Hydronephrosis - Causes, Symptoms, Diagnosis and Prevention

Hydronephrosis: A Kidney Disorder

Dr.Sanjiv Saxena profile Authored by Dr.Sanjiv Saxena on 9 Jan 2015 - 15:30.

Hydronephrosis

Hydronephrosis is an accumulation of urine in the kidney (any one or maybe both) causing swelling in the kidney. The condition may be present as a normal variant or may emerge as a consequence of any underlying illnesses. Sometimes, Hydronephrosis may result from any birth defect causing blockage which restricts the onward flow of urine. Although it may affect any age. About 80 percent of pregnant women develop physiological Hydronephrosis. Poorly managed or if left untreated, accumulated fluid may exert excess pressure on kidneys, causing reduced blood filtration rate and structural damage to the kidney, which may be irreversible.

Types of Hydronephrosis: Based on the pace at which the blockage occurs, Hydronephrosis is classified as:

  • Acute Hydronephrosis: Blockage of urine occurs suddenly like in the case of kidney stones. Symptoms develop within a couple of hours.
  • Chronic Hydronephrosis: Blockage occurs gradually or is without symptoms and so  may diagnosed after several weeks or months. 

 

Primarily, Hydronephrosis often results from either blockage in the urinary tract or from abnormal condition causing reverse flow of urine from bladder to kidneys. Further, this blockage or reverse flow may occur due to following reasons:

  • Kidney stones – Can be a cause of Hydronephrosis in both men and women. Kidney stones may travel to the ureter blocking the urine flow.
  • Primary vesicoureteral reflux 
  • Benign prostate hyperplasia (BPH) in men
  • Cancers of reproductive organs – especially prostate cancer in men and cervical cancer, ovarian cancer and womb cancers in women.
  • Kidney cancer and bladder cancer
  • Prostate Cancer
  • Cystocele
  • Bladder stones
  • Enlargement of the uterus during pregnancy, which exerts pressure on the ureters causing obstruction.
  • Other rare causes may include:
  • Formation of blood clot that travels to the ureter
  • Endometriosis in women (alters the structure of the urinary tract)
  • A lung infection that often spreads to the bladder. e.g. Tuberculosis
  • Injury to the nerves controlling bladder functions due to diabetes, brain tumor, multiple sclerosis etc.
  • Ovarian cysts in women
  • Urinary tract infection
  • Injury or surgery causing narrowing of the ureter
  • Radiation therapy causing scarring 
     

Hydronephrosis during pregnancy:

A large percentage of pregnant women develop hydronephrosis or hydroureter, which may be due to physiologic response to pregnancy. Experts think , hydronephrosis or hydroureter in pregnant women occur due to the effects of progesterone on the ureters which decreases their tone.

According to Pubmed, In more than 80% of the cases, hydronephrosis and hydroureters during pregnancy occurs most frequently and is most pronounced in primigravida (pregnant for the first time). The dilatation develops during the second trimester, and becomes more prominent on the right side and disappears within a few weeks after birth.

The condition is not seen in women whose ureters do not cross the pelvic brim. The extent of the dilatation can be reduced by placing the woman on the side least affected or in the knee-elbow position. Researchers conclude that the probability of hydronephrosis during pregnancy develops as a result of compression of the ureters between the pregnant uterus and the linea terminalis. The clinical significance of hydronephrosis lies in the association between ureteral obstruction and the high frequency of ascending urinary tract infection during pregnancy.

Hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of ultrasonography, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter say researchers.

 

 

Symptoms of acute and chronic Hydronephrosis may vary. Severity of symptoms may range from mild to severe, depending upon the blockage site, the duration for which urine remains in the kidneys, and extent of kidney swelling and damage. Some common symptoms presented may include:

  • Intense pain in the back, lower abdomen, hip area and in the area between the ribs, especially at the side of affected kidney
  • Pain in the testicles and vagina in men and women respectively
  • Nausea and vomiting
  • Severe pain on drinking fluids
  • Fever more than 100.4 F
  • Significant shivering
  • Blood in the urine
  • Feeling enlarged kidneys by touching them externally
  • On and off, dull pain
  • Less often urge to urinate or incomplete urination
  • Itching

When to see a doctor?

Visit your doctor, if you are experiencing:

  • Intense and persistent flank pain without notable cause which does not go on its own.
  • Back, hip or rib pain is accompanied by few or many of the above symptoms.

