An Overview of Hydronephrosis

Hydronephrosis, or swollen kidney, occurs when urine backs up into one or both of the kidneys. Usually, urine flows from the kidneys to the bladder. When a blockage or obstruction impedes the normal flow of urine, hydronephrosis can develop.

The urinary tract serves two distinct purposes. The primary function of the kidneys is to filter out extra water, salt, and waste. The second is to collect and excrete urine from the body. If the system becomes blocked, urine can accumulate, causing the kidneys to swell. This is hydronephrosis.

When this impacts one kidney, it is called unilateral hydronephrosis; when both are affected, it’s called bilateral hydronephrosis. In most cases, only one kidney will be affected.

Initially, a person with hydronephrosis may not experience any noticeable signs of dysfunction. But, over time, symptoms may appear as the swelling persists, causing notable discomfort. The extent of the symptoms depends on the reason for the blockage and its severity.  

A person with hydronephrosis may not be aware they have the condition. When symptoms are present, they may show up within a range of hours, weeks, or months. Symptoms can include:

• Flank pain
• Pain during urination
• Blood in the urine
• Fever
• Fatigue
• Malaise
• Nausea
• Vomiting
• Urinary tract infection (UTI)
• A persistent urge to urinate
• Changes in urinary frequency
• Inability to void the bladder completely
• Weak urine stream
• Incontinence
• Failure to thrive in infants

In extreme cases, the kidney swelling may be detectable by appearance or palpation (touch).

Hydronephrosis can affect people of all ages, from before birth to adulthood. If hydronephrosis happens before birth, it is referred to as antenatal hydronephrosis or fetal hydronephrosis.

Common risk factors for hydronephrosis include renal calculi (kidney stones), enlarged prostate, pelvic masses or tumors (such as ovarian cysts, cervical cancer, or prostate cancer), and neurogenic bladder (the neurological loss of bladder control).

Hydronephrosis can even occur during pregnancy as the developing fetus presses against the urinary tract. Diabetes can also contribute due to the progressive deterioration of kidney function in people with poorly controlled disease (diabetic nephropathy).

Among infants and children, boys are twice as to experience hydronephrosis than girls. However, the condition does not appear to be inherently linked to genetics or family history.

To diagnose hydronephrosis, you may be referred to a urologist for a series of tests and examinations. The most standard of which include:

• Physical exam: The physician will take a detailed account of your symptoms and medical history and examine the kidney area. This will include a visual and manual exam to detect signs of kidney swelling or tenderness.
• Imaging studies: The doctor may use ultrasound, X-rays, computed tomography (CT). or magnetic resonance imaging (MRI) to see if your kidney is swollen and where the obstruction is occurring. Contrast dyes are sometimes used to visualize blood vessels and soft tissue masses.
• Lab tests: Lab work may include a blood test to evaluate your kidney function (including urea and creatinine levels) and check if you could have an infection. You may also be asked to provide a urine specimen for a urinalysis to check for signs of an infection, blood, or kidney stones.

To ensure the correct diagnosis, the doctor may perform other tests to exclude causes that are similar to hydronephrosis. The differential diagnoses may include multicystic dysplastic kidney (a congenital malformation of the kidneys), ureteroceles (a birth defect of the ureters that connect the kidneys to the bladder), and vesicoureteric reflux (a condition where urine backflows from the bladder to the kidneys).

Although the treatment for hydronephrosis varies depending on the reason for the condition, in some cases, the situation resolves without the need for medical intervention. In mild to moderate cases, your physician may choose to wait and see if the condition improves on its own.

If your physician suspects a UTI or if you are at risk of developing one, they may prescribe you a course of antibiotics. If pain is an issue, you may also receive an over-the-counter or prescription nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or diclofenac.

In severe cases of hydronephrosis, surgery may be needed to remove obstructions or redirect the flow of urine. Hydronephrosis accompanied by a 5% to 10% loss of kidney function may warrant pyeloplasty (the surgical reconstruction of the kidney). Other indications for surgery include persistent kidney pain, a palpable lump on the kidney, or recurrent UTI with a high fever.

Neurologic causes of hydronephrosis (such as a spinal cord injury that impairs bladder function) may require ongoing catheterization to help clear urine and anticholinergic drugs to increase bladder capacity.

Severe hydronephrosis can cause permanent kidney damage, but, in most cases, only one kidney will be harmed. Fortunately, one kidney is usually capable of doing the work of two.

When the cause of hydronephrosis is determined, there may be certain lifestyle modifications patients can implement to lessen the chances of it happening again. For example, if a person is prone to kidney stones, a specialized diet may help to avoid a recurrence of them.

As another example, if hydronephrosis is caused by urinary retention, muscle and nerve problems in the pelvis, or organ prolapse, pelvic floor therapy from a trained physical therapist can assist with retraining the bladder to work in a more normal way.

Any medical diagnosis can be scary, but thankfully, the prognosis for hydronephrosis is good when you seek appropriate medical treatment. If you develop a fever, sudden pain in the abdomen, side, or back, or any other symptoms of hydronephrosis, don’t wait to get the care you need; see your doctor as soon as possible.