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Urinary and Genital Disorders (Children)

Enlarged kidney in a child

08/31/2010

Question:

My 10 year old was diagnosed with an enlarged kidney and had to have surgery to fix it. They did a dilation as the blood vessel was blocking the ureter and causing a blockage. They left a stent in but had to remove it a week later as it became blocked. It has been three months since the surgery and her pain has increased instead of decreasing and she is still having a lot of problems. She just finished her fourth round of antibiotics as she still has an infection since surgery. The doctors have done numerous tests and have come back to the original diagnosis. It is her kidney, not anything else but her kidney is functioning better than it was. They can`t understand why she is still in so much pain. The surgery should have fixed it. I was wondering if you have any suggestions as we are all stumped.

Answer:

This is a difficult question to answer without seeing the radiologic studies and reading what was done during the surgical procedure to correct the obstruction. It sounds like there was a blockage between the ureter and renal pelvis (where urine collects in the kidney), termed a ureteropelvic junction obstruction. At times a large artery going to the lower pole of the kidney also adds to the obstruction.

The treatment is to remove the blocked segment and reattach the healthy part of the ureter to the renal pelvis. Often a stent or plastic tube is left betweent the kidney and bladder for a few weeks to aid in healing. The success rate is 90% to 95%. If she is still experiencing pain, that is a sign that there is a recurrent blockage. Sometimes placement of a temporary percutaneous nephrostomy tube (small tube going into the kidney through the side) to drain the kidney is helpful, because if draining the kidney relieves the pain, then that confirms that there probably is a persistent blockage. In addition, an x-ray study of the kidney drainage can be performed. If another surgical procedure is necessary, often it can be done with laparoscopy.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University