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Hydronephrosis : Symptoms, Causes & Treatment

Even slight damage to the kidney can cause substantial illness to your body. Kidneys are responsible for the excretion of waste products. They also release wastes from our body through the urine. Any blockage or other such problem can lead to permanent kidney damage where the kidneys can no longer excrete the waste product. In such cases, it leads to the accumulation of urine in the kidney leading to Hydronephrosis.

Hydronephrosis means the swelling up of one or both the kidneys that usually happens due to the build-up of urine in them. It is of many types and can occur at any age. If it is one-sided, then it is termed as unilateral Hydronephrosis. If it affects both kidneys, you are likely to have bilateral Hydronephrosis.

What Causes Hydronephrosis

  • Any obstruction or blockage in your ureters can cause Hydronephrosis. Ureters are tube-like structures connecting the kidneys to the urinary bladder. They help in the drainage of urine.  Urinary tract blockages often develop where our kidney meets the ureter. Though less common, blockages can occur where ureter meets the bladder.
  • Vesicoureteral reflux.Vesicoureteral reflux occur when urine flows backward up into the kidney through the ureter from the bladder. Usually, urine flows only one way in the ureter. Urine flowing backwards or the wrong way, makes it difficult for our kidney to empty properly and may cause the kidney to swell.

Some other causes of urinary tract blockage [leading to Hydronephrosis],  include the following:

  • Kidney stone crystals
  • Cancer or tumour
  • Development of blood clots
  • Congenital problems, i.e. birth defects – Hydronephrosis in babies is often detected after (postnatal) or even before birth (prenatal)
  • Pregnancy and uterine prolapse in the case of women

The blockage restricts the flow of urine outside the body, and as a result, its quantity keeps increasing in the kidney, thereby causing its swelling. At the same time, the ureters can get dilated, causing hydroureteronephrosis. Hydronephrosis though many times it doesn’t cause symptoms, eventually, it can lead to symptoms.

Symptoms of Hydronephrosis:

Symptoms of hydronephrosis depend upon whether the swelling occurs acutely or progresses more gradually. If it is an acute obstruction, symptoms might include nausea, writhing pain and vomiting.

Acute Hydronephrosis may present with :

  • Sudden pains – they can be at the side and the back or abdomen and groin region. It can also occur during urination
  • Increased urge to urinate
  • Blood in urine
  • Nausea and vomiting
  • Fever and weakness

Chronic hydronephrosis develops over time and often does not display any specific symptoms. The patient may, however, have symptoms of kidney failure which are often nonspecific and may include  malaise, weakness, chest pain,  leg swelling, shortness of breath, nausea and vomiting. There may be heart rhythm disturbances and muscle spasms due to electrolyte abnormalities as the kidneys are unable to regulate sodium, potassium, and calcium.

If you see any symptoms or signs of Hydronephrosis, then consult your doctor immediately. You should never wait for the disease to progress towards extreme complications.

What complications can Hydronephrosis cause?

Hydronephrosis if left undiagnosed, can lead to complications like Urinary Tract Infection (UTI). It is also linked to increased temperature of the body along with high blood pressure.

Your doctor will most likely diagnose the condition and classify it. It can be mild Hydronephrosis, moderate or severe Hydronephrosis depending on the severity of the disease.

Diagnosis of Hydronephrosis

Hydronephrosis treatment depends on the underlying cause, which is detected by the clinical diagnosis of the patient.

  • Your doctor will begin with a physical examination. It is done by evaluation of pain and other signs of the illness, taking a detailed past history or by feeling the enlarged bladder in your pelvic area.
  • Blood Tests such as total blood count to detect any infection and the levels of creatinine, blood urea nitrogen to assess kidney function.
  • Urine Tests – Urine samples are taken to detect the presence of stones or bacterial infection.
  • An ultrasound study to confirm the diagnosis of hydronephrosis.
  • KUB X-rays(an X-ray that shows the kidney, ureter, and bladder) are used to classify a kidney stone as radiodense or radiolucent and may use KUB X-rays to determine if the stone is able to migrate down the ureter into the bladder.
  • MRI (Magnetic Resonance Imaging) and CT (X-ray Computed Tomography) scan might be prescribed.
  • There is also a possibility that your doctor can prescribe a MAG3 scan which will assess the functioning and the drainage capacity of the kidney.

Treatment of Hydronephrosis

  • Mild Hydronephrosis to moderate Hydronephrosis

Your doctor is most likely to keep you under observation. To prevent urinary tract infection, they (your doctor) might prescribe some antibiotics. Analgesics will be prescribed to relieve pain at the sides and back or the abdominal region.

  • Severe Hydronephrosis

If the blockage is severe and a huge amount of urine accumulates, your doctor will use a nephrostomy tube to drain the excess urine from the kidney.  Surgery can be an option to cure the underlying cause of obstruction to restore a normal urine flow from the kidneys to the urinary bladder. Shock wave lithotripsy could be done to break down and clear the kidney stones to cure the underlying cause of Hydronephrosis.

Left untreated, severe hydronephrosis can lead to permanent kidney damage. Rarely, it can cause kidney failure. But hydronephrosis typically affects only one kidney and the other kidney can do the work for both.

These frequently asked questions will provide you with an overview of Hydronephrosis:

FAQs of Hydronephrosls:

Q: What is the main cause of Hydronephrosis?

A: Several factors cause Hydronephrosis, but the leading cause is due to obstruction in the tubes that pass urine from the kidney to the urinary bladder from which it can be excreted through the urethra. Due to the blockage, it leads to the accumulation of urine and swelling up of the kidney.

Q: How do you fix or treat Hydronephrosis?

A: Hydronephrosis treatment constitutes a physical examination initially,  followed by a diagnosis of the underlying cause of the disease. As soon as your doctor detects the cause, he or she can then term it as mild, moderate, or severe Hydronephrosis. It can be treated by non-surgical as well as surgical methods depending on the severity. Your doctor will prescribe you antibiotics to prevent any infection and analgesics for relieving you of pain.

Q: How long does Hydronephrosis last?

A: If Hydronephrosis remains untreated, it can lead to severe outcomes and complications, leading to permanent kidney damage or failure. This can be resolved if kidney swelling is brought under control. The kidneys will recover even during blockage lasting up to six weeks.

Q: What food substances should I avoid during Hydronephrosis?

A: A kidney-friendly diet should be adopted during any renal (kidney) disease. With  Hydronephrosis, your doctor might ask you to limit the intake of sodium and potassium to 2,000 mg per day and restrict phosphorus to 800–1,000 mg per day. Avocados, dark-coloured sodas, brown rice, bananas, oranges, dairy products due to their high potassium content should be avoided. Some processed meats and canned foods have a lot of salt content which can be harmful during Hydronephrosis.

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Verified By Dr Bibekananda Panda
MD PEDIATRICS DNB NEPHROLOGY, Senior Consultant - NEPHROLOGY, Apollo Hospitals, Bhubaneshwar

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