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Hydronephrosis | Pediatrics

Pediatrics

Hydronephrosis

Our specialists provide compassionate, expert care for babies and children. We help you understand all aspects of your treatment options.

Medically reviewed by Albert Lee, D.O. on April 14, 2026.

Infant with hydronephrosis holding the finger of an adult.

Pediatric Urologists Here to Help Your Child

Doctors may find hydronephrosis before a baby is born during a routine prenatal ultrasound. They may also discover it in infants and children during medical exams or imaging tests. While the swelling itself is not a disease, it can be a sign that something is blocking the flow of urine or causing it to flow backward.

UC Davis pediatric urology experts and specialists in prenatal testing and screening offer comprehensive evaluation and advanced treatments to protect your child's kidney health.

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What is Hydronephrosis?

Hydronephrosis is a swelling of one or both kidneys. Urine usually travels from your kidneys to your bladder through tubes called ureters. When urine backs up or flows back into the kidney, it causes the kidney to stretch and swell.

Many cases of hydronephrosis in children go away on their own without treatment. However, severe or long-lasting hydronephrosis can damage your baby or child's kidney and affect how well it works. Urine flowing backwards from the bladder back into the kidney can also increase the risks of urinary tract infection (UTI).

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Symptoms of Hydronephrosis in Babies and Children

Most newborns and infants with hydronephrosis do not have symptoms. However, some children may develop symptoms, especially if they have a urinary tract infection (UTI) or severe blockage. 

Common Symptoms

If your child has hydronephrosis, you may notice:

  • Decreased appetite or poor feeding in infants
  • Frequent urinary tract infections (UTIs)
  • Pain in the back, lower abdomen or side

Emergency Symptoms

Seek immediate medical care if your child experiences: 

  • Fever along with abdominal or back pain (possible signs of infection)
  • Inability to urinate or very little urine
  • Nausea and vomiting with severe pain
  • Severe abdominal swelling
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Causes of Hydronephrosis

Hydronephrosis can occur when something interferes with normal urine flow out of the kidneys. Possible causes include:

Kidney Stones

While less common in children than in adults, kidney stones can block the ureter (the tube that carries urine from the kidney to the bladder). Children with certain medical conditions or a family history of kidney stones may be more likely to develop them.

Neurogenic Bladder

Conditions affecting the spinal cord, such as spina bifida, can affect the nerves that control the bladder. This may cause urine to back up into the kidneys.

Posterior Urethral Valves

Abnormal tissue in the urethra (the tube that carries urine out of the body) blocks urine from exiting the bladder.

Ureteral Strictures

Ureteral strictures are narrowed areas in the ureter, usually caused by inflammation, injury or congenital conditions. These narrowed areas can prevent normal urine flow out of the kidneys.

Ureteropelvic Junction (UPJ) Obstruction

A UPJ obstruction is a blockage where the kidney connects to the ureter. This narrowed area prevents urine from flowing normally out of the kidney.

Vesicoureteral Reflux (VUR)

VUR causes urine to flow backward from the bladder up into one or both ureters and sometimes the kidneys. This backward flow causes one or both kidneys to swell.

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Diagnosis and Testing of Hydronephrosis

If your child's doctor suspects hydronephrosis, they will perform several tests to confirm the diagnosis and determine the cause. Early and accurate diagnosis helps protect your child's kidney function. Tests may include:

Blood Tests

A blood test can reveal your child's kidney function by measuring waste products in the blood. These tests help doctors understand how well the kidneys are filtering blood and whether hydronephrosis is affecting kidney health.

Physical Exam

Your child's doctor will gently examine the abdomen to check for swelling, masses or tenderness. They will also look for signs of other birth defects that sometimes occur with hydronephrosis.

Nuclear Renal Scan

This test provides detailed information about how well each kidney is working and whether there is a blockage. Doctors give a small amount of radioactive material through an IV, and a special camera tracks how it moves through your child’s kidneys and bladder.

Ultrasound

This test uses high-frequency sound waves to create pictures of your child's kidneys and urinary system. Ultrasound can show whether one or both kidneys are swollen and how severe the swelling is.

Urinalysis

This urine test can detect signs of infection, blood or other problems in the urinary system. Children with hydronephrosis due to reflux are at higher risk for UTIs.

Voiding Cystourethrogram (VCUG)

This bladder X-ray test checks for vesicoureteral reflux (backward flow of urine). A small catheter is placed in the bladder, and a special dye is used to fill the bladder. X-ray pictures are taken while your child urinates to see if urine flows backward into the ureters or kidneys. If your child is able to pee, this test can also assess the urethra.

Hydronephrosis Treatments for Children

Treatment for hydronephrosis depends on how severe the swelling is, whether one or both kidneys are affected, the cause and your child’s symptoms. Our pediatric specialists work closely with families to determine the best approach for each child.

Watchful Waiting

If the swelling is not severe and kidney function is normal, your child's doctor may recommend careful monitoring with regular ultrasounds and kidney function tests. For some infants born with hydronephrosis, the condition resolves on its own as the urinary system matures.

Antibiotics

Some children with hydronephrosis are at higher risk for UTIs. Your child's doctor may prescribe a low dose of antibiotics to take daily to help prevent infections. If your child develops a UTI, prompt antibiotic treatment can prevent kidney damage.

Pyeloplasty Surgery

Pyeloplasty surgery can treat severe hydronephrosis caused by blockage where the ureter connects to the renal pelvis that is interfering with kidney function. During this surgery, the surgeon removes the narrow or blocked part of the ureter. The healthy part of the ureter is then reconnected to the kidney to allow normal urine flow.

Ureteral Stent or Nephrostomy Tube

If your child’s kidney is severely blocked or infected, doctors may place a ureteral stent (small tube) in the ureter to drain urine. A nephrostomy tube connects your kidney to the skin, bypassing your ureters. The tube may connect to a urine collection bag outside of your body instead. These are usually temporary solutions that protect your child’s kidneys before having surgery or other treatments.

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Preventing Hydronephrosis Complications

In many cases, you cannot prevent hydronephrosis. However, you can take steps to protect your child's kidney health and reduce the risk of complications:

Attend All Follow-Up Appointments

Regular monitoring with ultrasounds and kidney function tests helps doctors detect any changes early. Even if your child seems healthy, these checkups are essential for detecting problems before they cause kidney damage.

Ensure Adequate Hydration

Make sure your child drinks enough fluids throughout the day. Proper hydration helps the urinary system function well and may reduce the risk of kidney stones.

Give Antibiotics as Prescribed

If your child is taking daily antibiotics to prevent infection, give them exactly as prescribed, even when your child feels well. Do not stop the medication without talking to your doctor first.

Watch for Signs of Infection

Children with hydronephrosis due to urine flowing back into the kidney are more prone to UTIs. Contact your doctor right away if your child has fever, painful urination, foul-smelling urine or abdominal pain.

Approximately

1 in 100Pregnancies show hydronephrosis in the fetus during prenatal ultrasound

Source: National Institute of Diabetes and Digestive and Kidney Diseases: Hydronephrosis in Newborns

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