Is dilated and enlarged urinary bladder a sign of early stage renal failure?
U/S - URINARY TRACT: Findings: " Both kidneys increased in size measuring 11.5 x 6.5 cm with cortical thickness of 1.2 cm with loss of corticomedullary differentiation. Evidence of moderate-to-severe hydronephrotic changes. " Both ureters are seen significant dilated tortuous however, both ureters could represent changes of reflux. Voiding cystourethrogram is advised as the patient diagnosed "eagle XXXXXXX syndrome". " Urinary bladder dilated /enlarged with prevoid 1300 ml and post void 320 ml.
Is this early stage of renal failure ? What is the treatment and next steps ?
Hi and welcome.
There are no signs of kidney failure in his lab so this is early phase of course and kidney failure in hydronephrosis is usually seen only in very advanced hydronephrotic changes. But, this is severe hydronephrosis with repercussion on kidney parenchyma and bladder and without treatment it would lead to kidney failure for sure.
Causes may be congenital or this is megaureter which resulted from ureter obstruction or vesicoureteral reflux.
In every case, if there is urinary infection, he should be on antibiotics for longer period.
Therapy may included so called deflux procedure if there is pathology in bladder-ureter connection. To rule this out you should do miction scintigraphy. I'd there is ureter obstruction which is more probable then surgery is advised and it she done by pediatric urologica surgeon. If this condition progresses then kidney transplant may be required, but I don't think that it will be necessary since most cases are treatable. Wish you good health. Regards
After the surgery for fixing the reflux / obstruction , kidney could be recovered to be normal ? or effects on kidney parenchyma couldn't be retrieved ?
" loss of corticomedullary differentiation " this is non recoverable ?
Hi. Well, considering US description and good kidney markers I think that kidney parenchyma would mostly recover after the normal urine flow is established. He is still young and kidney cells have potential to hypertrophy at some degree. Loss of corticomedulary differentiation means that there is reduced kidney medulla tissue as a result of retrograde urine flow, but it doesn't mean that kidney tissue is irreversibly lost. When problem with ureter is fixed, urine will flow normally and kidneys morphology and function will improve.
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