Understanding Prenatal Hydronephrosis

Reviewed by James Brann, MD
Prenatal is what’s going on during your pregnancy while your child is still in your womb. Prenatal hydronephrosis involves either one or both of your child’s kidneys. Your kidneys make urine and each kidney is made up of two parts. The first part filters your blood, removing waste as well as excess salt and water. The second part collects urine.
With hydronephrosis, the part of your kidney that’s collecting urine has too much of it. This leads to swelling and your kidney becomes larger than it’s supposed to.

Some babies will only have hydronephrosis for a short amount of time before it goes away. This isn’t serious, and won’t cause long-term problems.
If hydronephrosis doesn’t go away, though, it could mean a serious problem with the urinary tracts. There could by a urinary tract block, or the urine could be flowing the wrong direction from the bladder into the kidney.

How to know if baby has prenatal hydronephrosis

Doctors can figure out if a baby has prenatal hydronephrosis during an ultrasound. This routine imaging test is used to look at a baby during your pregnancy. The ultrasound takes pictures of your baby inside the uterus. Prenatal hydronephrosis won’t cause any symptoms.

More testing

If your baby does have hydronephrosis, you doctor will check to see if it goes away, or if it worsens. You’ll likely have at least one additional ultrasound to follow-up during the length of your pregnancy.
During the ultrasound, your doctor will be checking to see if either one or both of your kidneys have hydronephrosis. They’ll also want to know how severe the condition is and will check the amniotic fluid. This is the uterus fluid, which surrounds your baby. It’s made of the baby’s urine. If the kidneys aren’t making enough urine, the amniotic fluid will be low.

If the follow-up shows hydronephrosis went away, you likely won’t need future tests.

If the follow-up shows hydronephrosis hasn’t gone away or it’s worse, you’ll likely need additional testing. This may mean more ultrasounds or more tests to look for other conditions.

Treating hydronephrosis

As for treating hydronephrosis, doctors don’t usually treat it during pregnancy, but they’ll follow it with testing.

After your child is born, the treatment will depend on how many kidneys are affected and the severity of it before birth.

If hydronephrosis already went away before you gave birth, your baby won’t need more testing or treatment after delivery. If it didn’t go away, you child will need more tests after being born. Your baby may also need treatment.
If the condition was mild or only involved one kidney, your child will need an ultrasound after about one week of age. They may also need more tests depending on the results. You child’s doctor may also want to prescribe an antibiotic medicine. This may prevent your child from developing a kidney infection.

If the condition was severe or involved both of your kidneys, your baby will need to have an ultrasound sometime within the first few days after being born. Your baby’s doctor will also most likely prescribe an antibiotic medicine. This can prevent your child from developing a kidney infection. In addition, your child made need more tests to check out the urinary tract.

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