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HYDRONEPHROSIS with ?PUJ OBSTRUCTION in infant. Reason.

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Infant 8 months old is diagnosed with moderate right hydro nephrosis? PUJ obstruction.Attached here the report , kindly review and detailed reply that what needs to be done. Is the situation very serious?

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 21 Doctors Online

Dear parent,
Thank you for your query at DoctorSpring.com
I can understand your concerns. Your child has right hydronephrosis, which means that there is an obstruction in the urinary tract. This is producing accumulation of urine and back pressure. This compresses a part of the kidney and dilates the pelvis portion of the kidney.
Firstly, though there is a problem, there is no reason to get unduly perturbed about it. This is treatable by surgery.
Before we discuss the treatment any further, we need to assess the functioning of kidneys. This is to see if this obstruction and back pressure has obscured the kidney function. This is done using an INTRAVENOUS PYELOGRAM and EC scan or DTPA scan.
After these tests are done, the surgeon would decide if a surgical relief of the obstruction is required. Kindly contact a pediatric surgeon or pediatric nephrologists near you for further guidance.
Wishing your child a speedy recovery.
Regards
Dr. Saptharishi


Patient replied :

Please find here the latest scan report. Kindly review it and give your valuable suggestions.


Dear parent,

Thank you for getting the above investigation done promptly on my advice. This has definitely helped quantify and qualify the disease better. This test also helps confirm the underlying diagnosis.
In Aryan's case, the EC scan confirms the presence of right hydronephrosis. The degree of obstruction is significant as there is definite delay in clearance of the isotope. The good news from the scan is that the renal functions are preserved. This means that the compression effect that I described in my last e mail has not yet taken shape in this child. In short, there are no anticipated long term complications to the kidneys in your child. Functionally, your son's kidneys are healthy and normal as of now.
Having understood all this, there are two paths in front of us..
1. Conservative or observation approach
2. Corrective approach or pyeloplasty
The observation approach allows the physician to avoid risks associated with surgery and anesthesia, but there is a definite percentage of children who sustain irreversible renal damage that could have been prevented by early pyeloplasty. Furthermore, the pyeloplasty in infants is associated with little perioperative morbidity. First, prophylactic antibiotic therapy is warranted for Aryan because any urinary tract infection (UTI) dramatically increases the chance of fibrosis and parenchymal damage.
I usually recommend the following indications for surgical interventions:
1. Ipsilateral UPJ obstruction with less than 40% of differential renal function on diuretic renograms
2.Obstructive pattern on diuretic renograms with abdominal mass, urosepsis, or other symptoms (eg, cyclic flank pain, vomiting)
3. Recurrent UTI under antibiotic prophylaxis
Aryan does not meet any of these three criteria at present. He has a differential renal function better than 40% and can be monitored with repeat renal scans at 3- to 6-month and 12-month intervals, and surgery is performed only if a clear deterioration in renal function is present.
Having explained all this in detail, my final advice is to go back to your pediatric surgeon and share these recommendations. See what he or she wants to do.
All the best. Hope my suggestions were helpful to you and your family.
Regards
Dr. Saptharishi L G


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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