Hydronephrosis: Causes & Treatment

Imagine waking up with a sudden, sharp pain, only to find out that your kidneys are swollen because your urine isn’t flowing out properly. This condition, known as hydronephrosis, can be both alarming and painful.

Hydronephrosis occurs when one or both kidneys swell up because urine can’t flow out of the body properly. This can cause sudden or intense pain in your back or side, vomiting, painful urination, blood in your urine, and feeling weak or feverish due to a urinary tract infection.

What Causes Hydronephrosis?

Hydronephrosis is usually caused by a blockage or obstruction in your urinary tract, which stops urine from flowing properly. Many different conditions can lead to this. Here are some common causes:

In Adults

• Kidney Stones: Hard deposits made of calcium and oxalate can get stuck in your kidneys or urinary tract, causing a blockage.
• Ureteral Obstruction: An obstruction in the ureters (the tubes that carry urine from the kidneys to the bladder) can block urine flow.
• Tumors: Tumors in the bladder, prostate gland, uterus, or nearby organs can obstruct the urinary tract and prevent urine from flowing.
• Benign Prostatic Hyperplasia (BPH): An enlarged prostate gland can press on the urethra, making it hard for urine to pass through.
• Narrowing of the Urinary Tract: This can happen due to injury, infection, birth disorders, or surgery, making it difficult for urine to flow smoothly.
• Nerve or Muscle Problems: Issues with the nerves or muscles that control the kidneys or ureters can affect urine flow.
• Urinary Retention: This occurs when you can’t completely empty your bladder, leading to a buildup of urine.
• Vesicoureteral Reflux: This is a condition where urine flows backward from the bladder to the kidneys.
• Ureterocele: A condition where the lower part of your ureter protrudes into your bladder, causing a blockage.

In Women

• Pregnancy: As the uterus expands, it can press on the ureters and block urine flow.
• Uterine Prolapse: The uterus sags or slips out of its normal position, pressing on the urinary tract.
• Cystocele (Fallen Bladder): When the wall between the bladder and vagina weakens, the bladder can droop into the vagina, obstructing urine flow.

In Babies (Antenatal Hydronephrosis)

• Increased Urine Production: The fetus produces more urine than usual, causing a buildup.
• Blockage in the Urinary Tract: A blockage at any point in the urinary tract can cause hydronephrosis.
• Backflow of Urine: Urine flows backward from the bladder to the kidneys, leading to swelling.

Understanding these causes can help in diagnosing and treating hydronephrosis effectively.

Common Symptoms Of Hydronephrosis

Hydronephrosis often doesn’t have any noticeable symptoms, especially if it’s mild. In some cases, particularly in babies with antenatal hydronephrosis, symptoms may not appear at all after birth. However, when symptoms do occur, they can be quite distressing and vary depending on the cause. Here are some common symptoms:

• Sudden or Intense Pain: You might feel sharp pain in your sides, abdomen, or back.
• Nausea or Vomiting: You could feel sick to your stomach or even vomit.
• Painful Urination: Peeing might become painful.
• Blood in Your Pee: Your urine could have traces of blood.
• Urinary Tract Infection (UTI): You might get a UTI, which can cause additional symptoms.
• Difficulty Emptying Your Bladder: You may struggle to completely empty your bladder.
• Changes in Urination: You could find yourself peeing more or less than usual.

If you have hydronephrosis, your risk of getting a UTI increases. This is because trapped urine can lead to bacterial growth in your urinary tract. Symptoms of a UTI include:

• Fever, chills, and feeling tired
• Painful or burning sensation when peeing
• Cloudy urine

Recognizing these symptoms early can help in seeking prompt medical attention and treatment.

How is Hydronephrosis Diagnosed?

Diagnosing hydronephrosis quickly is crucial to prevent long-term kidney damage. Here’s how your healthcare provider will diagnose the condition:

1. Physical Examination

• Symptom Check: Your doctor will ask about any symptoms you’re experiencing.
• Area Examination: They will check the area near your kidneys and bladder for tenderness or swelling.
• Medical History: You’ll be asked about your medical history and your family’s medical history.
• For People with a Penis: A rectal exam may be done to check for an enlarged prostate.
• For People with a Vagina: A pelvic exam may be done to check for issues with the uterus or ovaries.

