Hydronephrosis (Swollen Kidney): Symptoms, Causes, Treatment

What are the symptoms of hydronephrosis?

Hydronephrosis is a condition where one or both kidneys become swollen due to the accumulation of urine. The symptoms can vary depending on the severity and cause but may include:

1. Pain: Typically felt in the flank (side of the abdomen), back, or lower abdomen. The pain can be dull or sharp and may come and go.
2. Urinary Symptoms: These can include increased urinary frequency, urgency, or difficulty urinating.
3. Nausea and Vomiting: Particularly if the condition is severe or causing significant discomfort.
4. Fever: In cases where there is an associated infection.
5. Blood in Urine (Hematuria): Sometimes visible, sometimes only detectable under a microscope.
6. Swelling: If severe, there may be visible abdominal swelling due to the enlarged kidney.
7. Other Symptoms: These can include fatigue, weight loss, and general discomfort.

If you suspect hydronephrosis or experience persistent pain or other symptoms related to your kidneys, it’s important to seek medical evaluation for proper diagnosis and treatment.

What are the causes of hydronephrosis?

Hydronephrosis can be caused by various conditions that interfere with the normal flow of urine from the kidneys to the bladder. Some common causes include:

1. Kidney Stones: These can block the flow of urine at various points in the urinary tract, causing back pressure and swelling of the kidney.
2. Urinary Tract Obstruction: This can be due to congenital abnormalities, tumors, or scar tissue that narrows or blocks the urinary tract.
3. Enlarged Prostate: In men, an enlarged prostate can obstruct the flow of urine from the bladder, leading to hydronephrosis.
4. Pregnancy: The growing uterus can compress the ureters, leading to temporary hydronephrosis.
5. Vesicoureteral Reflux: A condition where urine flows backward from the bladder into the ureters and kidneys.
6. Ureteral Strictures: Narrowing of the ureters due to injury, surgery, or disease can block urine flow.
7. Tumors: Growths in the kidney, ureter, bladder, or nearby structures can obstruct urine flow.
8. Neurogenic Bladder: Nerve damage or disorders affecting bladder function can lead to urine retention and backflow.
9. Infection: Severe urinary tract infections can cause swelling and blockages that lead to hydronephrosis.
10. Retroperitoneal Fibrosis: A rare condition where fibrous tissue grows around the ureters, causing obstruction.

Hydronephrosis can develop rapidly (acute) or gradually over time (chronic). The underlying cause needs to be identified and treated to prevent kidney damage and other complications.

How is the diagnosis of hydronephrosis made?

The diagnosis of hydronephrosis, a condition in which the kidneys swell due to the accumulation of urine, is typically made through a combination of physical examination, imaging tests, and laboratory tests. Here are the common methods used to diagnose hydronephrosis:

1. Physical Examination: A doctor may perform a physical examination to check for signs of hydronephrosis, such as:
   • Abdominal tenderness or swelling
   • Mass or lump in the abdomen
   • Nausea and vomiting
2. Imaging Tests: Imaging tests are used to visualize the kidneys and urinary tract to detect any blockages or obstructions that may be causing the hydronephrosis. The most common imaging tests used are:
   • CT Scan (Computed Tomography): Uses X-rays and computer technology to produce detailed cross-sectional images of the body.
   • MRI (Magnetic Resonance Imaging): Uses strong magnetic fields and radio waves to produce detailed images of the body.
   • Ultrasound: Uses high-frequency sound waves to produce images of the kidneys and surrounding tissues.
   • IVU (Intravenous Urography): An X-ray exam that uses a contrast dye to visualize the kidneys, ureters, and bladder.
3. Laboratory Tests: Laboratory tests may be performed to check for underlying conditions that may be contributing to hydronephrosis, such as:
   • Urinalysis: A test that checks for abnormalities in urine, such as blood, protein, or bacteria.
   • Blood Tests: Blood tests may be ordered to check for kidney function, electrolyte levels, and other underlying conditions that may be contributing to hydronephrosis.
4. Cystoscopy: A flexible tube with a camera and light on the end (cystoscope) is inserted through the urethra to visually examine the inside of the bladder and ureters.
5. Urodynamic Studies: A test that measures the pressure and flow of urine as it flows from the bladder through the urethra.

Based on the results of these tests, a doctor can diagnose hydronephrosis and determine the underlying cause, which may be a blockage in the urinary tract, kidney stones, tumor, infection, or other conditions.

What is the treatment for hydronephrosis?

The treatment for hydronephrosis, a condition in which the kidneys swell due to the accumulation of urine, depends on the underlying cause and severity of the condition. Here are some common treatments for hydronephrosis:

1. Conservative Management: For mild cases of hydronephrosis, conservative management may be sufficient, which includes:
   • Antibiotics to treat infections
   • Analgesics to manage pain and discomfort
   • Fluid intake to increase urine production and help flush out the kidneys
2. Medical Treatment: For more severe cases, medical treatment may be necessary, which includes:
   • Antibiotics: To treat bacterial infections that may be causing the hydronephrosis
   • Alpha-blockers: To relax the muscles in the urinary tract and improve urine flow
   • Diuretics: To increase urine production and help flush out the kidneys
3. Surgical Treatment: In cases where medical treatment is not effective or if there is a blockage in the urinary tract, surgery may be necessary, which includes:
   • Nephrostomy: A tube is inserted into the kidney to drain urine directly into a collection bag
   • Ureteral stenting: A stent is placed in the ureter to keep it open and allow urine to drain properly
   • Surgery to remove blockages: Surgery to remove kidney stones, tumors, or other blockages that are causing the hydronephrosis
4. Minimally Invasive Procedures: Some procedures can be performed minimally invasively, such as:
   • Percutaneous nephrolithotomy (PCNL): A small incision is made in the back to insert a scope and remove kidney stones or other blockages
   • Laser lithotripsy: A laser is used to break up kidney stones or other blockages
5. Dialysis: In severe cases of hydronephrosis, dialysis may be necessary to remove waste products from the blood when the kidneys are no longer able to function properly.
6. Ureteroscopy: A ureteroscope is inserted through the urethra and bladder to visualize and treat blockages in the ureters.
7. Lithotripsy: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure that uses shock waves to break up kidney stones.
8. Drainage procedures: Procedures such as percutaneous nephrostomy (PCN) or ureteral stenting may be necessary to drain urine from the kidney and relieve pressure.

It’s essential to consult with a healthcare provider to determine the best course of treatment for your specific case of hydronephrosis.