For expecting parents, the joy of pregnancy is sometimes clouded by the anxiety of an unexpected diagnosis. One of the most common abnormalities detected during antenatal ultrasounds is Hydronephrosis—swelling of the kidney due to a build-up of urine. While many of these cases resolve on their own, some represent a significant blockage that threatens the long-term health of the child's kidney.
This article details a recent success story from our clinic involving a 1-month-old infant referred from Rajasthan. It serves as a testament to the power of early evaluation and timely surgical intervention in congenital renal conditions.
We recently managed the care of a baby, just 1 month and 20 days old, who was referred to us from a small town in Rajasthan. The journey began long before the baby was born, with an antenatal diagnosis of Right Hydronephrosis.
Post-natal follow-up is crucial in these antenatal cases to determine if the swelling is transient or if it represents a true obstruction. In this case, the condition was not resolving.
Clinical Evaluation Findings: Upon presentation, the infant underwent a rigorous evaluation to determine the severity of the condition. The findings were concerning:
The Functional Scan (EC Scan): To understand not just the anatomy but the function of the kidney, an EC (Ethylene Cysteine) scan was performed. This nuclear medicine scan provides a "Split Renal Function" (SRF) percentage, comparing the left kidney to the right.
Pelvi-ureteric Junction (PUJ) Obstruction is a blockage at the point where the kidney pelvis connects to the ureter (the tube that carries urine to the bladder). When this junction is narrow or kinked, urine cannot drain freely. It backs up into the kidney, causing:
In this specific case, the "tight" nature of the obstruction was evidenced by the significant APD of 28mm and the drop in function to 40%.
One of the most debated topics in pediatric urology is the timing of surgery for antenatally diagnosed PUJO. Generally, two schools of thought exist in the medical community:
Our Decision: Given the APD of 28mm, the thinning parenchyma, and the already reduced function (40%), "watching and waiting" posed a significant risk of permanent kidney damage. We decided to proceed with surgery to give this baby the best chance at a normal life.
The baby was admitted to Stephens Hospital in March of this year. The chosen procedure was a Right Pyeloplasty.
What is a Pyeloplasty? Pyeloplasty is a reconstructive surgery. The goal is not just to remove the blockage, but to remodel the drainage system. During the surgery, the narrowed segment of the PUJ is excised (removed). The healthy ureter is then stitched back to the healthy renal pelvis to create a wide, funnel-shaped channel that allows gravity to easily drain the urine.
In infants, this is a delicate procedure requiring precision, as the structures are tiny. However, when performed by experienced hands, it is highly effective with low morbidity.
The true measure of success in surgery is not just a technically good operation, but the long-term functional outcome for the patient.
The baby returned for a follow-up assessment at 7 months post-operation. The results were nothing short of excellent and validated the decision to operate early.
Ultrasound Findings:The massive swelling had resolved. The ultrasound showed only "minimal right-side PCS (Pelvicalyceal System) swelling." The pressure on the kidney was gone, and the thinning of the parenchyma had halted.
Functional Recovery (The EC Scan):This is the most critical metric. The repeat EC scan showed:
Why is 50% significant? We have two kidneys. In a perfectly healthy human body, each kidney does exactly half the work (50/50 split). Before surgery, this baby's right kidney was lagging at 40%. After surgery, it recovered fully to 50%. This indicates a complete normalization of kidney function. The kidney is now growing and filtering exactly as it should, indistinguishable in performance from the healthy left kidney.
The table below summarizes the dramatic turnaround in this infant’s health:
| Clinical Parameter | Pre-Operative Status (1 Month Old) | Post-Operative Status (7 Months Follow-up) |
| Diagnosis | Gross Hydronephrosis with PUJ Obstruction |
Resolved Obstruction |
| APD Measurement | 28 mm (Severe) | Minimal / Insignificant |
| Renal Parenchyma | Thinning observed | Pressure relieved, growth enabled |
| Drainage Pattern | Obstructed | Normal Drainage |
| Split Renal Function | ~40% (Impaired) | 50% (Normal/Perfect) |
This case adds to the growing body of evidence supporting early infant pyeloplasty. Numerous studies have proven that:
In this case, waiting could have resulted in the function dropping below 35% or 30%. Recovering from that deficit is much harder than recovering from 40%. The leap from 40% back to a perfect 50% highlights the incredible healing power of the infant body when given the right help at the right time.
Receiving a diagnosis of hydronephrosis or kidney obstruction in your newborn is frightening. You may feel overwhelmed by medical terms like "APD," "parenchymal thinning," and "split function."
However, modern pediatric urology offers hope and definitive cures.
This baby, once facing the threat of kidney damage, is now growing up with two perfectly functioning kidneys, thanks to the vigilance of the parents and timely surgical intervention at Stephens Hospital.
