Kidneys are vital for overall wellness. They remove waste products and surplus fluid from the blood to generate urine. When urine flows readily down the ureters and into the bladder and out of the body, the urinary system is operating properly. But if there is a blockage or urine flow reversal fluid may build up in the renal pelvis which can lead to a disorder known as hydronephrosis.
Hydronephrosis is not a disease but a structural problem where the kidney is enlarged. It is caused by an obstruction of the kidney or obstruction of the urinary system. If not regulated the continual pressure in the kidney might compromise its function and lead to long term health concerns . It is crucial to know the causes, to be able to notice early signs and to get medical care in time to preserve renal function.
Families and individuals in residential areas such as Baniyas, Shamkha and Shakhbout City in Abu Dhabi have easy access to expert urological care. The Royal Medical Center One Day Surgery in Shakhbout City offers a wide range of diagnostic evaluations and individualised treatment strategies to safely and effectively treat urinary tract diseases.
What is the definition of Hydronephrosis?
Hydronephrosis is enlargement of one or both kidneys due to a build up of urine. Normally urine passes from the kidneys at very low pressure. If there is an obstruction in the path or an anatomic defect that causes urine to reflux, the excess fluid distends the kidney’s collecting system.
The condition presents in two primary forms:
- Unilateral Hydronephrosis: Only one kidney is enlarged. This is the commonest kind. It is due to a local blockage in one ureter.
- Bilateral Hydronephrosis: Swelling of both kidneys at the same time. This typically signifies some form of obstruction farther down the urinary tract, either at the bladder neck or in the urethra and fluid cannot escape from both sides.
What are the Common Hydronephrosis Causes?
An investigation of the whole urinary system is necessary to establish the aetiology of hydronephrosis. Causes vary by age, anatomical factors and underlying health conditions:
- Renal Calculus: Kidney stones (nephrolithiasis) are still one of the most prevalent causes of hydronephrosis in adults. If a stone leaves the kidney it may become stuck in the tiny ureter causing a sudden obstruction. This leads to fast enlargement of the kidney and substantial pain.
- Birth Defects: In the neonate and young kid. In children, hydronephrosis is often caused by anatomical defects present from birth. The most common kind is called ureteropelvic junction (UPJ) obstruction, in which the connection between the renal pelvis and the ureter is too narrow to enable fluid to flow through.
- Vesicoureteral Reflux(VUR): Vesicoureteral reflux occurs when the valve that connects the ureter to the bladder does not close properly and urine spills back into the kidneys. VUR is common in newborns and toddlers with recurrent urinary tract infections.
- Compression of Tumour or Mass: Compression of the ureters externally and prevention of drainage may occur from benign or malignant tumours in the pelvis such as bladder, cervical, prostate or colon cancers.
- Benign Prostatic Hyperplasia (BPH): The prostate gland may get bigger in elderly men and press on the urethra . This can hinder the bladder from emptying and cause the kidneys to enlarge up .
- Pregnancy: In pregnancy the growing uterus may squeeze the ureters against the pelvic brim. The hormonal changes of pregnancy also cause relaxation of smooth muscle tissue in the ureters, which decreases the pace of urine flow and causes mild to severe gestational hydronephrosis.
How to Identify the Signs of Hydronephrosis?
Hydronephrosis symptoms may vary from mild to severe depending of how quickly the obstruction occurs, instantly or over time:
- Flank and Back Pain: Side and Back Pain Pain in the side, back or abdomen, sharp or dull, spreading down into the groin.
- Urination changes: Trouble urinating, a weak urine stream, frequent urination, or a constant feeling of needing to urinate.
- Urinary Tract Infections (UTIs) :Bacteria may develop more easily in stagnant urine, which can cause symptoms like burning, cloudy urine or discomfort when you urinate.
- Fever and Chills: Fever and chills are symptoms of a systemic ailment associated with an irritated and obstructed kidney and require urgent medical attention.
