Hydronephrosis
Hydronephrosis is kidney enlargement due to a blockage in the outflow of urine that distends the kidney. According to Merck Manual Online Medical Library, hydronephrosis can be caused by a kidney stone, blood clot, prostate enlargement, fecal impaction, injury, infection, radiation, or a tumor. An enlarging uterus creating pressure can cause hydronephrosis of pregnancy. The main symptom of hydronephrosis is excruciating, intermittent flank pain. Chronic hydronephrosis may have no symptoms. Treatment includes relieving the cause of the blockage.
What Is Hydronephrosis?
Hydronephrosis is a condition that typically occurs when the kidney swells due to the failure of normal drainage of urine from the kidney to the bladder. This swelling most commonly affects only one kidney, but it can involve both kidneys. Hydronephrosis isn’t a primary disease. It’s a secondary condition that results from some other underlying disease. It’s a structural condition that’s the result of a blockage or obstruction in the urinary tract. According to the Boston Children’s Hospital, hydronephrosis affects about one in every 100 babies.
Part 2 of 6
What Are the Symptoms of Hydronephrosis?
Symptoms
Normally, urine flows through the urinary tract with minimal pressure. Pressure can build up if there’s an obstruction in the urinary tract. After urine builds up for an extended period, your kidney can enlarge. Your kidney may become so engorged with urine that it starts to press on nearby organs. If it’s left untreated for too long, this pressure can cause your kidneys to lose function permanently.
The length of time you have the obstruction affects your symptoms. Mild symptoms of hydronephrosis include urinating more frequently and an increase in the urge to urinate. Other potentially severe symptoms you may experience are:
pain in the abdomen or flank
nausea
vomiting
pain when urinating
incomplete voiding
a fever
Interrupting the flow of urine increases your chances of getting a urinary tract infection (UTI). This is why UTIs are one of the most common complications of hydronephrosis. Some signs of a UTI include:
cloudy urine
painful urination
burning with urination
a weak urine stream
back pain
bladder pain
a fever
chills
If you see signs of hydronephrosis, schedule an appointment with your doctor to talk about your symptoms. Untreated UTIs may lead to more serious conditions such as pyelonephritis, or infection of the kidney, and sepsis, which is an infection in the bloodstream or blood poisoning.
Part 3 of 6
What Causes Hydronephrosis?
Causes
Hydronephrosis isn’t a disease. Instead, it can be due to internal and external conditions that affect the kidney and the urinary collecting system.
One of the most common of causes of hydronephrosis is acute unilateral obstructive uropathy. This is a sudden development of an obstruction in one of your ureters, which are the tubes that connect your kidneys to your bladder. The most common cause for this blockage is a kidney stone, but scarring and blood clots can also cause acute unilateral obstructive uropathy. A blocked ureter can cause urine to go back up into the kidney, which causes swelling. This backflow of urine is known as vesicoureteric reflux (VUR).
Other causes of blockage may include:
a kink in the ureteropelvic junction, which is where the ureter meets the pelvis of the kidney
an enlarged prostate gland in men, which can be due to BPH or prostatitis
pregnancy, which causes a compression due to a growing fetus
tumors in or near the ureter
a narrowing of the ureter from an injury or birth defect
Part 4 of 6
How Is Hydronephrosis Diagnosed?
Diagnosis
Getting as early a diagnosis as possible is extremely important. Your kidneys could be permanently damaged if your condition is left untreated for too long. Your doctor will likely begin by getting an overall assessment of your health status and then focus on any urinary symptoms you might have. Your doctor may be able to feel your enlarged kidney by gently massaging the abdomen and flank area.
Your doctor may use a catheter to drain some of the urine from your bladder. If they’re unable to release a large amount of urine this way, it could mean that your obstruction is in your bladder or your urethra. The urethra is a tube that carries urine from your bladder to the outside of your body. Your doctor may also want to perform a renal ultrasound or CT scan to get a closer look at the extent of the swelling and to possibly locate the area of the blockage. Both of these procedures let your doctor view an image of the inside of your body, but the renal ultrasound is generally considered as the gold standard for the diagnosis of hydronephrosis. It allows your doctor to get a closer look at your kidney.
Part 5 of 6
What Are the Treatment Options for Hydronephrosis?
Treatment
Treatment for hydronephrosis primarily focuses on getting rid of whatever is blocking the flow of urine. The treatment option your doctor chooses for you will depend on the cause of your obstruction.
