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Urinary and Genital Disorders (Children)

Bilateral hydronephrosis

01/12/2007

Question:

My son was jsut diagnosed with bilateral hydronephrosis. We then had several tests done (renal ultrasound and voiding cystogram. They`ve concluded that he has stage II (left side) and stage V (right side) vesicoureteral reflux. The scans from the cystogram show that the kidneys are swollen... the right severly, with no tissue evident. The doctor told us that he will likely lose his right kidney.

Could you give some insight into this. I know he can survive and be healthy with one kidney, but is this likely to be his reality?

Answer:

Ultrasounds are not very good at describing how healthy a kidney is. Very swollen kidneys can still have relatively good function. To determine function, a nuclear medicine scan is needed, a DMSA scan. Regardless, high grade reflux can improve if the child is quite young.

There is controversy as to how to manage high grade reflux with some stating that surgery is always needed and others stating that there is no rush to operate. The main thing is to keep the child free from infections - as it is infection, and not reflux, which can damage kidneys.

The only reason to remove a kidney is if it is causing problems. A refluxing nonfunctional kidney does not necessarily need to be removed. It depends on many factors, such as the age of the child, whether he is having infections, and the grade of the reflux.

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Response by:

Rama   Jayanthi, MD Rama Jayanthi, MD
Clinical Assistant Professor of Urology
College of Medicine
The Ohio State University