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Urinary and Genital Disorders (Children)

Infant Having Bilateral Hydronephrosis

02/09/2010

Question:

During my pregnancy doctor detected bilateral hydronephrosis with posterior urethral valve for our son. He has been diagnosed for posterior urethral valve immediately after birth. Since then he is on antibiotics. Now he is five and half month old very active baby. During recent ultrasound scanning, doctor found that his left kidney has severe hydronephrosis, and right kidney has mild. But the creatine level is good its 0.3. And they have suggested for him to do MCU and DMSA tests. As he is already been diagnosed for posterior urathral valve is it necessary to do all these tests? He is just five and half month old baby. For his condition what treatment we have to give him for the complete cure of his bilateral hydronephrosis? Please help, by giving valuable suggestions.

Answer:

Posterior urethral valves is one of the most serious birth defects of the urinary tract. More than one-third develop kidney failure despite optimal care. Consequently, a thorough investigation is the urinary tract is necessary, particularly if there is significant hydronephrosis. An MCU is performed to see whether there is significant urinary reflux from the bladder into one or both kidneys (approximately 50% have reflux). Reflux predisposes to a kidney infection, which can cause significant kidney damage. In addition, it is important to be certain that the valve leaflets have been destroyed. A DMSA scan is performed to evaluate kidney function (the serum creatinine may be normal), but one kidney may have poor function. These tests are pretty standard in boys with urethral valves.

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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