Prenatal Hydronephrosis and Vesicoureteral Reflux

Prenatal Hydronephrosis and Vesicoureteral Reflux - On December 23, 2001 I had my very first twenty week ultrasound. My husband and I were ecstatic to see our daughter's alien-like face, her profile, her little feet. She even allowed us to know she was a girl. Everything seemed fine-until a few days later when my obstetrician called. "I want you to go back," he said. But this time to a specialist. Something was wrong.

Facts

Our daughter had a severe case of prenatal hydronephrosis with vesicoureteral reflux (VUR). According to Cornell University Medical College, hydronephrosis is "the most common abnormality detected on prenatal ultrasonography." For us, it meant months of hospital visits, surgeries, tests, procedures and stress. But without knowing about the problem at twenty weeks pregnant, it could have been much worse.

Normally urine travels from the kidneys down through the ureters into the bladder. Hydronephrosis is a condition wherein the urine is not allowed to enter into the bladder and the kidney swells. The Children's Hospital in Boston reports it is four to five times more common in males than females, can occur in one or both kidneys, can resolve itself in more mild and even some moderate cases, and some severe cases-like my daughter's-require surgery.

In some cases a child will have vesicoureteral reflux, which is, according to now retired pediatric-urologist Stephen R. Shapiro, a condition "wherein there is passage of urine from the bladder into the ureters (the tubes draining the kidneys) during bladder filling or during urination." In other words, your urine backs up into your kidneys.

Causes of Hydronephrosis

The Children's Hospital in Boston reports that "it is unknown why some babies are born with the kinds of anomalies that lead to hydronephrosis. Neither hydronephrosis nor its causes have ever been linked to anything the parents did during pregnancy." Indeed while my husband and I feared my other two children, both boys, may get hydronephrosis, neither have had any urology problems.

Though the most common cause of fetal hydronephrosis is ureteropelvic junction (UPJ) obstruction which is due to an abnormal narrowing of the ureter as it is forming or an "abnormal tethering of the ureter by abnormal blood vessels or compression of the ureter by a tumor," according to Cornell University Medical College, the other cause is the aforementioned vesicoureteral reflux.

According to Dr. Shapiro, unlike with hydronephrosis where boys are more likely to be diagnosed, girls are twenty times more likely to be diagnosed with vesicoureteral reflux. Mild to even intermediate grades of reflux may outgrow themselves, but severe cases do call for surgery.

Procedures

Once your child is born, your doctor will perform any number of procedures to determine the cause of the hydronephrosis. The first is called a voiding cystourethrogram (VCUG) which keeps track of any reflux and determines its course both before and after surgery. This invasive procedure takes place in the nuclear medicine department where a catheter is placed into the bladder which is then filled with radiographic dye. The catheter is then removed and x-rays are taken to see the course the dye takes as your child urinates.

Another procedure is a simple non-invasive renal (kidney) ultrasound (RUS) used to determine the size and shape of the kidney. The Children's Hospital of Boston writes this is important to "detect a mass, kidney stone, cyst, or other obstruction or abnormalities."

The third procedure is called an Intravenous Polygram (IVP) and the final called a renal scan (MAG 3 with lasix), and both are according to the Children's Hospital in Boston "particularly helpful in identifying and assessing the degree of blockage."

Treatment

Depending on the severity of your child's hydronephrosis, your pediatric-urologist may opt to only watch over it with yearly ultrasounds to see how it progresses as mild to moderate cases have been known to correct themselves. For the first few months of your child's life, antibiotics will undoubtedly be prescribed to avoid any infections.

As in the case of my daughter and the severity of her hydronephrosis and reflux, she had to have a temporary nephrosomy tube placed in the blocked kidney to drain out the urine into her diaper until surgery could occur. When she was fifteen months old, she was admitted into the hospital for a week-your child's stay may be shorter or longer depending on any complications or lack thereof. The doctors removed her nephrosomy tube and the upper pole of her blocked kidney. They continue to monitor a cyst on that kidney today through yearly ultrasounds. VCUGs have unfortunately been required as well periodically. We hope to be finished in a year.

Financial Concerns

We were very young parents when our daughter was born, and to be honest finances were at the back of our minds. But with hospital stays and procedures and antibiotics and maintenance, we needed help. Ask your hospital social service worker or see your county human services health division if there is a program in your state like California Childrens Services. This program works with your health insurance (or lack thereof) and takes care of the bills that come flooding in and you don't have to pay a dime for anything related to your child's hydronephrosis.