If a blocked ureter is causing your condition, your doctor might need to do any of the following:
insert a ureteral stent, which is a tube that allows the ureter to drain into the bladder
insert a nephrostomy tube, which allows the blocked urine to drain through the back
prescribe antibiotics to control infection
Your doctor might remove the obstruction with surgery. If something like scar tissue or a blood clot is causing the blockage, your doctor might remove the affected area completely. They can then reconnect the healthy ends of your ureter to restore normal urine flow.
If the cause of your hydronephrosis is a kidney stone, you may need surgery to remove it. To do this, your doctor might perform endoscopic surgery, which involves using tiny instruments to perform the procedure. This allows your doctor to make smaller incisions, drastically reducing your healing and recovery time. Your doctor might also prescribe you antibiotics. This will help ensure you don’t develop a kidney infection.
Part 6 of 6
What Is the Long-Term Outlook?
Outlook
If you receive treatment early, your outlook is good. Removal of the obstruction is essential for your kidney to return to normal functioning. If your hydronephrosis requires surgery, you have a 95 percent chance of having a full recovery, according to the Boston Children’s Hospital.
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HYDRONEPHROSIS
Hydronephrosis
is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys.
The main function of the urinary tract is to remove wastes and fluid from the body. The urinary tract has four parts: the kidneys, the ureters, the bladder and urethra. The urine is formed when the kidneys filter blood and remove excess waste materials and fluid. Urine collects into a part of the kidney called the renal pelvis. From the renal pelvis, the urine travels down a narrow tube called the ureter into the bladder. The bladder slowly fills up with urine, which empties from the body through another small tube called the urethra. Hydronephrosis occurs when there is either a blockage of the outflow of urine, or reverse flow of urine already in the bladder (called reflux) that can cause the renal pelvis to become enlarged.
Hydronephrosis may or may not cause symptoms. The main symptom is pain, either in the side and back (known as flank pain), abdomen or groin. Other symptoms can include pain during urination, other problems with urination (increased urge or frequency, incomplete urination, incontinence), nausea and fever. These symptoms depend on the cause and severity of urinary blockage.
How is Hydronephrosis Caused?
Hydronephrosis
is usually caused by another underlying illness or risk factor. Causes of hydronephrosis include, but are not limited to, the following illnesses or risk factors:
Kidney stone
Congenital blockage (a defect that is present at birth)
Blood clot
Scarring of tissue (fromINJURY or previous surgery)
Tumor or cancer (examples include bladder, cervical, colon, or prostate)
Enlarged prostate (noncancerous)
Pregnancy
Urinary tract infection (or other diseases that cause inflammation of the urinary tract)
How is Hydronephrosis Diagnosed?
An ultrasound is typically used to confirm a diagnosis. This procedure uses sound waves to create an image of your kidneys. A doctor can also confirm a diagnosis with x-rays, computerized tomography (CT) and magnetic resonance imaging (MRI). Diagnosis could also involve a cystoscopy, which uses a long tube with a light and camera at the end (cytoscope) that allows the doctor to look inside the bladder and urethra.
Blood and urine tests can also check kidney function. The doctor can also check for blood in the urine, which can be caused by a kidney stone, infection or other factor.
How is Hydronephrosis Treated?
Hydronephrosis is usually treated by addressing the underlying disease or cause, such as a kidney stone or infection. Some cases can be resolved without surgery. Infections can be treated with antibiotics. A kidney stone can pass through by itself or might be severe enough to require removal with surgery.
In cases of severe blockage and hydronephrosis, excess urine may need to be removed using either a catheter to drain urine from the bladder or a special tube called a nephrostomy that drains urine from the kidney. The key to treatment is to get it addressed as soon as possible inORDER to avoid any permanent damage to the kidneys.
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. However, most people can recover from hydronephrosis if treated promptly.
Hydronephrosis of one kidney
Hydronephrosis is swelling of one kidney due to a backup of urine. This problem may occur in one kidney.
Causes
Hydronephrosis (kidney swelling) occurs as the result of a disease. It is not a disease itself. Problems that may lead to hydronephrosis include:
Blockage of a ureter due to scarring caused by prior infections, surgeries, or radiation treatments
Blockge from an enlarged uterus during pregnancy
Birth defects of the urinary system
Back flow of urine from bladder to kidney, called reflux
Kidney stones
Cancers or tumors that occur in the pelvis or abdomen
Problems with the nerves that supply the bladder
The blockage and swelling of the kidney may occur suddenly or may develop slowly.
