From the Guidelines
Hydronephrosis, also known as Plumber's disease, is a condition where the kidney swells due to the accumulation of urine, and its management involves preserving renal function through either a nonsurgical approach, including watchful waiting, intermittent antibiotic prophylaxis, or surgical approaches like endoscopic injection of bulking agents or ureteral reimplantation. The pathophysiology of hydronephrosis is closely related to vesicoureteral reflux (VUR), where genetic analyses have revealed monogenic causes and significant differentiation of innate immunity and epithelial function genes in children with VUR/febrile UTIs 1.
Diagnostic Evaluation
The diagnostic work-up for hydronephrosis should evaluate the overall health and development of the child, including height and weight, blood pressure, febrile UTI, renal status, VUR, and bladder and bowel function. Ultrasound (US) of the kidney and bladder is the first postnatal standard evaluation tool, and Voiding Cystourethrogram (VCUG) is recommended in patients with US findings of bilateral high-grade hydronephrosis, duplex kidneys with hydronephrosis of the lower pole and breakthrough febrile UTIs, a solitary kidney with hydronephrosis, ureteric dilatation, or abnormal bladders and a history of febrile UTIs 1.
Disease Management
The main management goal is preservation of renal function, and there are two main treatment approaches: nonsurgical and surgical. The nonsurgical approach includes watchful waiting, intermittent antibiotic prophylaxis or Continuous Antibiotic Prophylaxis (CAP), and bladder and bowel dysfunction (BBD) rehabilitation in those with lower urinary tract dysfunction (LUTD) 1.
- Key considerations in management include:
- Regular follow-up with imaging and monitoring of height and weight, blood pressure, and possibly serum creatinine to monitor spontaneous resolution of VUR and evaluate kidney status.
- CAP may not be needed in every VUR patient and generally consists of daily antibiotics given at a quarter to half of the regular therapeutic dose.
- A practical approach is to use CAP until BBD resolution, with initial medical management considered for a child with a febrile UTI and high-grade VUR, reserving surgical options.
- Surgical approaches can involve endoscopic injection of bulking agents or ureteral reimplantation (open vs minimally invasive) for cases where nonsurgical management is not effective or appropriate.
From the Research
Pathophysiology of Hydronephrosis
There are no research papers provided to assist in answering this question about the pathophysiology of Hydronephrosis.
Management of Hydronephrosis
There are no research papers provided to assist in answering this question about the management of Hydronephrosis.
Related Information on Leptospirosis
- The provided studies focus on leptospirosis, a different condition, and discuss its management and treatment options, including the use of antibiotics such as doxycycline and penicillin 2, 3, 4, 5, 6.
- Leptospirosis is a bacterial infection caused by the pathogen Leptospira, and its management needs to be refined 4.
- The disease is primarily transmitted through contact with animals or through exposure to contaminated water or soil 3.
- Treatment options for leptospirosis include antimicrobial therapy, such as doxycycline and ceftriaxone, as well as supportive therapy to manage symptoms 3, 6.
- Chemoprophylaxis regimens, such as weekly doses of doxycycline, have been assessed, but their effectiveness is still unclear 4, 5.