Hydronephrosis medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hydronephrosis}}
{{Hydronephrosis}}
* {{CMG}}; {{AE}}{{Vbe}}
{{CMG}}; {{AE}}{{Vbe}}


==Overview ==
==Overview ==
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==Medical Therapy==
==Medical Therapy==
* Mild-moderate [[hydronephrosis]]: [[Hydronephrosis]] could resolve spontaneously. However, antibiotic [[prophylaxis]] is recommended to lower the risk of [[urinary tract infection]].<ref name="pmid30025399">{{cite journal |vauthors=Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A |title=Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones |journal=Urol. Int. |volume= |issue= |pages=1–6 |date=July 2018 |pmid=30025399 |doi=10.1159/000490623 |url=}}</ref>
* Mild-moderate [[hydronephrosis]] could resolve spontaneously. However, antibiotic [[prophylaxis]] is recommended to lower the risk of [[urinary tract infection]].<ref name="pmid30025399">{{cite journal |vauthors=Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A |title=Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones |journal=Urol. Int. |volume= |issue= |pages=1–6 |date=July 2018 |pmid=30025399 |doi=10.1159/000490623 |url=}}</ref><ref name="pmid18947735">{{cite journal |vauthors=Onen A |title=An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis |journal=J Pediatr Urol |volume=3 |issue=3 |pages=200–5 |date=June 2007 |pmid=18947735 |doi=10.1016/j.jpurol.2006.08.002 |url=}}</ref><ref name="pmid12187248">{{cite journal |vauthors=Onen A, Jayanthi VR, Koff SA |title=Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively |journal=J. Urol. |volume=168 |issue=3 |pages=1118–20 |date=September 2002 |pmid=12187248 |doi=10.1097/01.ju.0000024449.19337.8d |url=}}</ref><ref name="pmid76278472">{{cite journal |vauthors=Nonomura K, Yamashita T, Kanagawa K, Itoh K, Koyanagi T |title=Management and outcome of antenatally diagnosed hydronephrosis |journal=Int. J. Urol. |volume=1 |issue=2 |pages=121–8 |date=June 1994 |pmid=7627847 |doi= |url=}}</ref>


* In Order to reduce the risk of permanent kidney injury, the blockage of urine may need to be drained if [[hydronephrosis]] is severe enough.
* In order to reduce the risk of permanent kidney injury, the blockage of urine may need to be drained if [[hydronephrosis]] is severe enough.<ref name="pmid7924663">{{cite journal |vauthors=Li F, Zhang MZ, Liu TC |title=[Diagnosis and treatment of hydronephrosis: report of 100 cases] |language=Chinese |journal=Zhonghua Wai Ke Za Zhi |volume=32 |issue=2 |pages=114–6 |date=February 1994 |pmid=7924663 |doi= |url=}}</ref>
* The drainage can be done with [[nephrostomy]] tube into the kidney.
* It is recommended to give pain medications and [[Antibiotic|antibiotics]] to be patient before initiating the surgical intervention.  
* Consider giving pain medications and [[Antibiotic|antibiotics]] to be patient before initiating the treatment.  
'''Mild to moderate hydronephrosis in adults'''
'''Mild to moderate hydronephrosis'''
* Observation is preferred method for the treatment of mild to moderate [[hydronephrosis]].<ref name="pmid16427220">{{cite journal |vauthors=Belarmino JM, Kogan BA |title=Management of neonatal hydronephrosis |journal=Early Hum. Dev. |volume=82 |issue=1 |pages=9–14 |date=January 2006 |pmid=16427220 |doi=10.1016/j.earlhumdev.2005.11.004 |url=}}</ref>
* Follow wait-and-see approach for the treatment of mild to moderate [[hydronephrosis]].
* [[Antibiotic|Antibiotics]] are recommended in case cultures turn positive for infection.<ref name="pmid18947797">{{cite journal |vauthors=Onen A |title=Treatment and outcome of prenatally detected newborn hydronephrosis |journal=J Pediatr Urol |volume=3 |issue=6 |pages=469–76 |date=December 2007 |pmid=18947797 |doi=10.1016/j.jpurol.2007.05.002 |url=}}</ref><ref name="pmid11956470">{{cite journal |vauthors=Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S |title=Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty |journal=J. Urol. |volume=167 |issue=5 |pages=2159–63 |date=May 2002 |pmid=11956470 |doi= |url=}}</ref>
* Consider treating the patient with [[Antibiotic|antibiotics]] to prevent [[Infection|infections]].
'''Severe hydronephrosis'''
'''Severe hydronephrosis'''
* Surgery may be the treatment of choice to eliminate the severity of the blockage or even correct the reflux.
* Surgery may be the treatment of choice to eliminate the severity of the blockage or even correct the reflux.


