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Home >> Pediatric Urology >> Hydronephrosis >> Diagnosis
Hydronephrosis - Diagnosis
Overview | Diagnosis | Treatment | FAQ
Most of the time in children, hydronephrosis is picked up prenatally, by ultrasound. Urinary tract infection or back pain would be other reasons to do an imaging study. Asymptomatic hydronephrosis is usually detected incidentally when an imaging study is performed for another reason, such as unexplained abdominal pain. Symptoms generally occur when the obstruction occurs suddenly; for instance, when a stone gets lodged in the urinary tract, the resulting back pressure of urine can cause excruciating pain that is accompanied with nausea and vomiting. If the urine is infected, hydronephrosis may be associated with more severe symptoms such as fever and chills, which is a condition that requires immediate attention. In children, hydronephrosis may cause failure to thrive, vague abdominal pain or swelling, urinary tract infections, or a fever of unknown origin.
Evaluation of a child who is known to have had prenatal hydronephrosis may include postnatal renal ultrasound twenty four hours after birth, as well as a voiding cystogram within the first week of life. A voiding cystogram requires placement of a tube through the urethra to directly fill the bladder with contrast. When the patient voids, the radiologist can seen if there is a urethral obstruction or ureteral reflux. A renal ultrasound or an x-ray study such as computed tomography (CT scan) are the most common tests used to initially address a symptomatic pain. If a child appears to have thinning of the renal cortex (the filtering part is compressed), then a nuclear renal scan would likely be done. This study allows injected low dose radioactive tracer to circulate through the kidney , and as it is excreted into the urine, a computer imaging camera determined how fast the material drains through each kidney. The rate at which it drains give an indication as to whether the kidney is “significantly” obstructed. One can also compare the percent function each kidney contributes to the total renal function. Rarely now, an IVP is ordered to further evaluate the anatomy of the obstruction. In older children, a special study of the blood supply to the kidney, called a MRA (Magnetic Resonance Angiogram) may be ordered if there is concern that a ‘crossing vessel’ is compressing and obstructing the ureter at the level of the UPJ.
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