Kidney

HYDRONEPHROSIS URETEROPELVIC(UPJ) URETEROVESICAL(UVJ)

Hydronephrosis is an accumulation of fluid in the kidneys found on ultrasound- this can be found before or after the baby is born. Kidneys filter out the waste found in the blood and make urine. This urine should then drain down the ureter (tube between the kidney and bladder) to the bladder and the patient should then void this out. Sometimes the urine can accumulate in the kidney for different reasons. The fluid/urine in the kidney is not necessarily an indication there is something wrong (and many times can go away on its own with time), but is an abnormality that is important to follow so as not to miss a possible issue such as ureteropelvic junction (UPJ) obstruction and ureterovesical junction (UVJ) obstruction.

UPJ is the connection between the kidney and the ureter.  If there is fluid buildup in the kidney and not the ureter, there is a possibility there is scarring in this area causing the urine to back up as it cannot drain as easily.  This scenario is like a kink in a hose, if all of the water cannot pass by the kink, it will start to back up behind the kink,  it will start to back up behind the kink.  This can lead to back pressure on the kidney that can damage kidney function or cause stagnant urine in the kidney which can predispose the patient to serious urinary tract infection with fever.  

If the amount of fluid in the kidney continues to increase over time on ultrasound we may need to perform a nuclear test that will better delineate whether there is an obstruction.  Should an obstruction be found, surgical correction may be needed.  This surgery is called a pyeloplasty and is done under general anesthesia.  The scarred part of the ureter/kidney is cut out and the ureter is reattached to the kidney so everything drains well as it should.  Patients normally spend at least one night in the hospital after this surgery and are then discharged home.

This is similar to a UPJ obstruction, only in a different location. The UVJ is the connection between the ureter and the bladder. If fluid is found both in the kidney and ureter, and continues to increase, the patient may have a scarring where the ureter meets the bladder. This can once again cause back up of fluid/urine, back pressure on the kidney, and stagnant urine predisposing the patient to a serious UTI with fever. Should an obstruction be found surgical correction may be needed. This surgery is called a ureteral re-implant and is done under general anesthesia. The scarred part of the ureter that is connected to the bladder is cut out and then reattached to the bladder is cut out and then reattached to the bladder so everything drains as it should. Patients normally spend at least one night in the hospital after this surgery and are then discharged home.