Hydronephrosis of my baby

rUSGEC scan-1EC scan-2MCUG

My boy is 21 months old. He was diagnosed as having mild hydronephrosis of left kidney at his mother’s womb. The doctor said it would be resolved automatically after his birth. We waited til his birth. Then we did ultrasonography two times but the problem persisted and not resolved. We did not observe any abnormality while urinating in the mean time. He never had urinary tract infection(UTI). His birth weight was 2.6 kg and now he is 12 kg. Last April when he was 19 months old we visited Calcutta. We consulted  Dr. Rajiv sinha (Peadiatric nephrologist). We said him in detail and he asked to perform a series of investigation to understand his condition. First of all an USG of KUB and urine culture and sensitivity(C/S) test. The USG  reported hydronephrosis of left kidney with Pelvis diameter 18 mm. The doctor said 18 mm is significant and so he need further evaluation. His Urine C/S showed no infection. The third test was micturating cystourethrogram MCUG and the report was-

1. No vesico-ureteric reflux noted

2. Significant post void residue

The doctor said it was not a problem and he asked for renal EC scan. The report was-

1. Split function 49.88(left) and 50.12(Right) kidney.

2. Normal global renal function

3.Normally functioning non obstructed Left kidney with functional stasis at pelvis.

4. Normally functioning non obstructed Right kidney.

Taking all the reports in consideration the doctor said that my child is ok and he does not require further treatment right now. He instructed to do USG and URINE C/S after 4 months.

Now 1.5 months passed. My baby suddenly cried while urinating at yesterday morning. We became worried and have collected sample for analysis. This afternoon i noticed his body temperature was 99 degree Fahrenheit. We have given him a dose of Paracetamol(Napa). We have consulted here with Dr. Jhulan Das Sharma (Ex. Head of Dept of Paediatrics, CMC) at chittagong. He suggested to start antibiotic Cefixime DS. Just now we have received his URINE R/M/E report where pus cell was 40-50 HPF, which means significant amount of infection (UTI). Please note that he has constipation since last one month and stools was very hard. Is it the cause of his current UTI or else?

Please help me to find out future course of action. I am feeling very nervous right now.

Regards

Dr. Happy Biswas

BCS Health(33rd BCS)

Author Info

APOLLO BISWAS

Comment ( 1 )

  • Dr. M. M. Haque

    You are exactly on the right track, so nothing to be worried. At this stage i can add something which may help you deciding your action plan-
    1. As your child had clinical symptoms plus pus cell in urine, antibiotic is a must at this moment and hopefully you have started it according to the consultation of Prof. Jhulan
    2. If culture shows any growth then you must repeat the culture after completing the course of antibiotic to see whether it is still positive or not
    3. For hydronephrosis, periodic follow up by USG and urine test is required, perfectly said by Dr. Rajiv
    4. Regular follow up by paediatric nephrologist is very important to evaluate kidney function.
    5. If PUJ obstruction is not relieved spontaneously, kidney anatomy and function deteriorate, then stenting will be the ultimate treatment of choice which is done by urologist. You can have an opinion from them as well.
    5. Constipation is a risk factor for UTI, so you have to treat it now with Syrup Osmolax(Lactulose), fiber containing diet etc. Give such food and drink that make stool soft and prevent future constipation

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