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Hydronephrosis

Hydronephroses

Hydronephrosis is a condition characterized by distention of the renal pelvis and calyces of one or both kidneys. This usually happens due to failure of the organ in draining out urine from the body due to some kind of obstruction [1].


Presentation

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]:

Weight Loss
  • A review of symptoms was significant for weight loss, loss of appetite, nausea, leg swelling and abdominal pain.[healio.com]
  • Also, the patient may have significant weight loss and palpable ptotic kidney 12 ) . However, our patient did not present such symptoms or signs, except an abdominal pain.[kjim.org]
Flank Mass
  • In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early.[ncbi.nlm.nih.gov]
  • Physical examination may detect a palpable abdominal or flank mass caused by the enlarged kidney. Causes [ edit ] Hydronephrosis is the result of any of several abnormal pathophysiological occurrences.[en.wikipedia.org]
Dutch
  • It is important to keep sight of these findings, especially in view of the emphasis on imaging techniques in the current Dutch guideline on appendicitis.[ncbi.nlm.nih.gov]
Virilization
  • The woman was not exposed to any virilizing agent during this pregnancy. She did not undergo any assisted reproductive technology for this pregnancy.[ncbi.nlm.nih.gov]
Abdominal Mass
  • A 34-year-old woman presented with progressive left abdominal pain and rebound abdominal mass at the left lower quadrant for 1 month.[ncbi.nlm.nih.gov]
  • mass Flank pain Nausea and vomiting Urinary tract infection Fever Painful urination (dysuria) Increased urinary frequency Increased urinary urgency Diagnosis Unilateral Hydronephrosis can be diagnosed with an imaging test such as an MRI, CT, X-ray or[wexnermedical.osu.edu]
  • In addition, individuals would also develop abdominal mass and flank pain. Diagnosis Diagnosis of hydronephrosis is made by ultrasound examination of the kidneys.[symptoma.com]
  • Common symptoms include: Flank pain Abdominal mass , especially in children Nausea and vomiting Urinary tract infection (UTI) Fever Painful urination (dysuria) Increased urinary frequency Increased urinary urgency In some cases, there may be no symptoms[medlineplus.gov]
  • Postnatal evaluation begins with US exam; further studies, such as voiding cystourethrogram (VCUG), based on the severity of postnatal hydronephrosis In neonates, it is the most common cause of abdominal mass.[unboundmedicine.com]
Right Flank Pain
  • The patient was a 52-year-old woman who had suffered from right flank pain for one week. Abdominal ultrasound and excretory urography revealed hydronephrosis of the right kidney.[ncbi.nlm.nih.gov]
  • We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain.[ncbi.nlm.nih.gov]
  • CASE A 36-year-old woman was admitted to our hospital with intermittent right flank pain for 4 years. The pain-free interval had been shortened when she sought medical attention.[kjim.org]
Hypertension
  • The speed of resolution of hypertension following relief of obstruction suggests that humorally mediated vasoconstriction can play an important role in the mechanism by which hydronephrosis causes hypertension.[ncbi.nlm.nih.gov]
  • A 7-year-old boy presented with a chronic, indurated, tender left thigh swelling in association with a hypertensive emergency.[ncbi.nlm.nih.gov]
  • What remains unclear, however, is why the factors described below result in hypertension in only a minority of obstructed patients: Acute, unilateral obstruction can cause hypertension via activation of the renin-angiotensin system; renal vein renin studies[emedicine.medscape.com]
  • […] mortality due to urinary tract obstruction is secondary to renal insufficiency/failure, salt-loosing nephropathy, urinary concentrating defects, renal tubular acidosis, hyperkalemia, hypomagnesium, hypophosphatemia, urinary tract infection, renal calculi, hypertension[quizlet.com]
  • The patient’s medical history was significant for hypertension, diabetes, hyperlipidemia and deep venous thrombosis.[healio.com]
Neglect
  • In the routine medical praxis, urolithiasis should not be neglected in the differential diagnosis of elevated concentrations of CA 19-9 marker.[ncbi.nlm.nih.gov]
Flank Pain
  • Of the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage.[ncbi.nlm.nih.gov]
  • Maternal hydronephrosis may cause flank pain during pregnancy. We aimed to investigate the association between maternal hydronephrosis and flank pain intensity.[ncbi.nlm.nih.gov]
  • The patient was a 52-year-old woman who had suffered from right flank pain for one week. Abdominal ultrasound and excretory urography revealed hydronephrosis of the right kidney.[ncbi.nlm.nih.gov]
  • We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain.[ncbi.nlm.nih.gov]
  • In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria.[ncbi.nlm.nih.gov]
Kidney Failure
  • Severe cases of urinary blockage and hydronephrosis can damage the kidneys and lead to kidney failure. If kidney failure occurs, treatment will be needed with either dialysis or a kidney transplant .[kidney.org]
  • Kidney failure is rare if the other kidney is working normally. However, kidney failure will occur if there is only one functioning kidney. UTI and pain may also occur.[medlineplus.gov]
  • Severe cases can lead to kidney failure, although most people can recover from hydronephrosis with prompt and proper treatment. UnityPoint Health Allen Hospital – Center for Urology 1717 W Ridgeway Ave.[unitypoint.org]
  • Prolonged, especially untreated, hydronephrosis is always accompanied by complete loss of kidney function i.e. kidney failure.[ic.steadyhealth.com]
  • However, because one normally functioning kidney is enough to sustain the body, permanent kidney failure is unlikely to develop unless both kidneys have been blocked for some time, usually at least a few weeks.[quizlet.com]
Hematuria
  • A 67-year-old woman was referred to the urology clinic for abdominal pain and hematuria. Urine analysis showed microscopic hematuria.[ncbi.nlm.nih.gov]
  • In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria.[ncbi.nlm.nih.gov]
  • Caucasian male patient was admitted in our clinic with complaints about blunt abdominal pain in the past two-month period localized in the right lumbar region and irradiating into the right inguinal area, constipation, abdominal bloating, and intermittent hematuria[ncbi.nlm.nih.gov]
  • Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage.[ncbi.nlm.nih.gov]
  • Ureter diseases causing hydronephrosis (intrinsic causes): Ureteral stone Ureteral clot due to hematuria Congenital diseases: ureteropelvic-junction obstruction , vesicoureteral reflux, megaureter , ureterocele.[urology-textbook.com]

