Kidney Conditions

An operation to remove the faulty junction (pelviureteric) to allow easy flow of urine from the kidney to the bladder.

This is a mechanical blockage and does not rectify spontaneously. If this blockage is allowed to remain it can have detrimental effects on the functioning of your child’s kidney due to the backpressure generated.

Your child will need to be given a general anaesthetic for the operation. A paediatric anaesthetist who has experience in anaesthetising children will explain what is involved. You may wish to discuss your queries further with them.

See steps below:

1. Hydro

2. Exposure and incision

3. Pathologies incl crossing vessels

4. Extent of excision

5. Anastomosis and transanastomotic stent

You can take your child home after 2 nights if all is well. 48 hours after the operation the stent is knotted prior to discharge home. Then you bring your child back after 7 days to remove the stent on the ward and take him back home the same day after he passes urine a couple of times.

Assessment of success of pyeloplasty is done by a renal tract ultrasound and an isotope scan (Mag3).

You will receive a follow up outpatient appointment after 4 months. At this stage a renal tract ultrasound is done. At further follow up 12 months after the pyeloplasty a renal tract ultrasound and an isotope scan (Mag3 scan) is performed. Your child will be discharged from further follow up if all is well at this follow up.

This is the most common birth defect. Duplex kidney simply means the 2 parts of the kidney haven’t joined together normally. It is seen in 1 4000 pregnancies. It can be seen in both kidneys but this is not very common with 15 to 20% of duplex kidneys involved. It occurs on the left side and is more common in girls.

Majority of the cases are diagnosed or suspected prenatally. Maternal US may show the features of swelling of the tubes and passages carrying urine from the half of the kidney affected. The end of the tube carrying urine from the upper half may be ballooned called an ureterocoele.

Expectant mum will have a follow up ultrasound scans to see how the condition is behaving? If it is getting worse or the ureterocoele is blocking easy passage of urine from bladder to contribute to the volume of amniotic fluid. There is a provision to puncture this balloon specially in cases of a big sized ureterocoele or bilateral ureterocoeles. These interventions are rarely needed and cases are selected very carefully.

In the majority of cases of a complex duplex system meaning dilated/swollen upper moiety the baby will be started on prophylactic antibiotics which is a major benefit of prenatal suspicion and postnatal prevention of UTI. Baby will have a renal tract US by the end of the first week of life, a voiding cystourethrogram (VCUG) with antibiotic cover and a magnetic resonance urography (MRU). These tests provide anatomical Functional imaging those that give the function in the involved kidney as well as separate function in both halves is called isotope scans viz. Mag 3 scan and DMSA. These tests are done once baby is 3 months old as reliability of the test is dependent on the maturity of the kidneys. If done earlier doesn’t give clear and reliable images.

The investigations provide your clinician with important information about the anatomy / structure and function in the 2 halves of the kidneys.

The upper half if poorly functioning can be removed to prevent future problems. This is called heminephrectomy, hemi meaning half of the kidney.

Does baby always need an operation to manage this condition?

No it is dependent on the swelling in that half of the kidney as well as poor function, sometimes an ureterocoele in the bladder at the end of the tube from the upper half may need attention too.

• Baby can be managed by heminephrectomy (removal of affected half with its tube), nephrectomy (whole kidney if it has poor function) or ureterouretrostomy (joining the upper and lower half ureters to each other lower down).
• Operation for the vesicoureteric reflux present in the lower half kidney ureter.
• Cystoscopic injection deflux. Commonly the lower half kidney ureter refluxes with low or high grade reflux. The high grade reflux can allow a larger volume of urine to go backward in the wrong direction to the kidney. By injecting deflux it minimises this refluxing urine and prevents it from reaching the kidney. The success rate of this operation is about 80% and dependent on the severity of reflux this may need a couple of injections.
• A prophylactic circumcision to prevent UTI may be required if your baby is male and gets recurrent UTIs

With prenatal suspicion the postnatal investigations take 3 to 4 months once your clinician has all the information by 4 to 5 months your baby is ready for the operation.

Heminephrectomy:

• Damage to the remaining lower half of kidney due to blood supply affected 5%
• Damage to the ureter of the remaining kidney 1 - 2%
• Urine leak collected at the top of lower half of kidney seen on US after the operation 5 – 10%. This usually resolves with time if it gets infected it will require external drainage of this urine collection done by interventional paediatric radiologist without an open operation.
• Bleeding requiring blood transfusion if baby’s haemoglobin drops 2 - 5%
• Ureteric stump related problems like UTI 6 – 8%

Nephrectomy:

• Infection
• Bleeding
• Ureteric stump related problems like UTI 6 - 8%