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]:
- Nausea and vomiting
- Increased urination
- Increased urge to urinate
- Development of urinary tract infection accompanied by fever
- Flank pain
- Abdominal pain
- Dysuria
Entire Body System
- Fever
Symptoms of a urinary tract infection can include the following: strong urge to use the bathroom painful urination cloudy urine back pain fever vomiting If your infant has had multiple urinary tract infections (UTIs) with (or without) a fever, it could [childrenshospital.org]
Call your health care provider if you have ongoing or severe flank pain, or fever, or if you think you may have hydronephrosis. Prevention of the disorders that cause this condition will prevent it from occurring. [medlineplus.gov]
Urinary tract infections are characterized by cloudy urine, painful or weak urination, back pain, and fever. [study.com]
When to Contact a Medical Professional Call your health care provider if you have ongoing or severe flank pain, or fever, or if you think you may have hydronephrosis. [account.allinahealth.org]
- Weight Loss
All the patients were enquired regarding symptoms such as breathlessness, fever, cough, chest pain, constitutional symptoms such as loss of appetite and loss of weight. [ncbi.nlm.nih.gov]
- 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]
- Anemia
[…] infection Swine pox Swine vesicular disease Teschen disease Transmissible gastroenteritis Diseases caused by parasites Ascariasis Coccidiosis Mange Metastrongylosis Trichinellosis Trichuriasis Nutritional deficiencies Biotin deficiency Iron deficiency anemia [pig333.com]
2019 30 Evaluating the distance travelled for urological pediatric appointments. 61 Otis-Chapados S...Moore K 31799921 2019 31 Ureteral involvement by metastatic malignant disease. 61 Hu J...Fu B 31446521 2019 32 [Evaluating the impact of preoperative anemia [malacards.org]
Initially, blood picture was suggestive of the neutrophilic leukocytosis with mild anemia and sputum examination was negative for acid-fast bacilli (AFB). Initial chest X-ray was suggestive of left-sided hydro-pneumothorax [Figure 1]. [ccij-online.org]
Urinalysis to look for blood, infection or abnormal cells Complete blood count (CBC) may reveal anemia or potential infection Electrolyte analysis may be helpful in chronic hydronephrosis since the kidneys are responsible for maintaining and balancing [medicinenet.com]
Fanconi anemia, complementation group O MedGen UID: 462003 •Concept ID: C3150653 • Disease or Syndrome Fanconi anemia (FA) is characterized by physical abnormalities, bone marrow failure, and increased risk for malignancy. [ncbi.nlm.nih.gov]
- Recurrent Infection
Here we present the case of a 16-year-old male patient who had delayed development of upper urinary tract obstruction with recurrent infections following high-grade renal trauma managed conservatively. [ncbi.nlm.nih.gov]
Children with grade IV hydronephrosis (severe) are the most likely to require surgery to prevent renal damage and recurrent infection. [childrenshospitaloakland.org]
Children with grade IV hydronephrosis, the most severe, are the most likely to need surgery to prevent kidney damage and recurrent infection. The surgery to correct hydronephrosis is called pyeloplasty. [ucsfbenioffchildrens.org]
Patients with grade IV hydronephrosis (severe) are the most likely to require surgery to prevent renal damage and recurrent infection. [urology.ucsf.edu]
Gastrointestinal
- Vomiting
Symptoms may include sudden or intense pain in the back or side, vomiting, painful urination, blood in the urine, weakness and fever due to a urinary tract infection. [my.clevelandclinic.org]
In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. [ncbi.nlm.nih.gov]
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]
- Abdominal Mass
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]
Some infants with severe hydronephrosis may have abdominal distention or palpable abdominal mass. [gaurology.com]
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]
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]
- Right Flank Pain
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]
- Failure to Thrive
[…] to thrive, in infants Causes Normally, urine passes from the kidney through a tube called a ureter that drains into the bladder, and then out of the body. [nchmd.org]
[…] to thrive, in infants Causes Typically, urine passes from the kidney through a tube called a ureter that drains into the bladder, and then out of the body. [mayoclinic.org]
[…] to thrive in infants In extreme cases, the kidney swelling may be detectable by appearance or palpation (touch). [verywellhealth.com]
Intrauterine growth restriction (IUGR), failure to thrive (FTT), and poor postnatal growth are common. [ncbi.nlm.nih.gov]
- Left Flank Pain
A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. [ncbi.nlm.nih.gov]
Cardiovascular
- 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]
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]
Begliomini Humanae Vitae Medicine Institute, São Paulo, SP, Brazil Correspondence ABSTRACT INTRODUCTION: Even though it is uncommon, uterine prolapse can cause compression of ureters and bilateral hydronephrosis, predisposing to arterial hypertension [scielo.br]
