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Hydronephrosis is the swelling of the collecting system of one or both kidneys. Hydronephrosis itself is not a disease of the kidney, but it can be a sign of an underlying problem with the kidney.
Hydronephrosis often has no symptoms, especially in infants and young children. Many infants are diagnosed with hydronephrosis on prenatal ultrasound. Sometimes hydronephrosis can be associated with urinary tract infections, abdominal or side pain, blood in the urine, kidney stones and vomiting.
Hydronephrosis can be physiologic and have no underlying cause. Alternatively, it can also be associated with vesicoureteral reflux (VUR), the abnormal backflow of urine from the bladder up the ureter and kidney.
Hydronephrosis can also be caused by a blockage in the ureter. This is most often at the top of the ureter (a ureteropelvic (UPJ) obstruction) but can also be at the bottom of the ureter, at the level of the bladder (a ureterovesical (UVJ) obstruction).
Hydronephrosis is typically diagnosed with an ultrasound, often prenatally. It is graded on a scale of 1-3, with grade 3 being the most severe. If reflux is suspected, a voiding cystourethrogram (VCUG) or contrast-enhanced voiding ultrasound (CEVUS) may be recommended. Alternatively, a nuclear medicine MAG-3 lasix renal scan may also be ordered to look for an obstruction.
Most hydronephrosis resolves on its own within a few years and does not require surgery. However, if there is an obstruction, sometimes surgery may be necessary if the hydronephrosis worsens, or if there are signs of kidney damage, kidney stones, UTI, recurrent vomiting or side pain. If there is reflux, surgery may be necessary if the child develops recurrent infections. Preventative antibiotics are sometimes recommended if there is dilation of the ureter and/or if there is VUR.
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