Hydronephrosis

Symptoms of hydronephrosis depend on the severity of the condition and duration of the obstruction. The primary sign of the condition precipitates as severe pain in the back region. This usually occurs due to buildup of urine in the bladder, collecting system, or renal capsule. In addition to this, other signs and symptoms of the condition include the following [7]:

• Nausea and vomiting
• Increased urination
• Increased urge to urinate
• Development of urinary tract infection accompanied by fever
• Flank pain
• Abdominal pain
• Dysuria

Hydronephrosis is usually diagnosed during an ultrasound examination of the kidneys. In addition, CT scan, X-rays and MRI are also conducted to further confirm the diagnosis [8]. Once the condition is confirmed, cytoscopy is done to understand the causative factor. In this method, a tube with a camera attached, is inserted to study the internal structures of the urethra and the bladder. This method helps to look for obstruction [9].

In many cases, blood and urine tests are also carried out to assess the kidney functioning. These tests help to check for hematuria which is indicative of presence of kidney stone or infection. Hydronephrosis can also be diagnosed during pregnancy. A routine ultrasound examination is carried out which can provide information about the development and condition of the baby.

Treatment of hydronephrosis largely depends on the causative factor. If the condition is caused due to blockage in the ureter then an ureteral stent is inserted that allows the ureter to drain the urine into the bladder.

Nephrostomy tube is inserted which facilitates the blocked urine to be filtered out of the body. Antibiotics are given to prevent the onset of kidney infections. In many cases, surgery would be the method of choice to remove the obstruction. In cases, when kidney stone is the causative factor, methods would be employed to remove the stone and facilitate urinary flow [10].

Failure to initiate prompt treatment of hydronephrosis can cause several debilitating conditions to set in. In such cases, prognosis of the condition is very poor. However, if treatment is initiated when the first sign develops then the prognosis is good and it can be treated completely.

Hydronephrosis is not a disease, but occurs due to several other conditions which cause the kidneys to swell. The most common cause is the obstruction in the urinary tract. Conditions other than obstruction or blockage that causes development of hydronephrosis include cancer of the bladder and cervix. Such type of cancers is the leading cause of hydronephrosis in women. Pregnancy is yet another condition that predisposes women population to develop hydronephrosis [4].

In men, swollen prostate and cancer of the prostate gland are also major causes. Conditions that disturb the normal functioning of the kidney also play an important role in development of hydronephrosis.

Hydronephrosis is a condition which is common in adults and babies. It has been estimated that about 1 in 100 individuals suffer from this kidney disorder. According to the statistics provided by Boston Children’s Hospital (BHC), hydronephrosis affects about 1 in 500 children [5].

Under normal circumstances, the major function of the kidneys is to filter off wastes and fluid from the system. The urine is formed when kidneys filter blood from the waste materials and fluid. This is then collected in the renal pelvis and from here the urine travels to the ureter and into the bladder. Conditions that obstruct the flow of urine may cause hydronephrosis [6].

Hydronephrosis can be prevented by following certain measures that would help prevent the onset of disease conditions that are known to trigger development of such a disorder.

The condition of hydronephrosis requires prompt diagnosis and treatment to avoid onset of secondary complications. If left untreated, kidney infection or atrophy can set in [2]. Development of sudden and acute pain in the back region signals the commencement of hydronephrosis. Obstruction such as development of kidney stones predisposes an individual to develop this condition [3]. Such a type of condition is pretty common in babies and it can affect the adult population as well.

Definition

Hydronephrosis is a common condition characterized by swelling of one or both kidneys due to buildup of urine in the organ. 

Causes

Hydronephrosis can occur due to obstruction in the ureter or any other underlying disease conditions. Development of kidney stones is also known to be a major cause. In other cases, the ureter can get blocked due to formation of tumors or development of scarring. Hydronephrosis may also be present at birth without any known prominent cause.

Symptoms

Hydronephrosis presents with a sudden and sharp pain in the back region. In addition, other symptoms include development of urinary tract infection, fever, blood in urine, pain during urination, increased in frequency of urination and increase in urge to urinate. In addition, individuals would also develop abdominal mass and flank pain.

Diagnosis

Diagnosis of hydronephrosis is made by ultrasound examination of the kidneys. In addition, to further confirm the condition, X-ray and CT scan of the kidneys and MRI of the abdomen is also done. To identify the cause of hydronephrosis, cytoscopy is also carried out. In pregnant women, the onset of hydronephrosis is diagnosed through routine ultrasound examination.

Treatment

Treatment of hydronephrosis depends on the cause of the condition. Insertion of ureteral stent and nephrostomy tube forms the primary basis of treatment regime. Surgery is the treatment of choice in condition when the obstruction cannot be removed through other methods. Antibiotics are administered to prevent development of infections.

1. Frokiaer J, Zeidel M. Urinary Tract Obstruction. In: Brenner and Rector's The Kidney, 9, Elsevier, New York 2011.
2. Doganis D, Siafas K, Mavrikou M, et al. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007; 120:e922.
3. Demko TM, Diamond JR, Groff J. Obstructive nephropathy as a result of retroperitoneal fibrosis: a review of its pathogenesis and associations. J Am Soc Nephrol. Apr 1997;8(4):684-8.
4. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. Mar 1988;27(3):249-59.
5. Harrison MR, Golbus MS, Filly RA, et al. Fetal hydronephrosis: selection and surgical repair. J Pediatr Surg 1987; 22:556.
6. Klahr S. Pathophysiology of obstructive nephropathy. Kidney Int. Feb 1983;23(2):414-26.
7. Rose BD, Black RM. Manual of Clinical Problems in Nephrology. Boston, Mass: Little, Brown & Co; 1988:337-343.
8. Thoeny HC, Binser T, Roth B, Kessler TM, Vermathen P. Noninvasive assessment of acute ureteral obstruction with diffusion-weighted MR imaging: a prospective study. Radiology. Sep 2009;252(3):721-8.
9. Platt JF, Rubin JM, Ellis JH. Acute renal obstruction: evaluation with intrarenal duplex Doppler and conventional US. Radiology. Mar 1993;186(3):685-8.
10. Zanetta VC, Rosman BM, Bromley B, et al. Variations in management of mild prenatal hydronephrosis among maternal-fetal medicine obstetricians, and pediatric urologists and radiologists. J Urol 2012; 188:1935.

• Diagnosis of hydronephrosis
  Guest, 2018-03-11 17:21