Musculoskeletal
- Back Pain
The patient was discharged on the 7th postoperative day with no complications and no back pain. She remained well at 3 months with normal activity and good cosmetic result. [ncbi.nlm.nih.gov]
You have mild lower back pain or pain on one side when you urinate. When should I seek immediate care? You have severe, stabbing back pain. You have blood in your urine. You cannot urinate, or you urinate very little. [drugs.com]
Urinary tract infections are characterized by cloudy urine, painful or weak urination, back pain, and fever. [study.com]
- Low Back Pain
A 28-year-old woman was admitted to hospital because of chronic left low back pain. Microscopic hematuria was not seen. Computed tomography showed the horseshoe kidney and left hydronephrosis. [ncbi.nlm.nih.gov]
Urogenital
- Kidney Failure
Loss of kidney function, UTI, and pain may occur if the condition is left untreated. If hydronephrosis is not treated, the affected kidney may be permanently damaged. Kidney failure is rare if the other kidney is working normally. [medlineplus.gov]
If both kidneys are obstructed, kidney failure may result. [merckmanuals.com]
Possible Complications If hydronephrosis is not treated, the affected kidney may be permanently damaged. Kidney failure is rare if the other kidney is working normally. However, kidney failure will occur if there is only one functioning kidney. [account.allinahealth.org]
In some cases, excess urine will need to be drained from the bladder or kidney. Severe cases can lead to kidney failure, although most people can recover from hydronephrosis with prompt and proper treatment. [unitypoint.org]
- Flank Pain
RESULTS: 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]
UTI and pain may also occur. Call your health care provider if you have ongoing or severe flank pain, or fever, or if you think you may have hydronephrosis. Prevention of the disorders that cause this condition will prevent it from occurring. [medlineplus.gov]
- 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]
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]
- Renal Insufficiency
Intravenous pyelogram IV contrast is contraindicated in renal insufficiency. IV contrast is contraindicated in patients with previous anaphylaxis to contrast or iodine. Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [clinicaladvisor.com]
The relevant parameters influencing outcomes and costs were age (p=0.001), neoplasical aetiology (p=0.001), leukocytosis (p=0.001), renal insufficiency (p=0.001), and moment of the intervention (p=0.005). [ncbi.nlm.nih.gov]
Decreased bladder compliance and detrussor instability were documented. 11% of patients had renal insufficiency and required at least temporary upper tract decompression with percutaneous nephrostomy. [medicalnewstoday.com]
Morbidity and 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 [quizlet.com]
- Nocturia
He has had urinary frequency, nocturia, hesitancy, and urinary dribbling for several years with slight worsening with time. CT scan revealed left-sided hydronephrosis (Figure 69-1). [accessmedicine.mhmedical.com]
Nephrolithiasis*, hydronephrosis*, renal colic* Last Update: 2012-04-11 Usage Frequency: 2 Quality: Slovenian hidronefroza, urinarna inkontinenca, hematurija, nikturija, zvišan kreatinin v krvi English Hydronephrosis, Urinary incontinence, Haematuria, Nocturia [mymemory.translated.net]
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.
X-Ray
- Nephrolithiasis
Nephrolithiasis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Updated February 5, 2018. Accessed June 5, 2018. Obstructive uropathy. [winchesterhospital.org]
Hydronephrosis; Chronic hydronephrosis; Acute hydronephrosis; Urinary obstruction; Unilateral hydronephrosis; Nephrolithiasis - hydronephrosis; Kidney stone - hydronephrosis; Renal calculi - hydronephrosis; Ureteral calculi - hydronephrosis; Vesicoureteral [medlineplus.gov]
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]
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].
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 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
- Frokiaer J, Zeidel M. Urinary Tract Obstruction. In: Brenner and Rector's The Kidney, 9, Elsevier, New York 2011.
- Doganis D, Siafas K, Mavrikou M, et al. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007; 120:e922.
- 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.
- Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. Mar 1988;27(3):249-59.
- Harrison MR, Golbus MS, Filly RA, et al. Fetal hydronephrosis: selection and surgical repair. J Pediatr Surg 1987; 22:556.
- Klahr S. Pathophysiology of obstructive nephropathy. Kidney Int. Feb 1983;23(2):414-26.
- Rose BD, Black RM. Manual of Clinical Problems in Nephrology. Boston, Mass: Little, Brown & Co; 1988:337-343.
- 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.
- Platt JF, Rubin JM, Ellis JH. Acute renal obstruction: evaluation with intrarenal duplex Doppler and conventional US. Radiology. Mar 1993;186(3):685-8.
- 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.