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What is the seriousness of my 10-year-old daughter's kidney condition with spina bifida and hydronephrosis?
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Pediatric Medicine
Question #29513
26 days ago
80

What is the seriousness of my 10-year-old daughter's kidney condition with spina bifida and hydronephrosis? - #29513

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Hello doctor, I have a 10-year-old girl with spina bifida. She recently had an MRI which showed: • A sacrococcygeal mass suspected to be a teratoma • Right kidney: small in size with hydronephrosis (possible reflux) • Left kidney: duplicated (two kidneys on the left side) She may also have bowel issues due to rectal compression. I would like your medical opinion regarding: 1. The kidney condition and its seriousness 2. Whether surgery is needed urgently 3. What tests or follow-up you recommend Can I send you her MRI report and additional details? Thank you very much

How long has she been experiencing kidney or urinary symptoms?:

- More than 6 months

Has she had any urinary infections or issues with urination?:

- Yes, frequent infections

What symptoms is she experiencing related to her bowel health?:

- Constipation

Has she had any previous surgeries related to her spina bifida or kidneys?:

- Yes, multiple surgeries

How has her overall health been recently?:

- Very good, no concerns

What is her current medication regimen, if any?:

- Not sure

How often does she have follow-up appointments with her healthcare providers?:

- Rarely
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Doctors' responses

Dr. Nikhil Chauhan
I am currently working as a urologist and kidney transplant surgeon at Graphic Era Medical College & Hospital, Dehradun. It's a role that keeps me on my toes, honestly. I handle a pretty wide range of urology cases—stones, prostate issues, urinary tract obstructions, infections, you name it. Some are straightforward, others way more complex than you expect at first glance. Every patient walks in with a different story and that’s what keeps the work real for me. Kidney transplant surgery, though, that’s a whole different zone. You’re not just working on anatomy—you’re dealing with timelines, matching, medications, family dynamics, emotional pressure... and yeah, very precise coordination. I’m part of a team that manages the entire transplant process—from evaluation to surgery to post-op care. Not gonna lie, it’s intense. But seeing someone who’s been on dialysis for years finally get a new shot at life—there’s nothing really like that feeling. In the OR, I’m detail-focused. Outside of it, I try to stay accessible—patients don’t always need answers right away, sometimes they just need to feel heard. I believe in walking them through what’s going on rather than just giving reports and instructions. Especially in transplant cases, trust matters. And clear, honest conversation helps build that. Urology itself is such a misunderstood field sometimes. People ignore symptoms for years because it feels “awkward” or they think it’s not serious until it becomes unmanageable. I’ve had patients who came in late just because they were embarassed to talk about urine flow or testicular pain. That’s why I also try to make the space judgment-free—like whatever it is, we’ll figure it out. At the end of the day, whether I’m scrubbing in for surgery or doing OPD rounds, I just want to make sure what I do *actually* helps. That the effort’s not wasted. And yeah, some days are frustrating—some procedures don’t go clean, some recoveries take longer than they should—but I keep showing up, cause the work’s worth doing. Always is.
25 days ago
5

Hello parent,

Thank you for sharing this complex case. Your daughter’s combination of spina bifida + hydronephrosis + suspected teratoma + duplicated kidney requires urgent multidisciplinary evaluation. Here is my direct opinion.

1. Seriousness of the kidney condition – Moderate to High

· Right kidney: Small size + hydronephrosis + possible reflux → already damaged or dysplastic. This kidney may have poor function. Frequent UTIs confirm ongoing risk. · Left kidney: Duplicated (two ureters). Duplication can cause reflux, obstruction, or infection – but alone is not dangerous if draining well. · Overall kidney function depends on the left kidney. If right kidney is non-functional, the left must be protected aggressively.

Key point: Loss of left kidney function would be catastrophic. The hydronephrosis on the right and possible reflux on either side need full evaluation.

2. Urgent surgery needed? – Yes, for the teratoma. Kidneys may need planned surgery

· Sacrococcygeal teratoma – even if benign (mature), it can compress rectum (causing constipation) and potentially affect bladder/bowel nerves. Needs surgical resection by a pediatric surgeon. Not “emergency tonight” but urgent within weeks, not months. · Kidneys: No emergency surgery unless: · Recurrent pyelonephritis despite antibiotics · Worsening hydronephrosis on left side · Poor bladder emptying (common in spina bifida) requiring clean intermittent catheterization (CIC) or anti-reflux surgery

Immediate step: Renal/bladder ultrasound + voiding cystourethrogram (VCUG) to quantify reflux and hydronephrosis.

