Hydronephrosis medical therapy: Difference between revisions
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* 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]]: [[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> | ||
* 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. | * The drainage can be done with [[nephrostomy]] tube into the kidney. | ||
* Consider giving pain medications and [[Antibiotic|antibiotics]] to be patient before initiating the treatment. | * Consider giving pain medications and [[Antibiotic|antibiotics]] to be patient before initiating the treatment. | ||
'''Mild to moderate hydronephrosis''' | '''Mild to moderate hydronephrosis in adults''' | ||
* Follow wait-and-see approach for the treatment of mild to moderate [[hydronephrosis]]. | * Follow wait-and-see approach for the treatment of mild to moderate [[hydronephrosis]]. | ||
* Consider treating the patient with [[Antibiotic|antibiotics]] to prevent [[Infection|infections]]. | * Consider treating the patient with [[Antibiotic|antibiotics]] to prevent [[Infection|infections]]. | ||
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* [[Voiding cystourethrogram|Voiding]] cystourethrograp<nowiki/>hy (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. | ||
==== Severe unilateral hydronephrosis ==== | ==== 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]]. | * 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]]. | * And should be followed with USG once the [[neonate]] returns to the normal [[birth weight]]. | ||
==== Moderate and mild unilateral hydronephrosis ==== | ==== Moderate and mild unilateral hydronephrosis in infants ==== | ||
* If renal [[pelvic]] length is less than 15mm during the [[Pregnancy|third trimester]] then it is considered as a moderate and mild unilateral [[hydronephrosis]]. | * If renal [[pelvic]] length is less than 15mm during the [[Pregnancy|third trimester]] then it is considered as a moderate and mild unilateral [[hydronephrosis]]. | ||
* In the patients follow up with [[ultrasound]] after 7 days on birth to access whether the [[hydronephrosis]] has persisted or not in [[neonatal]] period. | * In the patients follow up with [[ultrasound]] after 7 days on birth to access whether the [[hydronephrosis]] has persisted or not in [[neonatal]] period. | ||
Revision as of 17:53, 27 July 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
- Mild-moderate hydronephrosis: Hydronephrosis could resolve spontaneously. However, antibiotic prophylaxis is recommended to lower the risk of urinary tract infection.[1]
- In Order to reduce the risk of permanent kidney injury, the blockage of urine may need to be drained if hydronephrosis is severe enough.[2]
- The drainage can be done with nephrostomy tube into the kidney.
- Consider giving pain medications and antibiotics to be patient before initiating the treatment.
Mild to moderate hydronephrosis in adults
- Follow wait-and-see approach for the treatment of mild to moderate hydronephrosis.
- Consider treating the patient with antibiotics to prevent infections.
Severe hydronephrosis
- Surgery may be the treatment of choice to eliminate the severity of the blockage or even correct the reflux.
Bilateral hydronephrosis
- Infants with severe bilateral antenatal hydronephrosis evaluated initially by using ultrasonography.
- Infants with severe bilateral hydronephrosis raise the concern of obstruction like
- Ureterocele
- Posterior urethral valves (PUV) defect
- Voiding cystourethrography (VCUG) should be performed if hydronephrosis is positive on USG.
Severe unilateral hydronephrosis in infants
- If renal 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.
Moderate and mild unilateral hydronephrosis in infants
- If renal pelvic length is less than 15mm during the third trimester then it is considered as a moderate and mild unilateral hydronephrosis.
- In the patients follow up with ultrasound after 7 days on birth to access whether the hydronephrosis has persisted or not in neonatal period.
- By age 18 months moderate hydronephrosis resolves on its own.
Antibiotic prophylaxis
- In prenatally diagnosed hydronephrosis patients a very higher chances of urinary tract infections(UTI) have been reported.
- Urinary tract infections(UTI) in prenatal babies raise the suspicion of underlying renal abnormality.
- 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 .
References
- ↑ 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.
- ↑ 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.