The Fight to Save Ethan's Kidneys: From Birth through Childhood

Erica and her husband were overjoyed to learn in 2015 that they'd have their second child. The pregnancy progressed smoothly and happily. 

This quickly changed when during her 20-week anatomy scan Erica's obstetrician diagnosed baby Ethan with hydronephrosis in utero. 

About Hydronephrosis

Hydronephrosis happens when there's a blockage in the urinary tract, stopping urine from flowing smoothly from the kidneys to the bladder. This condition can impact either one kidney (unilateral hydronephrosis) or both (bilateral hydronephrosis) and can range from mild to severe swelling. If not addressed, hydronephrosis can result in kidney damage or a decline in kidney function.

A Transition to Exceptional Care at WakeMed

The obstetrician chose to monitor Ethan's condition to make sure he was emptying his bladder. Unfortunately, his kidneys kept filling with fluid as evidenced in ultrasounds Erica was receiving every two weeks. So, the obstetrician transferred Erica's care to WakeMed Maternal Fetal Medicine – Raleigh Medical Park. This team referred Erica to pediatric urologist Timothy Paul Bukowski, MD, FACS, FAAP.

Upon first meeting Dr. Bukowski, Erica felt at ease. She and her husband were so uncertain about their son's future, and Dr. Bukowski took the time to explain his condition and give the couple hope.

Dr. Bukowski shared treatment options for Ethan's condition to be determined once Ethan was delivered. He also suggested that Erica transition all of her care to WakeMed, so Ethan would immediately go to the WakeMed Raleigh Campus Level IV NICU after delivery. 

Baby Ethan Enters the World with More Challenges

Erica had a scheduled induction two weeks prior to her due date to ensure all necessary care would be ready and waiting upon his arrival. Ethan was born on April 24, 2016. 

Erica explains, "He was taken to the NICU for a completely different reason than hydronephrosis. He was having breathing issues and was put on oxygen."

It was crucial for newborn Ethan to begin breathing independently right after birth. If he struggled for too long, he risked experiencing birth asphyxia, which could lead to severe brain damage or even be fatal. Ethan remained in the NICU for 10 days. Dr. Bukowski visited him and performed scans. 

Erica recalls, "Because my son was on oxygen, it took a bit of time to complete his kidney scans. Dr. Bukowski was amazing in closely monitoring him though. My husband and I were relieved to learn that he did not immediately require surgery." 

Distress at Two Months Old

All went well for baby Ethan for a few weeks after he was discharged home to his mom and dad. Then he took a turn.

Erica shares, "Around midnight when Ethan was two months old, he started running a fever. I was overwhelmed and called Dr. Bukowski, leaving a voice message. He returned my call and told us to take Ethan to WakeMed Children's – Emergency Department."

Ethan received a scan and was diagnosed with a urinary tract infection (UTI). He then required a spinal tap to check the infection.

"I was terrified of my baby receiving a spinal tap, but Dr. Bukowski was reassuring. During the two days that my son was in the hospital, he came by and checked on him."

Surgery for Ethan's Kidneys

In the follow-up consultation after Ethan's discharge, Dr. Bukowski scheduled Ethan for a utero pelvic junction obstruction surgery for his condition. The first surgery would be done at three months old. He told Erica and her husband that Ethan would need another surgery on the other kidney at six months old. 

"Dr. Bukowski explained to us that there was a kink causing an obstruction where the kidney and the ureters meet. Unfortunately, Ethan had it in both kidneys, and he had a severe case." 

Severe hydronephrosis can heighten the risk of UTIs and, if not addressed, may result in kidney failure. It is categorized into four grades, with Grade 4 indicating significant swelling of the pelvis and calyces, which take on a ballooned appearance. Typically, treating severe hydronephrosis involves surgery aimed at alleviating the swelling and pressure in the kidney by ensuring a clear pathway for urine flow.

Dr. Bukowski performed the surgeries on baby Ethan at the scheduled time with great success. Annual scans continued thereafter to monitor Ethan's kidney function. 

The Need for More Surgery

"Ethan did great," glows Erica. "He grew normally throughout his toddler years and had clear scans until age seven when we learned he had to have stents placed in his kidneys."

Dr. Bukowski informed the couple that Ethan had hydronephrosis in his left kidney though his right kidney was clear. Stents would protect Ethan from further complications. 

"I was terrified that my son might lose his kidney, but Dr. Bukowski calmly reassured us that he was not in danger of losing his kidney. The surgery would help him have normal and healthy kidney function." 

Relief and Calm After Years of Challenges

It's been two years since Ethan's last surgery, and, today, at age nine, Ethan has continued to have clear scans and is doing well. 

Dr. Bukowski notes, "The family came to me when Ethan was a newborn as he had kidney blockages on both sides prenatally. This is fairly uncommon. We found upon evaluation that he had ureteropelvic junction obstructions, and we needed to repair these issues through pyeloplasty surgeries. In his case, since we were able to address the problems early before he had any renal function loss, Ethan should enjoy long-term renal function health on par with those who have never needed these surgeries."

He is a typical boy and enjoys playing video games and neighborhood soccer as well as riding his scooter. 

Erica smiles, " Dr. Bukowski is definitely the best. I'm glad we were able to connect with him when it came to Ethan. I even scheduled with him for my third child's circumcision. He is so reassuring and definitely helped my husband and me through the whole journey."

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About WakeMed Pediatric Urology

WakeMed Children’s – Pediatric Urology is dedicated to the comprehensive care of pediatric patients with both common and complex urological issues. Our pediatric urology team offers medical management and surgical intervention, including advanced laparoscopic procedures, for children who require both routine and highly specialized care.

Pediatric Urology services at WakeMed Children are led by Dr. Timothy Bukowski. With more than 25 years of experience, Dr. Bukowski believes in treating each child and family as if they were his own. Well-known in the community for his experience and expertise, Dr. Bukowski was selected as one of the Best Doctors in America by Best Doctors for the last 18 consecutive years.

About WakeMed Maternal Fetal Medicine

Our multidisciplinary team of maternal fetal medicine physicians, genetic counselors, sonographers and nurses provides a wide range of specialized services for women who have a high-risk pregnancy. You can rely on the expertise and experience of our team — which includes 9 board-certified Fetal Echocardiography sonographers — to provide you the best quality care. This includes women who are at increased risk for genetic disorders due to advanced maternal age or family history, women who are experiencing or have a history of pregnancy complications and women with preexisting medical conditions that might adversely affect a pregnancy outcome.