Management of Kidney Malrotation in Children

Initial Assessment and Imaging

• The Society for Fetal Urology recommends grading hydronephrosis according to their classification, and renal and bladder ultrasound should be obtained to assess for hydronephrosis 1

Conservative Management for Asymptomatic Cases

• The American Academy of Pediatrics recommends monitoring blood pressure annually for children with congenital renal anomalies, and yearly serum creatinine should be obtained to assess renal function 1

Management of Complicated Cases

• Children with kidney malrotation should be referred to a pediatric urologist when hydronephrosis develops or worsens on surveillance imaging, or when recurrent urinary tract infections occur, as defined by standardized CDC criteria 1, 2
• Procedures for complicated cases, such as laparoscopic pyeloplasty or ureterocalicostomy, should be performed by a pediatric urologist trained in minimally invasive techniques 2

Monitoring Protocol

• The American Academy of Pediatrics recommends renal ultrasound every 6-12 months initially, then annually if stable, and annual blood pressure measurement, and yearly serum creatinine to estimate GFR 1