Logan Miles, just three weeks old, was transferred to Mount Sinai Kravis Children’s Hospital for escalation of care after he first presented at a community hospital with abrupt decrease in urine output and abdominal distension.
He was found on the exam to have large kidneys and a distended abdomen. The decrease in urine output, along with the severe metabolic derangements (including a life-threatening elevation in potassium), made it clear that Logan had severe kidney injury and that there was likely some urinary blockage causing the severe hydronephrosis.
When Logan was admitted to the Mount Sinai pediatric intensive care unit (PICU) in the middle of the night, Jennifer Gillen, MD, a critical care attending physician, worked to coordinate care for this critically ill neonate. Overnight, pediatric nephrology, urology, and radiology joined forces with Dr. Gillen to care for Logan in the PICU. Hilary Hotchkiss, MD, inserted a peritoneal dialysis catheter emergently and Joy Masseaux, MD, performed a renal/bladder ultrasound and voiding cystourethrogram.
The imaging showed that Logan had a defect in his urologic tract that severely limited the passage of urine into his bladder. Bilateral percutaneous nephrostomy tubes were placed by Rahul Patel, MD, in Interventional Radiology, which initially relieved the blockage. A few days later, Fernando Ferrer, MD, and Neha Malhotra, MD, performed a cutaneous bilateral ureterostomy, a complex urologic procedure for this exceedingly rare birth defect.
Approximately one year later, Drs. Ferrer and Malhotra successfully performed a bilateral ureteral reimplantation, which completed the correction of Logan’s birth defect.
From the time of the first surgery in 2021 to today, Logan has continued to grow and thrive. Dr. Ferrer and Jessica Reid-Adam, MD, a pediatric nephrologist who treated him during the initial hospitalization, continue to see him in the outpatient setting as needed. He is off all medications, with only mild residual chronic kidney disease.
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Fernando Ferrer, MD
Professor of Urology
Jessica Reid-Adam, MD
Associate Professor of Pediatrics, and Medical Education
Jennifer Gillen, MD
Assistant Professor of Pediatrics
Hilary Hotchkiss, MD
Assistant Professor of Pediatrics (Nephrology)
Neha Malhotra, MD
Assistant Professor of Pediatrics (Pediatric Urology)
Joy Masseaux, MD
Assistant Clinical Professor of Diagnostic, Molecular and Interventional Radiology, and Pediatrics