Hydronephrosis medical therapy
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- Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
The goal of treatment for hydronephrosis is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.The initial care for the patient is aimed at minimizing pain and preventing urinary tract infections. Otherwise, surgical intervention may be required.
Medical Therapy
- Mild-moderate hydronephrosis: Hydronephrosis could resolve spontaneously. However, antibiotic prophylaxis is recommended to lower the risk of urinary tract infection.[1]
- In Order to reduce the risk of permanent kidney injury, the blockage of urine may need to be drained if hydronephrosis is severe enough.[2]
- The drainage can be done with nephrostomy or pyeloplasty tube into the kidney.[3][4]
- Consider giving pain medications and antibiotics to be patient before initiating the treatment.
Mild to moderate hydronephrosis in adults
- Follow wait-and-see approach for the treatment of mild to moderate hydronephrosis.
- Consider treating the patient with antibiotics to prevent infections.
Severe hydronephrosis
- Surgery may be the treatment of choice to eliminate the severity of the blockage or even correct the reflux.
Bilateral hydronephrosis
- Infants with severe bilateral antenatal hydronephrosis evaluated initially by using ultrasonography.
- Infants with severe bilateral hydronephrosis raise the concern of obstruction like[5]
- Ureterocele
- Posterior urethral valves (PUV) defect
- Voiding cystourethrography (VCUG) should be performed if hydronephrosis is positive on USG.
Severe unilateral hydronephrosis in infants
- If renal pelvic diameter is more than 15 mm in diameter in the third trimester the it is considered as severe unilateral hydronephrosis.[6][7]
- And should be followed with USG once the neonate returns to the normal birth weight.
Moderate and mild unilateral hydronephrosis in infants
- If renal pelvic length is less than 15mm during the third trimester then it is considered as a moderate and mild unilateral hydronephrosis.[8][9]
- In the patients follow up with ultrasound after 7 days on birth to access whether the hydronephrosis has persisted or not in neonatal period.
- By age 18 months moderate hydronephrosis resolves on its own.
Antibiotic prophylaxis
- In prenatally diagnosed hydronephrosis patients a very higher chances of urinary tract infections(UTI) have been reported.
- Urinary tract infections(UTI) in prenatal babies raise the suspicion of underlying renal abnormality.
- So in these patients antibiotic prophylaxis is started as soon as possible after the delivery until exclude the diagnosis with either VUR or obstructive uropathy .
References
- ↑ Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A (July 2018). "Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones". Urol. Int.: 1–6. doi:10.1159/000490623. PMID 30025399.
- ↑ Li F, Zhang MZ, Liu TC (February 1994). "[Diagnosis and treatment of hydronephrosis: report of 100 cases]". Zhonghua Wai Ke Za Zhi (in Chinese). 32 (2): 114–6. PMID 7924663.
- ↑ Zhang S, Zhang Q, Ji C, Zhao X, Liu G, Zhang S, Li X, Lian H, Zhang G, Guo H (January 2015). "Improved split renal function after percutaneous nephrostomy in young adults with severe hydronephrosis due to ureteropelvic junction obstruction". J. Urol. 193 (1): 191–5. doi:10.1016/j.juro.2014.07.005. PMID 25014578.
- ↑ Josephson S (1990). "Suspected pyelo-ureteral junction obstruction in the fetus: when to do what? I. A clinical update". Eur. Urol. 18 (4): 267–75. PMID 2289519.
- ↑ González R, Schimke CM (1998). "[The prenatal diagnosis of hydronephrosis, when and why to operate?]". Arch. Esp. Urol. (in Spanish; Castilian). 51 (6): 575–9. PMID 9773587.
- ↑ Onen A (June 2007). "An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis". J Pediatr Urol. 3 (3): 200–5. doi:10.1016/j.jpurol.2006.08.002. PMID 18947735.
- ↑ Onen A, Jayanthi VR, Koff SA (September 2002). "Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively". J. Urol. 168 (3): 1118–20. doi:10.1097/01.ju.0000024449.19337.8d. PMID 12187248.
- ↑ Onen A (December 2007). "Treatment and outcome of prenatally detected newborn hydronephrosis". J Pediatr Urol. 3 (6): 469–76. doi:10.1016/j.jpurol.2007.05.002. PMID 18947797.
- ↑ Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S (May 2002). "Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty". J. Urol. 167 (5): 2159–63. PMID 11956470.