Antenatal (before birth) hydronephrosis (fluid-filled enlargement of the kidney) can be detected in the fetus by ultrasound studies performed as early as the first trimester of pregnancy. In most instances this diagnosis will not change obstetric care, but will require careful follow-up and possible surgery during infancy and childhood.
Possible causes of antenatal hydronephrosis include:
Most cases of hydronephrosis diagnosed during pregnancy are just followed with ultrasound, monitoring the growth of the fetus and the condition of the kidneys. In these cases, a routine, normal delivery can be performed. Rarely, in a fetus with severe obstruction of both kidneys and insufficient amniotic fluid, drainage of the kidneys or bladder by tube or operation may need to be done. In these babies, however, the kidneys are often very abnormal and do not function properly regardless of treatment.
Several studies may need to be performed to evaluate the kidneys:
The treatment of antenatal hydronephrosis depends on the underlying cause. Infants and children with who have vesicoureteral reflux are managed with antibiotics and surveillance with periodic ultrasounds and voiding cystograms. Infants and children with an obstruction or blockage of the urinary tract may require surgical correction. Babies with hydronephrosis without reflux or obstruction are followed with periodic ultrasounds to monitor the hydronephrosis and the growth of the kidneys. The management of multicystic dysplastic kidneys is controversial: the multicystic dysplastic kidney doesn't work, but the opposite kidney is usually normal. Some urologists recommend removal, whereas others do not remove the dysplastic kidney unless its large size causes problems or unless there is a question of tumor or blockage.
This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at The University of Texas Medical School and is presented to inform you about surgical conditions. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about surgical treatment. If you have any questions about the information above or your child's care, please contact our doctors.
UT Pediatric Urology
UT Physicians Professional Building
6410 Fannin St. Suite 950
Houston, Texas 77030
Phone: (832) 325-7234
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