==== Bilateral hydronephrosis ====
==== Bilateral hydronephrosis ====
* Infants with severe [[bilateral]] [[antenatal]] [[hydronephrosis]] evaluated initially by using [[ultrasonography]].
* Infants with severe [[bilateral]] [[antenatal]] [[hydronephrosis]] evaluated initially by using [[ultrasonography]].<ref name="pmid9297403">{{cite journal |vauthors=Armadá Maresca M, Rivilla Parra F, Viña Simón E, García Casillas J |title=[Diagnosis and treatment of neonatal hydronephrosis. Influence of prenatal diagnosis] |language=Spanish; Castilian |journal=An. Esp. Pediatr. |volume=46 |issue=5 |pages=483–6 |date=May 1997 |pmid=9297403 |doi= |url=}}</ref>
* Infants with severe [[bilateral]] [[hydronephrosis]] raise the concern of obstruction like
* [[bilateral]] [[hydronephrosis]] raise the concern of obstruction such as:<ref name="pmid9773587">{{cite journal |vauthors=González R, Schimke CM |title=[The prenatal diagnosis of hydronephrosis, when and why to operate?] |language=Spanish; Castilian |journal=Arch. Esp. Urol. |volume=51 |issue=6 |pages=575–9 |date=1998 |pmid=9773587 |doi= |url=}}</ref>
** [[Ureterocele]]  
** [[Ureterocele]]  
** [[Posterior urethral valves|Posterior urethral valve]]<nowiki/>s (PUV) defect  
** [[Posterior urethral valves|Posterior urethral valve]]<nowiki/>s (PUV) defect  
* Voiding cystourethrography (VCUG) should be performed if hydronephrosis is positive on USG.
* [[Voiding cystourethrogram|Voiding]] cystourethrograp<nowiki/>hy (VCUG) should be performed if [[hydronephrosis]] is positive on USG.<ref name="pmid16377104">{{cite journal |vauthors=Becker A, Baum M |title=Obstructive uropathy |journal=Early Hum. Dev. |volume=82 |issue=1 |pages=15–22 |date=January 2006 |pmid=16377104 |doi=10.1016/j.earlhumdev.2005.11.002 |url=}}</ref><ref name="pmid18520762">{{cite journal |vauthors=Estrada CR |title=Prenatal hydronephrosis: early evaluation |journal=Curr Opin Urol |volume=18 |issue=4 |pages=401–3 |date=July 2008 |pmid=18520762 |doi=10.1097/MOU.0b013e328302edfe |url=}}</ref>


===Disease Name===
==== Severe unilateral hydronephrosis in infants ====
* If renal [[Pelvis|pelvic]] diameter is more than 15 mm in diameter in the [[third trimester]] the it is considered as severe unilateral [[hydronephrosis]].
* And should be followed with USG once the [[neonate]] returns to the normal [[birth weight]].


* '''1 Stage 1 - Name of stage'''
==== Moderate and mild unilateral hydronephrosis in infants ====
** 1.1 '''Specific Organ system involved 1'''
* If renal [[pelvic]] length is less than 15mm during the [[Pregnancy|third trimester]] then it is considered as a moderate and mild unilateral [[hydronephrosis]].
*** 1.1.1 '''Adult'''
* In the patients follow up with [[ultrasound]] after 7 days on birth to access whether the [[hydronephrosis]] has persisted or not in [[neonatal]] period.
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
* By age 18 months moderate [[hydronephrosis]] resolves on its own.
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
==== Antibiotic prophylaxis ====
** 2.1 '''Specific Organ system involved 1 '''
* In [[Prenatal|prenatally]] diagnosed [[hydronephrosis]] patients a very higher chances of [[urinary tract infections]]([[Urinary tract infection|UTI]]) have been reported.<ref name="pmid7627847">{{cite journal |vauthors=Nonomura K, Yamashita T, Kanagawa K, Itoh K, Koyanagi T |title=Management and outcome of antenatally diagnosed hydronephrosis |journal=Int. J. Urol. |volume=1 |issue=2 |pages=121–8 |date=June 1994 |pmid=7627847 |doi= |url=}}</ref>
**: '''Note (1):'''
* Urinary tract infections([[UTI]]) in prenatal babies raise the suspicion of underlying [[renal]] abnormality.
**: '''Note (2)''':
* So in these patients [[antibiotic]] [[prophylaxis]] is started as soon as possible after the delivery until exclude the diagnosis with either VUR or obstructive [[uropathy]] .<ref name="pmid163771042">{{cite journal |vauthors=Becker A, Baum M |title=Obstructive uropathy |journal=Early Hum. Dev. |volume=82 |issue=1 |pages=15–22 |date=January 2006 |pmid=16377104 |doi=10.1016/j.earlhumdev.2005.11.002 |url=}}</ref>
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2 '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 18:28, 12 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

