PEDIATRI

set-15_ped
Information 1
• 32-year-old female G3P2 refened to you for postnatal management of
fetal right sided hydronephrosis found on prenatal ultrasound.

1. Mention another information that you need to complete the

anamnesis
Answer 1 :
• Past Medical History
• Previous surgery History
• Allergies
• Medications
• Review of Symptoms
Information 2
• Prenatal sonography at 18 weeks found mild right hydronephrosis. The left kidney
and bladder were normal. There was no oligohydramnios present. Repeat fetal
sonography at 32 weeks post-conceptual age is normal except for worsening, now
moderate right hydronephrosis
• Past Medical History : None
• Previous surgery History : none
• Family history: mother with history of HN which resolved as infant
• Social Habit: lives with both parents, 2 older brothers
• Allergies : None
• Medications : none
• Review of Symptoms : unremarkable

2. Mention the specific physical examination and Laboratory finding for this case
Answer 2
Vitals
GA
HEENT
Heart
Lungs
Abdom
en
GU

Back
Anus
Ext
Neuro
Information 3
Vitals T 98.4 BP 84/s8 P 160 RR 22
GA no distress, well-developed, well-nourished newborn male
HEENT EOMI, PERRLA
Heart RRR
Lungs CTA B
Abdomen soft, non-distended, RUQ firm mass
GU normal appearing uncircumcised penis; both testes palpably
normal and descended; normal scroturn
Back (-) dimple; (-) hairy patch
Anus normal position
Ext normal pulses; normal tone
Neuro normal
Question 3
A repeat RBUS on day of life 2 shows moderate right hydronephrosis.
There is no ureteral dilation. The left kidney and bladder are normal.

3. What is your differential diagnosis at this point, and what are the
recommended testing ?
Answer 3
• Right hydronephrosis secondary to UPJ obstruction or VUR.
• ectopic ureter (absence ofureteral dilation), ureterocele (absence
ofureteral dilation and cystic structure present in bladder on
ultrasound), or posterior urethral valves (unilateral issue, no ureteral
dilation, and normal appearing bladder)

• VCUG and nuclear renogram.

Question 4
VCUG Results show at 2 weeks old :
• A normal bladder and urethra without evidence of reflux is seen on VCUG

The MAG3 nuclear renogram demonstrates:

• Good split function bilaterally
• Left T Yz of l0 minutes
• Right T Yz calctslated to be 80 minutes

4. Now what is your assessment?

 Answer 4
2-week-old with right UPJ obstruction with normal functioning kidneys.
Question 5 :
5. What is your recommendation?
Answer 5
Surgical intervention with open dismembered pyeloplasty (Anderson-
hynes technique)
Question 6
• Postoperative imaging demonstrates a recurrence of the UPJ
obstruction following pyeloplasty.

6. What do you recommend?

Answer 6
• As long as there is reasonable renal function (>15%) in the affected
kidney, a redo pyeloplasty, spiral or vertical flap procedure, or
ureterocalicostomy.
Question 7

7. What would be indication for nephrectomy?

Answer 7
• Massive hydronephrosis in poorly functioning kidney (<15%)