My child has Hydronephrosis from birth. Why does my doctor make me do Ultrasounds again and again?
Many changes occur in the kidney before and after birth. Hydronephrosis indicates there is more urine filling up in the kidney than is expected. It implies that there is an imbalance between the amount of urine being formed and the urine transported down the ureter into the bladder and outside. As the kidney, ureter, bladder and urethra and importantly the joint between the adjacent structures grow, the degree of hydronephrosis may improve or worsen. This is the predominant reason why the doctor wants to repeat the ultrasound again and again till one and a half years of age.
The paediatric urologist also specifically look for subtle pointers that damage to the kidney is occurring, and that would prompt a more detailed evaluation of the function and drainage using a Nuclear isotope scan, Micturating Cystourethrogram MCU /VCUG. However, for this, it is important to ask for the Ultrasonologist to document
– the kidney’s meat – renal parenchymal thickness
– the width of the urine collecting area of the kidney at a particular angle – pelvis AP diameter
– whether the ureter is also distending with urine – hydroureter
– whether there is any abnormality within the bladder or the bladder wall – bladder wall thickness, ureterocele
– whether there is any backing up of urine in the urethra (in boys) and vagina (in girls) – posterior urethral dilatation, hydrocolpos
– and the state of the opposite kidney – cystic kidney, absent kidney.
All of these have a bearing on interpreting what the hydronephrosis signifies and what its impact on the child can be. Hydronephrosis without abnormality in any other component is actually the least of the paediatric urologist’s worries, though some do need surgery. It is the ones with additional abnormalities that have a high chance of early urine infection and rapid kidney damage. The fear of kidney damage in the young kidney is that when the child grows up there may be insufficient healthy kidney to remove waste the child might grow into chronic kidney failure.
