Hydronephrosis

Question 1

20 week % with GU abnormality

Answer 1

3% of which most will be AN hydronephrosis

Question 2

definition of significant dilatation

AP diameter at which results in impaired renal function

Answer 2

AP > 5mm in 2nd trimester
>7mm in newborn
>50mm of dilatation usually results in impaired renal function

Question 3

unilateral HN management
when to do US
if dilatation less than 10mm
If dilatation 10-15mm
if more than 15mm
if bilateral HN and dilatation >10mm or less than 10mm

Answer 3

• Is there also hydroureter?
• Start antibiotics at birth?
• US at 5-10 days or 1 week when not dry
• If dilatation less than 10mm with no calyceal dilatation then stop abx
• If dilatation 10-15mm then repeat US
• If more than 15mm for MAG3
• If bilateral HN and dilatation >10mm then for MCUG within 3 days
• If <10mm then repeat USS and do MCUG within a few weeks•
If dilatation < 15mm and unilateral with no ureteric dilatation or bladder abnormality, repeat US 3 months and MCUG if urinary tract infection

Question 4

risk of lower pole lose function from heminephrectomy

Answer 4

down side of heminephrectomy is risk of loss of function of lower normal moiety at rate of 5-10%

Question 5

duplex kidney imaging

Answer 5

For ectopic ureters – imaging
First investigation is US, but if upper pole very small or cryptic, can do MRU, can also do methylene blue test, catheter into bladder, blue into bladder, then walk around, see if blue from bladder or clear from ectopic ureter
DMSA know function before surgery
Treatment of choice upper pole moiety heminephrectomy via laparoscopy and child will be dry afterwards
down side of heminephrectomy is risk of loss of function of lower normal moiety at rate of 5-10%
Can do lap ligation of upper pole ureter with ureteric catheter in correct ureter beforehand
Ureteroureterostomy at lower end
More ectopic the ureter, the more abnormal the renal tissue will be due to reciprocal induction

Question 6

surgery for duplex kidney

Answer 6

Can do lap ligation of upper pole ureter with ureteric catheter in correct ureter beforehand

Ureteroureterostomy at lower end

More ectopic the ureter, the more abnormal the renal tissue will be due to reciprocal induction

Question 7

AN HN antenatal history

Answer 7

an scans and information
renal cysts
presence and degree HN
AP diameter
cortical thinning
echogenicity renal parenchyma
dilated ureters
bladder thickwalled, keyhole sign
bladder not seen in extrophy
seeing penis confirm male
posterior urethra may be seen
oligohydraminos

Question 8

indications for MCUG in AN hydronephrosis

Answer 8

bilateral hydronephrosis
hydroureter
abnormal bladder
ureterocele in duplex - any BOO or coexisting reflux

Question 9

abnormal creatinine post natal level

Answer 9

more than 80