Workup

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.

Nephrolithiasis
  • : Acute unilateral obstructive uropathy (when urine cannot drain through the ureter) Blockage of a ureter due to scarring, tumor, urinary stones Chronic unilateral obstructive uropathy Vesicoureteric reflux (backflow of urine from bladder to kidney) Nephrolithiasis[wexnermedical.osu.edu]
  • For instance, unilateral hydronephrosis is a frequent complication in patients suffering from acute/chronic unilateral obstructive uropathy, people with vesicoureteral reflux and patients with nephrolithiasis.[ic.steadyhealth.com]
  • Hydronephrosis; Chronic hydronephrosis; Acute hydronephrosis; Urinary obstruction; Unilateral hydronephrosis; Nephrolithiasis - hydronephrosis; Kidney stone - hydronephrosis; Renal calculi - hydronephrosis; Ureteral calculi - hydronephrosis; Vesicoureteral[medlineplus.gov]
  • It is caused by obstruction of urine flow, nephrolithiasis, or vesicoureteral reflux. Signs and symptoms include flank pain, nausea, vomiting, fever, and dysuria.[icd10data.com]
  • (Nephrolithiasis resulting in hydronephrosis) Introduction Clinical definition renal calyx and pelvis distension secondary to an obstruction in urine flow distal to the renal pelvis dilation of the ureter describes hydroureter Epidemiology demographics[medbullets.com]

Treatment

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].

Prognosis

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.

Etiology

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.

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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].

Prevention

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.

Summary

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.

Patient Information

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.

References

Article

  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.

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Last updated: 2018-06-22 11:15