Hydronephrosis in Babies: Causes, Symptoms & Treatment

Hydronephrosis can be an extremely painful condition of the renal system and can affect anyone including babies. If your baby seems irritable or cries when urinating, then it is best that you consult with the paediatrician. This condition should not be ignored as it can have harmful effects.

What is Hydronephrosis?

Hydronephrosis is a medical condition of the renal system where the urine cannot be discharged causing pain while urinating. This causes the urine to move back towards the kidneys and causes swelling and pressure on the kidney tissue. The blockage is usually located in the ureter. Ureters are the tubes connecting the kidney to the bladder. In babies, it is caused mostly by a congenital disease (a disease present from birth) of the renal system. The disease can affect one or both kidneys. The latter is known as bilateral hydronephrosis in infants.

Causes of Baby Hydronephrosis

There are many reasons why your child could be suffering from this ailment apart from congenital hydronephrosis. These are discussed below.

• One of the main causes of hydronephrosis is the presence of kidney stones. If the stones are too large, it might lead to blocking of the ureter, leading to collection of the urine which causes swelling in the kidneys.
• Hydronephrosis could also be caused by the presence of a tumour or cyst that presses against the ureter, causing the blockage.
• Another leading cause is the presence of blood clots or scarring. Scarring is generally not observed in babies unless they have had some renal damage before.
• Some babies are naturally born with narrow ureters. In such cases, the uterer is more susceptible to blockages.

Symptoms of Hydronephrosis in Babies

There are many symptoms of the condition that you can lookout for. Some of the symptoms include:

• Crying during urination is indicative of pain.
• Pain in the lower abdomen. You can observe this if your baby cries when you gently palpate or press on the region.
• Urination that is more frequent than usual.
• Nausea can be observed in older children.
• Vomiting
• Fever

Also, keep in mind that the longer the condition remains untreated, the worse the symptoms will appear to be. So, look out for these symptoms and try to get it treated as soon as possible.

One of the most common side effects of hydronephrosis is the development of urinary tract infections or UTI. Some common symptoms of this infection are:

• Back pain
• Fever
• Cloudy urine
• Pain when urinating indicated via crying or irritability

Diagnosis

Since hydronephrosis is not a disease in itself, but rather a condition caused by other factors, the diagnosis is two pronged. The first step would be to establish that the condition exists in your baby. The second step would be to determine what is causing the blockage.

The diagnosis of the disease can be done during your pregnancy or after.

Prenatal Testing

During your pregnancy, hydronephrosis is usually diagnosed from your regular prenatal ultrasound check-up. If the size of your child’s kidneys as well as the level of amniotic fluid seems to suggest something may be wrong, then your doctor will have you come in for more regular check-ups to monitor the health of your baby’s kidneys.

Postnatal Testing

Doctors have advanced tools and tests at their disposal to make accurate diagnosis of the issue plaguing your baby’s kidneys. They might recommend one or more of all the tests below to identify the issue:

• Renal Ultrasound (RUS): This ultrasound is focused directly over the renal system of your baby to give the doctor a better and complete picture of the condition of the kidneys.
• Voiding Cystourethrogram (VCUG): In this test, a liquid dye is injected into your baby’s bladder using a catheter. Once your baby urinates, the flow of the dye will be picked up via X-ray.
• Renal Scan (MAG 3): This test involves injecting a small amount of radioisotope into your baby’s bloodstream. As it finds its way into the renal system, a special gamma camera will take pictures of the radioisotope. With this test, the doctor will be able to compare the functioning of both the kidneys while also determining the extent of the blockage.

Complications

If hydronephrosis is left untreated or is given improper medical care, then your baby’s kidneys could get severely damaged. Apart from the kidneys stopping their regular function of filtering the blood, removing toxins, waste excretion, RBC regulation and regular urination, it could also lead to infections and the permanent failure of the kidneys.

There are cases where the baby continues to have chronic hydronephrosis where the prognosis is bleak even after timely medical intervention.

Treatment of Hydronephrosis in Infants

The nature and method of the treatment will be dependent on the stage or type of hydronephrosis your baby has. Some of the options for treatment are:

• Foetal intervention: If the condition of the kidneys and the rest of the renal system looks to be critical, then your doctor will want to intervene at this time itself. This will include neonatal surgery and maternal-foetal medicine.
• Observation: In cases of mild to a moderate condition of hydronephrosis, the paediatrician will recommend that the best line of treatment would be to simply observe the renal system as it corrects itself. She might, at most, give your baby a low dosage of antibiotics that will prevent any infection of the urinary tract.
• Surgery: Your doctor will recommend surgery to correct hydronephrosis only in the most severe cases. There are a number of surgeries that could be done such as kidney stone removal if, in fact, it is kidney stones that are causing the blockage. However, one of the most common surgeries is pyeloplasty where the portion of the ureter with the blockage is removed.

Hydronephrosis is a condition of the renal system that can cause serious complications, apart from just causing pain. In order to avoid critical and severe conditions, It is advisable that you immediately seek the advice of your child’s primary healthcare provider as soon as you spot the first sign. Keep in mind that most cases of congenital hydronephrosis get resolved on its own and there is no need to rush to surgery unless recommended by the doctor. Make sure you get all the required tests on time and be diligent in keeping appointments with the paediatrician.