Hydronephrosis in infancy.

Hydronephrosis of the pelvi-ureteric type rarely presents in infancy. Nixon (1953) found only one case in a child under the age of 6 months out of 78 cases seen at The Hospital for Sick Children, Great Ormond Street, between 1929 and 1950. It is, however, a condition which can be treated by conservative surgery and it is important that it should not be overlooked. The following two cases of pelvi-ureteric hydronephrosis are described because they closely resembled other causes of renal enlargement. Case Reports Case 1. G.S., a boy, was admitted to The Hospital for Sick Children under Professor Moncrieffon March 18, 1955, at the age of 2 months. His abdomen had been enlarged since birth. For four days before admission he had been vomiting intermittently. He had been having his bowels open three times a day. On examination he was seen to be a well-fed infant. The abdomen was large and there was divarication of the recti. The liver and spleen were not palpable. There was an easily palpable mass with a smooth rounded lower pole in each loin, the right being larger than the-left. The bladder was not palpable. On rectal examination nothing abnormal was found. The blood urea level was 38 mg. per 100 ml. A radiograph of the abdomen showed that there was a large soft tissue mass lying posteriorly on each side of the abdomen. There was no calcification in the masses and no abnormality in the spine (Fig. 1). The provisional diagnosis was of polycystic kidneys. On the third day after admission the infant's bowels were open five times. The stools were offensive and he lost weight. He was therefore transferred to the gastroenteritis unit. No pathogens were found in the stools. He was given a week's course of chloramphenicol, but the relaxed stools continued for three weeks and even then did not completely return to normal. It was noted during this time that the size and tenseness of the loin swellings varied a little from day to day. The possibility of bilateral hydronephrosis was therefore considered and an intravenous pyelogram was performed which showed concentration of dye in each kidney, but detail was grossly distorted. The blood urea level was now 46 mg. As the diagnosis ''