3. Tests and follow-up recommended

✅ Immediately (next 1-2 weeks):

· Renal function panel (creatinine, BUN, electrolytes) · Urine culture + sensitivity (even if no fever) · Renal ultrasound (to compare with MRI – assess left kidney drainage, right kidney size) · VCUG (to grade reflux, especially on the duplicated left system) · DMSA scan (to see split renal function – how much each kidney works)

✅ For the teratoma:

· Alpha-fetoprotein (AFP) – helps differentiate mature vs immature teratoma · Pelvic MRI with contrast (if not already done) to define mass extension · Referral to pediatric surgery / surgical oncology

✅ Long-term follow-up:

· Urodynamics (due to spina bifida – neurogenic bladder is almost always present) · Clean intermittent catheterization (if not already doing) · Prophylactic antibiotics (e.g., trimethoprim-sulfamethoxazole) to prevent UTIs until reflux is addressed · Regular monitoring every 3-6 months by pediatric urology + nephrology

📌 Can you send MRI report?

Yes, absolutely – you can share de-identified MRI findings and additional details. However, final surgical decisions require physical exam and correlation with imaging. I strongly recommend presenting at a pediatric tertiary care center with:

· Pediatric urology · Pediatric surgery (for teratoma) · Pediatric nephrology · Spina bifida clinic

⚠️ Red flags requiring immediate ER visit

· Fever with chills (possible kidney infection) · No urine output for >8-12 hours · Severe abdominal or back pain · Vomiting or inability to pass stool

Do not delay the teratoma workup. Do not assume the kidneys are fine without a DMSA scan and VCUG. This child needs coordinated care within 2-4 weeks.

Dr Nikhil Chauhan Urologist

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Dr. Arsha K Isac
I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.
25 days ago
5

Hello

Yes, you can absolutely send the MRI report and any additional details—I can help interpret them and explain what they mean in practical terms.

If you cant send , please type here the interpretation

Based on what you’ve shared, here is a clear medical overview.

Kidney condition and seriousness: Your daughter appears to have three related but manageable issues. A small right kidney with hydronephrosis usually means long-standing urine backflow (reflux) or obstruction that has affected kidney growth. A duplicated left kidney (duplex kidney) is a congenital variation where the kidney has two drainage systems; many children live normally with this, but it can increase the risk of infections or reflux. The overall seriousness depends mainly on how well each kidney is functioning, not just their structure. In children with spina bifida, bladder dysfunction is common and can contribute to reflux and hydronephrosis, so protecting kidney function long term is the key priority.

Sacrococcygeal teratoma and urgency of surgery: A sacrococcygeal mass suspected to be a teratoma is typically treated with surgical removal, but the urgency depends on specific features. Surgery is usually planned rather than emergency if the child is stable, there is no rapid growth, no neurological decline, and no bowel or bladder obstruction causing acute symptoms. However, earlier surgery is generally recommended to prevent complications such as compression of bowel or nerves, infection, or—rarely—malignant change. If there are worsening bowel problems, urinary retention, severe pain, or rapid enlargement of the mass, that would increase urgency.

Bowel issues from rectal compression: Compression from the mass can cause constipation, difficulty passing stool, or incomplete emptying. In children with spina bifida, bowel dysfunction can also be neurogenic, so both factors may contribute. This is important but usually manageable with coordinated care.

Key tests and follow-up typically recommended: Doctors usually focus on measuring kidney function and defining the urinary tract anatomy clearly. This often includes a renal ultrasound to monitor hydronephrosis, a test to look for urine reflux (voiding cystourethrogram), and a nuclear medicine scan (such as a DMSA or MAG-3 scan) to determine how much each kidney contributes to total function. Blood tests for kidney function and regular urine tests for infection are also standard. For the mass, imaging review by pediatric surgery is essential, and tumor marker blood tests are sometimes done before surgery and during follow-up.

When to seek urgent care: Seek prompt medical attention if she develops fever with urinary symptoms, severe abdominal or back pain, vomiting, inability to pass urine or stool, new leg weakness, or rapidly worsening swelling or pain in the lower back or pelvic area.

