They can have normal feeds within 24 hours of operation.

What is the outlook for children with hydronephrosis?

  • If the cause of the hydronephrosis is an obstruction and this is removed shortly after birth, kidneys will be able to work properly.
  • The earlier the hydronephrosis is discovered, the better the outcome

Post Author: Dr. KK Surgical and Paediatric centre


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