The diagnosis of Hydronephrosis may involve a series of tests, including physical assessment, imaging tests, blood exams, urine analysis, and some more tests to probe into the underlying cause.

  • Physical exam – Examine symptoms of enlarged kidneys
  • Ultrasound – Assessing kidney swelling.
  • Blood exams –  To detect infections.
  • Urine analysis –  To detect urinary tract infection.
  • Intravenous urography –  To detect the site of obstruction with the help of a dye.
  • Computerized tomography (CT) scans – To obtain multiple images of kidney in 3D form to examine the kidney thoroughly. 

Further, bladder catheterization, MRI scans, cystoscopy, voiding cystourethrogram (VCUG), etc. can also be useful in the diagnosis, in some situations.

During pregnancy, the fetus can be diagnosed for Hydronephrosis on routine ultrasounds scan.

Hydronephrosis in infants:

Infants with hydronephrosis may be diagnosed before (prenatal) or after (postnatal) birth. The most common urological problem found during prenatal ultrasound screening is the antenatal hydronephrosis. It is observed as kidney is enlarged with fluid filled in it due to obstruction in the output of the urine. It is normally caused by narrowing of the ureter.

 

Regular ultrasound testing during pregnancy will help monitor kidney growth and function of the baby during the pregnancy, infancy and childhood. Normally the condition will usually resolve on its own without any damage to the kidney.  In some instances, though the kidney appears enlarged in the ultrasound, it is found to function normally after delivery.

 

 

 

Treatment options may vary with overall health status, extent of blockage, damage and severity of symptoms. Basically, all available treatments work to:

  • Expel out the accumulated urine
  • Prevent kidney damage

Drugs and medications: Experts may prescribe various medications to treat symptoms as well as underlying conditions like infections, chemotherapy for cancers, neurogenic bladder and so on.

In most cases, surgery involving multiple procedures may be required. Early surgery after the diagnosis is done if one is experiencing severe symptoms or  the kidney damaged has started.

Percutaneous catheterizaton of kidney:  To drain the urine out using a catheter inserted directly into the kidneys via small incisions. This helps to relieve pain and excess pressure on the kidneys instantly, thereby preventing further damage.

Ureteral stenting: To remove the obstruction in the ureter by inserting small tube called stent into the ureter.

Laser treatment: To remove the blockage caused due to kidney stone by breaking down the stone with the aid of sound waves. 

Surgery to remove enlarged prostate: When the underlying cause is BPH.

Cancer therapy: When the underlying cause is any cancer, chemotherapy, radiation therapy and surgery may be used alone or in combination.

Alternative treatments: (should be consulted with respective specialist before considering any alternative treatment)

  • Micro-Chinese Medicine Osmotherapy: A Chinese therapy that utilizes ancient herbal remedies in combination with advanced equipment to improve the kidney function. 
  • Herbal medicines: Homeopathy experts may prescribe some beneficial herbal preparations to treat Hydronephrosis. E.g. Punarnavamandur, varunadivati and so on. (Note: Take any herbal preparation, or supplement only after expert advice).

Diet and nutrition recommendations:

  • Drink lots of fluid and water (about 8 glasses per day)
  • Include lemon oil as a part of your diet or drink
  • Take Zendocrine Detoxification Complex
  • Cabbage, cauliflower, blueberries, garlic, onion, apple, raspberries, strawberries, etc.
  • Include egg white and fish in your diet

Avoid eating:

  • Limit the salt intake and foods rich in sodium
  • Avoid soda, caffeine rich drinks, chocolates, etc.
  • Limit alcohol consumption
  • Limit processed and deep fried foods
  • Reduce sugar intake

Complications: If prolonged or not treated on time, Hydronephrosis may lead to scarring of the kidney tissues that may cause:

  • Altered or loss of kidney functions
  • Fatigue
  • Swelling of legs and hands
  • Difficulty in breathing
  • Kidney failure

The only preventive measure against Hydronephrosis is to treat the possible cause promptly and effectively. If you happen to have any of the health conditions that might lead to Hydronephrosis, talk to your doctor and get yourself screened( Kidney health checkup) periodically to track your kidney health. Further, eating healthy, exercising daily and maintaining hygiene and a healthy weight, can prevent you from various health issues.

 

 

 

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.