Hydronephrosis in one kidney occurs in about 1 in 100 people.
Symptoms
Common symptoms include:
Flank pain
Abdominal mass
Nausea and vomiting
Urinary tract infection
Fever
Painful urination (dysuria)
Increased urinary frequency
Increased urinary urgency
In some cases, there may be no symptoms.
Exams and Tests
The condition is found on an imaging test such as:
MRI of the abdomen
CT scan of the kidneys or abdomen
Intravenous pyelogram (IVP)
Kidney scan
Ultrasound of the kidneys or abdomen
Treatment
Treatment depends on the cause of the kidney swelling. Treatment may include:
Placing a stent (tube) through the bladder and ureter to allow urine flow in the kidney and bladder
Placing a tube into the kidney through the skin, to allow the blocked urine to drain out of the body into a drainage bag
Antibiotics for infections
Surgery to correct the blockage or reflux
Removal of any stone that is causing blockage
People who have only one kidney, who have immune system disorders such as diabetes or HIV, or who have had a transplant will need treatment right away.
People who have long-term hydronephrosis may need antibiotics to reduce the risk of urinary tract infections.
Outlook (Prognosis)
Loss of kidney function may occur if the condition is left untreated.
Possible Complications
If hydronephrosis is left untreated, 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.
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.
Prevention
Prevention of the disorders that cause this condition will prevent it from occurring.
Alternative Names
Hydronephrosis; Chronic hydronephrosis; Acute hydronephrosis; Urinary obstruction; Unilateral hydronephrosis; Nephrolithiasis - hydronephrosis; Kidney stone - hydronephrosis; Renal calculi - hydronephrosis; Ureteral calculi - hydronephrosis; Vesicoureteral reflux - hydronephrosis; Obstructive uropathy - hydronephrosis
What causes hydronephrosis?
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There are numerous causes of hydronephrosis that are categorized based upon the location of the swelling and whether the cause is intrinsic (located within the urinary collecting system), extrinsic (outside of the collecting system) or if it due to an alteration in function.
Examples of intrinsic causes of hydronephrosis
Ureter
Kidney stone. Likely the most common reason to have unilateral hydronephrosis is a kidney stone that causes obstruction of the ureter. The stone gradually moves from the kidney into the bladder but if it should act like a dam while in the ureter, urine will back up and cause the kidney to swell. This would be classified as an intrinsic obstruction.
Blood clot
Stricture or scarring
Bladder
Bladder cancer
Bladder stones
Cystocele
Bladder neck contracture
Urethra
The inability to empty the bladder (urinary retention) for any reason may cause bilateral hydronephrosis.
Urethral stricture
Urethral valves
Urethral cancer
Examples of extrinsic causes of hydronephrosis
Ureter
Tumors or cancers that compress the ureter and prevent urine flow. Examples include lymphoma and sarcoma, especially if they are located in the retroperitoneum, where the kidneys and ureters are located behind the sac that contains the bowel.
Retroperitoneal fibrosis
Ovarian vein syndrome
Cancer of the cervix
Cancer of the prostate
Pregnancy
Uterine prolapse
Scarring due to radiation therapy
Urethra
Prostate hypertrophy or swelling is a common cause of urinary retention and subsequent hydronephrosis in males.
Prostate cancer
Examples of functional causes of hydronephrosis
Bladder
Neurogenic bladder or the inability of the bladder to function properly occurs because of damage to the nerves that supply it. This may occur in brain tumors, spinal cord injuries or tumors, multiple sclerosis, anddiabetes among other causes.
Vesicoureteral reflux where urine flows backwards from the bladder into the ureter. Prenatal hydronephrosis is an example, though it may occur at any time in life. Continue Reading
Medically Reviewed by a Doctor on 9/2/2016
You Asked, We Answered
Who is at risk for hydronephrosis?
There are several demographic groups that are considered to have an increased risk of hydronephrosis. These groups include pregnant women (due to an enlarging womb that may compress the ureters); men over the age of 50 (due to enlargement of the prostate or prostate cancer); sexually active women (due to their risk for recurrent urinary tract infections); and those who are predisposed to recurrent kidney stones.
- Steve Kim, MD
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