Overall, many children with spina bifida and these findings do well with coordinated care from pediatric urology and pediatric surgery. The situation is important but not necessarily an emergency unless symptoms are rapidly changing.

Take care Feel free to reach out again

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The presence of hydronephrosis and a small right kidney, alongside spina bifida and potential reflux, requires careful monitoring and possibly intervention to preserve kidney function and prevent complications like infections or further kidney damage. The duplicated left kidney is relatively common and may not pose a significant issue unless function is compromised or it’s affected by any reflux. The seriousness depends on the degree of hydronephrosis and how well the kidneys are functioning currently. An urgent surgical intervention could be indicated if there’s severe hydronephrosis or recurrent infections that can’t be managed conservatively. However, decisions on surgery often depend on specific diagnostics such as a voiding cystourethrogram (VCUG) to examine reflux severity and differential renal function studies like a MAG3 scan to evaluate each kidney’s contribution to overall renal function. A pediatric nephrologist or urologist would typically guide this assessment. For bowel issues due to rectal compression, a multidisciplinary approach including gastroenterologists may be helpful. These conditions often require a balance of managing day-to-day symptoms while planning for long-term health. You should follow-up with her current care team to review imaging results, any renal function assessments, and evaluate for surgical necessity. If she experiences pain, fever, or any signs of infection, immediate medical attention should be sought. While I can’t directly review imaging or receive documents, ensuring all follow-up appointments with specialists are scheduled is essential for comprehensive care.

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Dr. Bharat Joshi
I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.
25 days ago
5

Hello dear See as per clinical history below findings are present Sacchrococcygeal mass ( presence of tumour) Right kidney dysfunction ( due to hydronephrosis) Spina bifida It seems serious condition so will require comprehensive evaluation Iam suggesting some tests Please share the result with pediatrician or oncologist for better clarity Tumour markers like HCG ,AFB Biopsy Urine analysis Crp Lft Rft Esr CBC Mri ct scan Please share the mri details for confirmation Hopefully you recover soon Regards

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Dr. Prasannajeet Singh Shekhawat
I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.
25 days ago
5

Hello It sounds like your daughter is facing some complex health challenges. I can definitely help you understand the situation better.

1. Kidney Condition: - The small right kidney with hydronephrosis suggests that there may be an obstruction or reflux affecting its function. This can be serious if it leads to kidney damage over time. - The duplicated left kidney is a congenital condition and can vary in function. Sometimes, one of the kidneys may not work well, but it can also function normally.

2. Surgery Urgency: - The urgency for surgery often depends on the severity of the hydronephrosis and the function of the kidneys. If the right kidney is significantly affected, surgical intervention may be necessary to relieve the obstruction and prevent further damage.

3. Tests/Follow-Up: - Follow-up imaging (like a renal ultrasound) to monitor kidney function and size. - Urodynamic studies may be needed to assess bladder function, especially if there are bowel issues. - Regular consultations with a pediatric nephrologist and possibly a urologist would be beneficial.

Feel free to send over her MRI report and any additional details you have. I can help you interpret the findings better!

Thank you

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Dr. Shayeque Reza
I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.
25 days ago
5

Your child’s findings suggest a complex but manageable condition that needs coordinated specialist care. The sacrococcygeal mass (likely a Sacrococcygeal teratoma) is important to evaluate promptly because, although many are benign, they can grow, compress nearby structures (like the rectum), and sometimes require surgical removal, often by a pediatric surgeon—timing depends on symptoms, size, and imaging features but should not be excessively delayed. The kidney findings are also significant: a small right kidney with hydronephrosis suggests possible damage from reflux or obstruction, which can affect long-term kidney function, while a duplicated left kidney is a congenital variant that can function normally but may increase risk of infections or reflux. Given her history of Spina bifida, she may also have neurogenic bladder, which can contribute to these urinary issues and requires careful monitoring.Overall, she needs evaluation by a pediatric urologist and pediatric surgeon, with tests such as renal function blood tests, urine analysis/culture, a voiding cystourethrogram (VCUG) to check reflux, and possibly a nuclear scan (DMSA) to assess kidney function. This is not necessarily an emergency unless symptoms worsen, but it does require timely, well-coordinated care to protect kidney function and address the mass safely.

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