Bilateral Hydronephrosis with Grade 3 To 4 Vesicoureteral Reflux

Introduction: Bilateral hydronephrosis is the enlargement of the parts of the kidney that collect urine. Bilateral means both sides. Bilateral hydronephrosis occurs when urine is unable to drain from the kidney into the bladder. Hydronephrosis is not itself a disease. It occurs as a result of a problem that prevents urine from draining out of the kidneys, ureters, and bladder. VUR grade 3 is similar to grade 2 where urine travels up the ureter and enters the part of the kidney where urine is collected before it drains to the ureter (renal pelvis). However, in grade 3 the ureters and renal pelvis appear abnormal in size or shape. Case Presentation: A 3 Years old female child is a known case of bilateral vesicoureteric reflex with bilateral hydroureteronephrosis with the developmental delay with sickle cell anemia came to the hospital for further management. As narrated by mother-child was apparently alright till 6 months of age after the child developed excessive passing of urine and in increased more times. Conclusion: After taking treatment for the bilateral vesicoureteric reflex with bilateral hydroureteronephrosis patient was hemodynamically stable hence the patient is being discharged.

Palliative radiation treatment used for multiple purposes in a single irradiation field

In this case report, radiation therapy was performed for bilateral hydronephrosis developed during multiple bone metastases of breast cancer and ileus due to peritoneal dissemination. The patient’s preirradiation creatinine level was 8.2 mg/dL, which decreased by the fourth day after starting irradiation therapy. Creatinine level ultimately decreased to 0.6 mg/dL. Pain due to lumbar spine metastasis alleviated and ileus was resolved, allowing the patient to live at home for approximately 5 weeks. The effect of radiotherapy for bilateral hydronephrosis and gastrointestinal obstruction was rapid and good. Palliative radiation treatment can be used for multiple purposes, and in the present patient, we were able to prolong the vital prognosis.

Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis

To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.

Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy

Objective: Improvement of renal function in obstructive uropathy is a main goal of urinary diversion. In cases of failed internal diversion, percutaneous nephros-tomy (PCN) is used to divert urine from the obstructed kidney. PCN also affect on quality of life, particularly having both sides. The objective of this study was to identify a predicting factor associated with improvement of renal function after bilateral PCNs and to avoid performing bilateral PCNs. Materials and Methods: Data of all patients with bilateral hydronephrosis asso-ciated with malignancy who were performed bilateral PCNs in Siriraj Hospital between December 2011 and December 2016 were reviewed and collected. Success with PCN was defined as a serum creatinine less than 2 mg/dl or decreased more than 95% of initial serum creatinine. Results: A total of 240 patients met the criteria. Mean age was 64.6 ± 14.9 years old. Most common organ of malignancy was cervix. Mean initial serum creatinine (iCr) and nadir serum creatinine (nCr) were 7.7 and 1.9 mg/dl, respectively. On multivariate analysis, no significant predicting factors were demonstrated but only iCr tended to have a statistically significant (p = 0.058). From receiver operating characteristics analysis, at cut-off value of iCr 5 mg/dl could demonstrate signifi-cant difference between success and failure (p = 0.027). Sensitivity and specificity were 72.4% and 44.0%, respectively. Conclusion: Only the iCr was more likely to be a predicting factor. At cut-off value of iCr 5 mg/dl, if a patient presented with iCr more than 5 mg/dl and unilateral PCN at dominant side did not improve serum creatinine, performing contralateral PCN might not help.

Acute Kidney Injury as Presenting Symptom of Primary Lymphoma of the Uterus: Uncommon Presentation of a Rare Disease

Background: Primary uterine lymphoma is a rare disease, with diffuse large B cell lymphoma being the most common subtype. There are a limited number of reports, series, and reviews in the literature on this disease and its variable clinical presentations. Further data is needed to prevent delay in diagnosis and treatment.Case: We present the case of a 73-year-old with acute kidney injury secondary to severe bilateral hydronephrosis in setting of an enlarged uterus, confirmed to be primary uterine diffuse large B cell lymphoma.Conclusion: Acute kidney injury secondary to severe bilateral hydronephrosis is an uncommon clinical presentation of primary uterine lymphoma. This case highlights the importance of heightened awareness of such rare presentations so not to delay diagnosis and treatment of this disease, and emphasizes benefit of surgical resection in the diagnosis and treatment of this disease.

Dolichocolon Presenting with Bilateral Hydronephrosis in a Neonate

Background. Dolichocolon is an inborn anatomic variant of the colon with redundancies often causing constipation and/or volvulus presenting in childhood, adolescence, or adulthood. To the best of our knowledge, this is the first case of dolichocolon presenting in infancy with constipation and bilateral hydronephrosis. Case Presentation. A nineteen-day-old neonate presented to the emergency department with severe constipation and discomfort. During his admission, he developed pyelonephritis, and subsequent ultrasound of the kidneys and bladder showed bilateral hydroureteronephrosis. A barium enema was performed and it showed a dolichocolon. Enemas and lactulose were initiated with good effect on both the constipation as well as the hydronephrosis. Conclusions. Dolichocolon in a neonate can cause severe constipation which could also lead to an obstructive nephropathy if untreated. Monitoring of urine flow might be indicated when a neonate presents with severe constipation.

Extraperitoneal laparoscopic repair of huge inguinoscrotal bladder hernia: a case report and literature review

Inguinal herniation of urinary bladder is a rare condition which might associated with significant complication. Exact pre-operative diagnosis is extremely important. We reported a case of huge inguinoscrotal bladder hernia, associated with bilateral hydronephrosis and kidney injuries, managed by laparoscopy technique.

Non-surgical management of vesicoureteral junction obstruction: a case report

Objective: To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly. Case Description: A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development. Comments: VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.