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Suggest Treatment For Mild Hydronephrosis
Question: I am 50 yr oldkidney transplant recipient with 24 years. For last eight years now l had mild hydronephrosis which has increased over the years. PCS dilated till 2014 usg and the ureter is also dilated now with tortous 1/3 . My creatinine range is 1.5-1.7. DTP scan shows no obstruction T is 13. CT scan shows dilation with a kink in ureter below a hernia but no obstruction. Passing adequate urine same as intake. Opinion divided on intervention with stent. Nephrologist over last 8 years have advised no intervention as creatinine is normal and there is no visible obstruction. But now one nephrologist is advised stenting to reduce hydronephrosis, surgeon and Radiologist not too keen as old transplant and susceptibility to infection and no urine output reduction. Request advise
The kidney was donated by my father. It age now is 80 years. Does it have any bearing.
The kidney was donated by my father. It age now is 80 years. Does it have any bearing.
Brief Answer:
Not to intervene is the best approach.
Detailed Answer:
Hello
Thanks for query .Based on the facts that you have undergone Renal Transplant 8 years back and recently noticed hydronephrosis and dilatation of upper third ureter due to kinking pf ureter Neephrologist has suggested to put a stent to reduce hydronephrosis where as Urologist has opined not to go for any intervention .
In view of your creatinine levels well within acceptable range suggesting near normal renal function and absence of any demonstrated ureteral obstruction I personally feel that any active surgical intervention has a risk of retrograde infection .More over the effect of dilatation of ureter after removal of stent will not lost longer .
I think your Urologist has rightly opined not to intervene. I would suggest to observe the progress of Hydronephrosis and renal function and review the situation every six months and take a call depending upon the situation at that particular time .
Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.
Dr.Patil.
Not to intervene is the best approach.
Detailed Answer:
Hello
Thanks for query .Based on the facts that you have undergone Renal Transplant 8 years back and recently noticed hydronephrosis and dilatation of upper third ureter due to kinking pf ureter Neephrologist has suggested to put a stent to reduce hydronephrosis where as Urologist has opined not to go for any intervention .
In view of your creatinine levels well within acceptable range suggesting near normal renal function and absence of any demonstrated ureteral obstruction I personally feel that any active surgical intervention has a risk of retrograde infection .More over the effect of dilatation of ureter after removal of stent will not lost longer .
I think your Urologist has rightly opined not to intervene. I would suggest to observe the progress of Hydronephrosis and renal function and review the situation every six months and take a call depending upon the situation at that particular time .
Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The transplant is 24 years old. Hydronephrosis is 8 years old it has increased very gradually in 8 years, ureter dilated recently but no obstruction detected.There is a inguinal hernia located above the ureter end . Surgeon feel adequate urine output and no obstruction and normal KFT hence no intervention. Age of father kidney 80 yrs as his age at time of donating to me was 55. T of DTPA was 4 and now 13. Will I gain any advantage in function effeciency or longevity of kidney with a stenting. Thanks.
Brief Answer:
Though Kidney is 80 years old No evidence of deranged Renal function
Detailed Answer:
Hello
Thanks for follow up .I would rather say that you are lucky enough that the kidney is functioning very well though donated kidney is 80 years old and there is no evidence of deranged renal function.
The points in favor of not putting the stent are -
1)Stent causes passive dilatation of ureter and improves drainage of the urine from kidney in to bladder However this dilatation remains as long as stent is there in ureter
2).More over there is adequate drainage of the kidney in spite of kinking of the ureter .
3) Putting a stent involves high risk of introducing infection from outside which will complicate the things further rather than any help.
3) Stent has no action of improving or prolonging the life of Kidney.
Thanks and Regards.
Dr.Patil.
Though Kidney is 80 years old No evidence of deranged Renal function
Detailed Answer:
Hello
Thanks for follow up .I would rather say that you are lucky enough that the kidney is functioning very well though donated kidney is 80 years old and there is no evidence of deranged renal function.
The points in favor of not putting the stent are -
1)Stent causes passive dilatation of ureter and improves drainage of the urine from kidney in to bladder However this dilatation remains as long as stent is there in ureter
2).More over there is adequate drainage of the kidney in spite of kinking of the ureter .
3) Putting a stent involves high risk of introducing infection from outside which will complicate the things further rather than any help.
3) Stent has no action of improving or prolonging the life of Kidney.
Thanks and Regards.
Dr.Patil.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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