The goal of treatment for hydronephrosis is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.The initial care for the patient is aimed at minimizing pain and preventing urinary tract infections. Otherwise, surgical intervention may be required.

Medical Therapy

  • In order to reduce the risk of permanent kidney injury, the blockage of urine may need to be drained if hydronephrosis is severe enough.[5]
  • It is recommended to give pain medications and antibiotics to be patient before initiating the surgical intervention.

Mild to moderate hydronephrosis in adults

Severe hydronephrosis

  • Surgery may be the treatment of choice to eliminate the severity of the blockage or even correct the reflux.

Bilateral hydronephrosis

Severe unilateral hydronephrosis in infants

Moderate and mild unilateral hydronephrosis in infants

Antibiotic prophylaxis

References

  1. ↑ Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A (July 2018). "Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones". Urol. Int.: 1–6. doi:10.1159/000490623. PMID 30025399.
  2. ↑ Onen A (June 2007). "An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis". J Pediatr Urol. 3 (3): 200–5. doi:10.1016/j.jpurol.2006.08.002. PMID 18947735.
  3. ↑ Onen A, Jayanthi VR, Koff SA (September 2002). "Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively". J. Urol. 168 (3): 1118–20. doi:10.1097/01.ju.0000024449.19337.8d. PMID 12187248.
  4. ↑ Nonomura K, Yamashita T, Kanagawa K, Itoh K, Koyanagi T (June 1994). "Management and outcome of antenatally diagnosed hydronephrosis". Int. J. Urol. 1 (2): 121–8. PMID 7627847.
  5. ↑ Li F, Zhang MZ, Liu TC (February 1994). "[Diagnosis and treatment of hydronephrosis: report of 100 cases]". Zhonghua Wai Ke Za Zhi (in Chinese). 32 (2): 114–6. PMID 7924663.
  6. ↑ Belarmino JM, Kogan BA (January 2006). "Management of neonatal hydronephrosis". Early Hum. Dev. 82 (1): 9–14. doi:10.1016/j.earlhumdev.2005.11.004. PMID 16427220.
  7. ↑ Onen A (December 2007). "Treatment and outcome of prenatally detected newborn hydronephrosis". J Pediatr Urol. 3 (6): 469–76. doi:10.1016/j.jpurol.2007.05.002. PMID 18947797.
  8. ↑ Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S (May 2002). "Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty". J. Urol. 167 (5): 2159–63. PMID 11956470.
  9. ↑ Armadá Maresca M, Rivilla Parra F, Viña Simón E, García Casillas J (May 1997). "[Diagnosis and treatment of neonatal hydronephrosis. Influence of prenatal diagnosis]". An. Esp. Pediatr. (in Spanish; Castilian). 46 (5): 483–6. PMID 9297403.
  10. ↑ González R, Schimke CM (1998). "[The prenatal diagnosis of hydronephrosis, when and why to operate?]". Arch. Esp. Urol. (in Spanish; Castilian). 51 (6): 575–9. PMID 9773587.
  11. ↑ Becker A, Baum M (January 2006). "Obstructive uropathy". Early Hum. Dev. 82 (1): 15–22. doi:10.1016/j.earlhumdev.2005.11.002. PMID 16377104.
  12. ↑ Estrada CR (July 2008). "Prenatal hydronephrosis: early evaluation". Curr Opin Urol. 18 (4): 401–3. doi:10.1097/MOU.0b013e328302edfe. PMID 18520762.
  13. ↑ Nonomura K, Yamashita T, Kanagawa K, Itoh K, Koyanagi T (June 1994). "Management and outcome of antenatally diagnosed hydronephrosis". Int. J. Urol. 1 (2): 121–8. PMID 7627847.
  14. ↑ Becker A, Baum M (January 2006). "Obstructive uropathy". Early Hum. Dev. 82 (1): 15–22. doi:10.1016/j.earlhumdev.2005.11.002. PMID 16377104.

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