Hydronephrosis Referral Guidelines

• Fetal: Hydronephrosis can be detected during a routine prenatal ultrasound in the second trimester. Fetal hydronephrosis should be referred to our Prenatal Pediatrics Institute for a high-resolution (level II) ultrasound and MRI scans to evaluate your baby’s condition.
  
  • The Prenatal Pediatrics Institute at Children’s National may recommend further testing after the baby is born. Testing may include:
  • X-ray of the bladder to check for vesicoureteral reflux
  • Diagnostic imaging of the kidneys to assess function and proper urine drainage
• Newborns: Newborns and infants with hydronephrosis usually show few or no symptoms at all. Older children have moderate to severe cases may experience:
  
  • Ideally, the first postnatal sonogram should not be performed until after the 1st week of life.
  • Reasons to perform a sonogram immediately at the time of birth include:
  • Bilateral hydronephrosis or unilateral hydronephrosis with distended bladder in a male
  • Bilateral hydronephrosis and bladder abnormalities in a female
  • Any hydronephrosis and oligohydramnios in fetus of either sex
  • Prenatal renal abnormality and no void > 24 hours
• Children: Older children are more likely than infants to have symptoms which include:
  
  • Urinary tract infection, characterized by persistent feeling of needing to urinate, cloudy or bloody urine, fever, pain in the lower abdomen with urination
  • Back or flank pain with nausea and vomiting

• Mild unilateral hydronephrosis/pyelectasis (SFU Grade 1 or 2)
  
  • If initially seen on DOL 1-5, repeat sonogram in 3 months:
    
    • If improved, no further studies
    • If stable, repeat in 6-9 months
    • If worsened, refer to pediatric urologist
• If initially seen on sonogram after DOL 1-5:
  
  • Repeat in 6-9 months
  • If stable, no further studies
  • If worsened, refer to pediatric urologist
• If associated with duplication of collecting system or bilateral
  
  • Refer to pediatric urologist
  • Start antibiotic prophylaxis with amoxicillin 25 mg/kg/day until further evaluation is completed, provide enough refills as evaluation may take up to 6 weeks to complete
• Moderate or several unilateral hydronephrosis (SFU Grade 3 or 4)
  
  • Refer to pediatric urologist
  • Start antibiotic prophylaxis with amoxicillin 25 mg/kg/day until further evaluation is completed, provide enough refills as evaluation may take up to 6 weeks to complete

The physician referral line is 202-476-2670.

• The parents should bring the following to their appointment:
  
  • Prenatal and postnatal imaging, films, or CD (postnatal sonogram at 2-3 weeks of age)
  • Prenatal and postnatal sonogram films or CD, lab work