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Hydronephrosis is a condition, affecting about 1 in 100 babies, where urine overfills or backs up into the kidney. It causes the kidney to swell up and become abnormally dilated. Hydronephrosis can affect one (unilateral) or both (bilateral) kidneys, and it resolves on its own in most of the cases.
The severity of the condition depends on the extent of blockage and the degree to which the kidney is stretched, ranging from mild to severe. In most of the cases, it is the blockage at the top of the ureter near the kidney, an area known as the ureteropelvic junction (UPJ) that leads to abnormalities which can impair foetal lung development   .
The condition can affect the infant's ability to drain urine from the urinary system - affecting the kidneys, bladder, ureters and urethra. Hydronephrosis isn't a primary disease, but a secondary condition that results from some other underlying diseases  .
Causes Of Paediatric Hydronephrosis
It is not a disease. Hydronephrosis can arise due to internal and external conditions that affect the kidney and the urinary system of the infant. One of the most common causes of hydronephrosis is acute unilateral obstructive uropathy  . It can also develop due to any abnormal developments or formations of the kidney in the absence of obstruction or reflux. There are few genetic causes of hydronephrosis, which can also act as the reason behind the condition developing in the child.
Studies point out that about 2 per cent of prenatal ultrasound examinations reveal some degree of hydronephrosis, making it one of the most commonly detected abnormalities in pregnancy. It is unclear as to why the ureter becomes blocked during development.
Hydronephrosis is increasingly reported in males rather than females  .
Some of the common causes of hydronephrosis are as follows  :
- Congenital blockage (a defect that is present at birth)
- Scarring of tissue
- Tumour or cancer
Types Of Paediatric Hydronephrosis
There are three major categories of paediatric hydronephrosis and they are as follows  :
Vesicoureteral reflux: This develops when the urine flow from the kidneys to the bladder gets disrupted and abnormally backs up into the ureter.
Blockage/obstruction: This occurs due to four different causes and in different locations and that is, where the kidney meets the ureter, where the ureter meets the bladder, within the urethra and when there is an incorrect attachment of the ureter to the bladder.
Idiopathic hydronephrosis: The reason behind this type of hydronephrosis is not yet clear, however, it resolves on its own before or after birth.
Symptoms Of Paediatric Hydronephrosis
Newborns and infants with hydronephrosis usually show few or no symptoms at all. However, some of the signs of the condition are as follows  :
- Cloudy urine
- Painful urination
- A weak urine stream
- A fever
Diagnosis Of Paediatric Hydronephrosis
Your physician can usually detect hydronephrosis through a routine prenatal ultrasound during the second trimester. Ultrasound can detect the foetal kidneys and bladder by 14 or 15 weeks gestation, though 20 weeks of pregnancy is the ideal time to detect hydronephrosis. Because, during this period, the foetus is larger and the kidneys are producing urine  .
If the condition is detected, your doctor will ask you to carry out the following tests:
- Diagnostic imaging of the kidneys to assess function and proper urine drainage
- X-ray of the bladder to check for vesicoureteral reflux
Babies with severe cases of prenatal hydronephrosis have an ultrasound of the kidneys and bladder a few days after birth.
Treatment For Paediatric Hydronephrosis
- Surgery to repair any urinary tract blockage, in more severe cases
- Foetal surgery to place a drainage tube in your baby's bladder, in the most severe cases
- Antibiotics will be prescribed after your baby is born to prevent infection
- Close observation for mild or moderate cases, including ultrasounds before and after birth
On A Final Note...
Many cases of hydronephrosis resolve on their own before the baby's birth. Studies point out that most cases of hydronephrosis at birth will resolve over time with the kidneys working normally.
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