- Nausea and vomiting :Nausea and vomiting may be associated with acute renal colic and acute kidney oedema.
In the chronic slowly advancing types there may be few or no apparent symptoms until the illness is found on routine blood testing or common imaging shows a decreased kidney function.
What are the Complications that might arise with hydronephrosis?
Without treatment, the constant pressure of fluid in the kidney may cause progressive damage to the tissue. Primary hydronephrosis complication includes:
- Permanent Kidney Damage: Long-standing high blood pressure may result in a restriction in blood flow to the renal tissues, causing scarring and loss of filtering ability.
- Severe kidney infections: Urine may get trapped and infected behind a blockage and may lead to pyelonephritis or life threatening urosepsis.
- Kidney Failure: Bilateral untreated blockages might result in acute or chronic renal failure requiring complex intervention or dialysis.
What is the diagnosis of Hydronephrosis?
Diagnosis of hydronephrosis is based on imaging and laboratory assessment to identify the obstruction and to define its aetiology:
- Renal ultrasound: Initial noninvasive imaging modality to evaluate for renal oedema. Evaluate for distention and obvious fluid collection.
- Computed Tomography (CT) scan: Cross-sectional imaging with high resolution to detect small kidney stones, soft tissue masses or external compression of tissues.Voiding Cystourethrogram (VCUG): A special X-ray test that uses fluoroscopy, most typically performed in children to screen for vesicoureteral reflux.
- Blood and Urine screens: Urinalysis screens for blood or infection; serum creatinine and blood urea nitrogen (BUN) levels assess kidney function.
Hydronephrosis: What are the current treatment options?
Treatment of hydronephrosis is directed at the underlying cause, with the objective of relieving the pressure on the kidney and restoring or maintaining kidney function over the long term. The therapy options for severe hydronephrosis are:
Antibiotics: When a concomitant infection is present, intravenous or oral antibiotics are administered immediately to avoid systemic consequences.
Nephrostomy / Ureteric Stent Placement:
- Ureteral Stent: A thin, flexible tube that is placed into the ureter to go around a blockage and maintain an open channel.
- Percutaneous Nephrostomy Tube: When a stent cannot be put in place during an emergency, a tube is placed through the back straight into the kidney to drain the fluid to the outside.
Surgical Procedures: When the blockage is caused to structural problems or chronic stones, surgery offers a final cure:
- Ureteroscopy or Lithotripsy :These are minimally invasive techniques that shatter the kidney stones into little bits to pass naturally.
- Prostate Procedures: Medications or surgery to eliminate prostate tissue in guys with BPH that is squeezing the urethra .
Frequently Asked Questions
Q: Does hydronephrosis resolve on its own?
A: In pregnancy or minor hydronephrosis in the neonatal period, mild hydronephrosis usually resolves spontaneously without long-term effects. However, moderate and severe cases consequent to physical blockages need intensive medical or surgical intervention to protect renal function.
Q: Is hydronephrosis frequently painful?
A: No. Kidney stones that acutely block are quite painful. The majority of hydronephrosis cases are chronic, slowly progressive problems. You may not notice any symptoms until the tissue compression is already advanced.
Q: How to track hydronephrosis in children?
A: Serial ultrasonography tests are used to track renal oedema, measure the pelvic diameter and determine if the condition is stable, improving or requiring surgical correction in paediatric patients.
Conclusions:
Hydronephrosis is a serious, but curable disease, which may be successfully treated with early diagnosis and modern urological therapy. All of them, whether it be a kidney stone or structural congenital variation or external compression require rapid treatment so as to protect renal tissue and adequate urine function.
If you or a loved one is suffering from back pain, trouble urinating or reoccurring infections, book an appointment for an examination at Royal Medical Center One Day Surgery in Shakhbout City, Abu Dhabi. Our medical staff provides precise diagnosis and compassionate treatment for patients in Baniyas, Shamkha and surrounding regions. Call us now to set up your consultation!
