Bilateral Hydrouteronephrosis Dilated Vur with Cystitis: A Case Study

Background: Hydroureteronephrosis is a blockage to free flow of urine from the kidney causes hydroureteronephrosis, which causes dilation of the renal pelvis, calyces, and ureter, resulting in gradual atrophy of the renal cortex. “Dilation of the ureter due to obstruction of urine outflow is called hydroureter”. Hydronephrosis produces a dull pain and discomfort in the lower abdomen due to increasing bladder distension. A continuous obstruction in the flow of urine can lead to high blood pressure, sepsis, urinary tract infection, hematuria, and renal failure.

Clinical Findings: Difficulty in passing urine since 2-3month, in situations of benign prostate enlargement, urinary frequency, a weak urine stream, and a sense of incomplete emptying, lack of appetite and fever (Temperature - 101˚F).

Diagnostic Assessment: Blood test: Hb – 9.1 gm%, Total RBC count – 5.04millions/cumm, RDW – 17.8%, HCT – 31.9%, Total WBC count – 11600/cumm, Monocytes – 04%, Granulocytes – 30%, Lymphocytes – 64%, AST(SGOT) – 45U/L. Peripheral Smear: RBCs – predominantly microcytic mildly hypochromic with mild anis poikilocytosis showing few pencil cells. Platelets – adequate on smear. No hemiparasite seen.

Ultrasonography: The right kidney measure is 5 x1.9cm and left is 5.6 x2.6cm shows mild dilation of pelvic-calyceal system. Left kidney shows mild hydronephrosis with renal pelvic diameter 1.06cm hydroureters seen up to left vesico-urethric junction. Bilateral uterus dilated up to lower end to UVR. Uterus bladder is thickened wall and distended Mild cystitis dilation of B/L dilated uterus and hydronephrosis with UVR.

Therapeutic Intervention: Syp Cefixime 2.5ml x BD, Syp. MVBC 5ml x BD, Syp. Calcimax 5ml x BD, Syp. Orofer 5ml x OD, Syp. Nitrofurantoin 2.5ml x BD, Inj. Metro 100mg x TDS, Inj. Pantop 40mg x OD, Inj. Ceftriaxone 500mg IV x B and IVF DNS with Inj. KCL stat.

Outcome: After treatment, the child show improvement. No complaint of fever, pain, and difficulty in urine pass and urine frequency .

Conclusion: The patient was hospitalized to AVBRH's Pediatric Ward No. 14 with Bilateral hydrouteronephrosis dilated VUR with cystitis. Her health begins to improve when he received proper therapy.