Hydronephrosis Referral Guidelines

• Fetal: Hydronephrosis can be detected during a routine prenatal ultrasound in the second trimester. You may be referred to our Fetal Medicine Institute for a high-resolution (level II) ultrasound and MRI scans to evaluation your baby’s condition.
• The Fetal Medicine 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 who have moderate to severe cases may experience:
• Pain in the side or abdomen
• Intermittent nausea and vomiting, particularly in the afternoons and early evenings, which spontaneously improve by the next morning and which is not also associated with fever
• Blood in the urine

• Children: Older children may be more likely to get urinary tract infections (UTI), in which symptoms include:
• Persistent feeling of needing to urinate
• Pain in the lower abdomen during urination
• Cloudy or bloody urine
• Back or side pain
• Fever
• 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, recommend starting antibiotic prophylaxis with amoxicillin 25 mg/kg/dy until further evaluation is completed

• Moderate or several unilateral hydronephrosis (SFU Grade 3 or 4)
• Refer to pediatric urologist; recommend starting antibiotic prophylaxis with amoxicillin 25 mg/kg/dy until further evaluation is completed

The physician referral line is 202-476-2670

• The parent 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