2. Urine Tests

• Sample Analysis: A sample of your urine will be checked for blood, stone crystals, bacteria, or signs of infection.
• Catheter Use: If necessary, a catheter might be used to collect urine directly from the bladder.

3. Blood Tests

• Infection Check: A complete blood count (CBC) can show if there’s an infection.
• Kidney Function Tests: Tests for creatinine, estimated GFR (eGFR), and blood urea nitrogen (BUN) will show how well your kidneys are working.

4. Imaging Procedures

• Ultrasound: This is the main test used to see your kidneys and urinary tract.
• CT Scan or MRI: These may be used if more detailed images are needed.

Note for Babies: Hydronephrosis can be detected in a fetus as early as the first trimester using ultrasound. It’s often discovered during a routine 20-week ultrasound. If diagnosed, the birth parent may need additional ultrasounds to monitor the baby. Most cases resolve on their own before or shortly after birth.

The Treatment Of Hydronephrosis

The goal of treating hydronephrosis is to restore normal urine flow from the kidney and reduce swelling and pressure. The treatment approach depends on the underlying cause of the condition.

Immediate Interventions

• Nephrostomy Tube: In cases of sudden, severe blockage, a nephrostomy tube might be inserted through the skin directly into the kidney to drain urine safely.
• Ureteral Stent: A soft plastic tube can be temporarily placed in the ureter to keep it open, ensuring proper urine flow and relieving immediate pressure.

Addressing Kidney Stones

• Shock Wave Lithotripsy (ESWL): High-energy shock waves break kidney stones into smaller pieces or dust, allowing them to pass naturally.
• Ureteroscopy: A thin tube is inserted into the urethra to break up and remove stones, especially effective for stones in the bladder or lower ureters.

Surgical Options

• Stone Removal: Surgery may be necessary for large or difficult-to-remove kidney stones that completely block the system.
• Tumors or Scar Tissue: Surgery might also be required to remove tumors, scar tissue, or other structural blockages causing hydronephrosis.

Infections

• Antibiotics: If a urinary tract infection (UTI) or narrowing of the urinary tract due to inflammation is present, targeted antibiotics will be prescribed to clear the infection.

Discuss all possible treatment options with your healthcare provider to determine the best approach for your specific condition.

Conclusion

Understanding and addressing the causes of hydronephrosis is crucial for effective treatment and relief. Treatment options vary depending on the underlying condition, ranging from monitoring mild cases to surgical interventions for more severe blockages. Restoring normal urine flow and reducing kidney swelling are primary goals, achieved through various reliable urological methods.

Consult with our experts at CureStone to explore the most suitable treatment options for your condition. Prompt and appropriate treatment can alleviate symptoms and prevent long-term complications, ensuring better kidney health and overall well-being.

Frequently Asked Questions (FAQs)

Can hydronephrosis go away on its own without treatment?

It depends entirely on the cause. Mild cases caused by temporary factors, such as pregnancy or minor infant developments (antenatal hydronephrosis), often resolve on their own. However, if the swelling is caused by a physical blockage like a kidney stone or a tumor, it will not go away without medical intervention.

Is hydronephrosis dangerous or life-threatening?

If left untreated, severe or chronic hydronephrosis can be very dangerous. Continuous pressure from blocked urine can cause permanent damage to kidney tissue, leading to irreversible kidney failure or severe blood infections (sepsis) from trapped, infected urine.

How quickly does a kidney recover after treating hydronephrosis?

If the blockage is caught early and cleared promptly, the kidney usually begins to recover and relieve its swelling within a few days to a couple of weeks. If the blockage was present for months, the recovery may be partial, depending on how much permanent tissue damage occurred.

What is the fastest way to relieve pain and swelling from hydronephrosis?

The fastest and most effective way to relieve the symptoms of hydronephrosis is to decompress the kidney. Urologists typically achieve this immediately by inserting a temporary ureteral stent or a nephrostomy tube to instantly bypass the blockage and drain the trapped urine.