Medical Monday: Hydronephrosis

It's that time again: Medical Monday! I blog each Monday about a different condition Connor has and then post a link to it on the side bar as I go. This way people can get a better idea of what Connor deals with on a daily basis and his family and friends can understand what I'm saying when I call and spout ridiculously long medical terms.

DISCLAIMER: I would like to emphasize for those people who stumble upon this blog that I'm not a doctor, and I have no medical experience other than the approximately 900 doctor's appointments I've been to in the past two years. I just know about these things in relation to how they apply to Connor and not anyone else's child, so if you want accurate info on this sort of thing, please please please ask your doctor or go to the medical library instead of looking it up on the Internet. The library is your friend.

Today's topic is hydronephrosis. Let's have a mini English lesson and play break down the word, shall we?

hydro-- water

nephro (o is dropped)--kidney

osis-- disease

The kidneys are your body's cleaning system-- kind of like the filter on a fish tank. They sift out all of the waste products and extra water from your blood and use it to create urine, which then travels down the ureters to the bladder where it is stored until it is released from the body. They also produce two major hormones and one enzyme.

There are several different things that can cause the condition called hydronephrosis, but by far the most common reason for it is that somewhere down this system, a blockage has occurred. It can be something like a kidney stone, or it can be a problem with the formation of the ureter. The urine tries to flow down the ureter, but the blockage prevents it from reaching the bladder, so it backs up into the kidney. The kidney continues to produce urine, but now there's nowhere for it to go. Hence "water kidney disease." What ends up happening is that the kidney begins to swell like an inflating balloon, and if it gets big enough, irreversible damage can occur. Almost all hydronephrotic kidneys never get to this size however, and often times the blockages either resolve themselves before the child is born or can be fixed with minor procedures. Not in Connor's case, of course, because that would be waaaaaaay too simple for this kid.

Connor's blockage was a type called a ureteropelvic junction obstruction. What this means is that the blockage was right at the base of the kidney, at the joint where the ureter and the kidney meet. That's a pretty common place for the blockage to occur. What wasn't common was just how large Connor's kidney became and how serious the condition was.

Connor's blockage caused his right kidney to begin enlarging while I was only four months pregnant with him, and it continued to grow throughout my pregnancy. Here's a freaky fetal MRI picture they took of him while I was eight months pregnant. Ignore the crazy Mars Attacks eyeballs and brain and check out his body. The top white area in his torso is his lung. The bottom white area is his kidney. The kidney is bigger. Think about that for a minute. A kidney at that stage in development is supposed to be less than eight millimeters across. Connor's right kidney was sixty-two.

So when the kidney is ballooning up like this, there's only so much it can expand before bad things start happening. All of the material inside that is supposed to be doing its job of filtration and hormone production starts getting squished up on the inside, and as the cells are compressed they can be damaged. When a kidney is extremely enlarged, like Connor's, those cells can stop functioning, and blood pressure can skyrocket because the kidneys aren't pulling enough salt out of the bloodstream. The kidney also begins to displace the other organs, pushing against the diaphragm so it is hard to breath, and pressing on some of the major blood vessels of the body, cutting off blood supply. This is extremely dangerous.

So what can you do in an extremely severe case of hydronephrosis like Connor's? You can't just remove the blockage and leave the kidney to recover in a case like this, because the kidney is too damaged to work properly even after it's "deflated." You have to take the kidney out. Connor had his right kidney and the top portion of his ureter removed when he was five days old in a procedure called a nephrectomy. You can read about his surgery and the events leading up to it here, if you are interested.

Luckily, you can live quite easily with only one kidney, and Connor's left one seems to be functioning quite well. It's a little larger than the kidneys of most kids of his size, but that's pretty common when you've only got one-- it grows a little so it can do the work of two! We call it his "super kidney." Once a year we go in and have his urine tested to make sure that his left kidney is functioning the way it should be, and this adds yet another check-mark under "no contact sports" as we want to protect the one he's got, but otherwise it shouldn't affect him in any way.

You can learn more about hydronephrosis and nephrectomies here:

Children's Hospital Boston: Hydronephrosis

UCSF Medical Center: Hydronephrosis

Urology at Hopkins: Ureteropelvic Junction Obstruction

Encyclopedia of Surgery: A Guide For Patients and Caregivers-- Nephrectomy

~Jess