Hydronephrosis - Symptoms, Diagnosis, Cures

Symptoms, signs and complications

To learn more: Symptoms Hydronephrosis

The symptoms of a hydronephrosis depend on different characteristics and, precisely, vary according to three parameters:

• Speed ​​with which the urinary tract is blocked
• Degree of closure, partial or total
• Unilateral or bilateral obstruction

It is quite obvious how the second and third parameters affect symptoms. A total closure of the urinary tract, in fact, is much more serious than a partial closure; the same applies to bilateral hydronephrosis: in fact, the involvement of both kidneys implies superior renal failure, compared to when the hydronephrosis is unilateral.

The first parameter, instead, deserves a separate discussion. Depending on how quickly the passage to the urine flow closes, you can have two different forms of hydronephrosis, in some respects similar and for others different.

When the occlusion is formed rapidly, one speaks of acute hydronephrosis ; when, on the contrary, the obstruction is created slowly, we speak of chronic hydronephrosis .

ACUTE HYDRONEFROSIS

Acute hydronephrosis is usually due to kidney stones and develops in a few hours (this is why it is called acute).

The main symptom of an acute hydronephrosis is severe pain, which occurs at the lumbar and one or both sides (between the ribs and the hip). Sometimes, the painful sensation can also be felt at the level of the testicles (in humans) or the vagina (in women). Moreover, it tends to come and go and get worse when the patient drinks something.

The following symptoms and signs are added to the pain:

• Nausea and vomit
• Difficulty urinating
• Bacterial renal infections due to urine stagnation
• High fever, above 38 ° C
• Uncontrollable chills
• Blood in the urine (irrefutable proof of the presence of a kidney stone)
• Swelling at the kidneys, when hydronephrosis is severe

CHRONIC HYDROPHONES

The condition of chronic hydronephrosis is established, on the other hand, very slowly: in fact, weeks are required, if not even months. The explanation of this gradualness is to be connected, almost certainly, to the causes: for example, a tumor in the reproductive organs, a pregnancy etc., are slow processes, which take time to cause hydronephrosis.

Symptoms and signs do not differ much from those described for acute hydronephrosis. Pain is always the main manifestation of the disorder, with the only difference that, in some cases, it is lighter.

WHEN TO REFER TO THE DOCTOR?

It is advisable to contact your doctor promptly when you feel severe pain in one side (or back) and, at the same time, difficulty urinating and high fever. The latter is, very often, synonymous with a bacterial renal infection, which, if left untreated, can lead to complications.

COMPLICATIONS

The complications usually arise in the presence of a severe hydronephrosis that is not treated promptly and appropriately.

• Fatigue
• Ankle and hand swelling due to water retention
• Shortness of breath
• malaise
• Blood in the urine

The greatest dangers facing hydronephrosis patients are renal atrophy and kidney failure . These two pathological conditions are more likely to occur when the hydronephrosis is bilateral, because in unilateral forms the healthy kidney is able to compensate for the sick kidney.

Another danger to be avoided, which may arise as a result of poorly treated hydronephrosis, is sepsis . Sepsis occurs when the bacterial renal infection, consequent to the stagnation of urine, also affects the blood.

Diagnosis

As with many diseases, a pre-diagnosis of hydronephrosis is established by the doctor thanks to careful physical examination. Subsequently, for a certain diagnosis, an ultrasound and further tests, both clinical and instrumental, are necessary to identify the causes and any associated pathologies and complications.

EXAMINATION OBJECTIVE

The doctor questions the patient about the symptoms felt and tries to identify some specific signs of hydronephrosis. Based on the description, it is also possible to get an idea of ​​the type of hydronephrosis and its causes; for example, if the onset of symptoms was sudden (acute form), the patient probably also suffers from kidney stones; vice versa, if the symptoms have arisen gradually, at the origin there may be a tumor or a benign enlargement of the prostate.

ULTRASOUND

Ultrasound is the instrumental examination that allows to establish if the patient is affected by hydronephrosis. In fact, through ultrasound images, the specialist doctor is able to see renal swelling due to the accumulation of urine.

CLINICAL TESTS

By performing some clinical tests, it is possible to clarify part of the causes and find out whether hydronephrosis has caused complications.

• Blood tests . They are used to assess whether there is a bacterial infection in progress.

  Furthermore, they provide a quantitative data on the creatinine values ​​present in the bloodstream. It should be noted that this last element is not always reliable, since, especially in unilateral hydronephrosis, it could appear normal. The reason is related to the fact that the healthy kidney compensates for the deficiencies of the sick one, thus leaving creatinine levels in the blood unchanged.

• Urine tests . They are used to assess if there are traces of blood. In fact, their presence is almost always synonymous with kidney stones.

OTHER INSTRUMENTAL EXAMINATIONS

Figure: Contrast urography of a patient with hydronephrosis. The left kidney (with respect to the reader) is the one affected by the pathology. The contrast medium shows the dilation of the renal pelvis (or pelvis) and the ureter. From the site: doctorshangout.com

Once the diagnosis of hydronephrosis is established, to set a correct therapy it is very important to shed light on some details of the disorder, such as where the obstruction is located or if there is a tumor at its origin. Excellent information is obtained from:

• Intravenous urography . It is a radiological exam, which allows to evaluate the urinary tract from a morphological and functional point of view. It involves the use of X-rays and a contrast medium (iodine solution), injected into the bloodstream. The contrast medium, highlighting the urinary flow through the kidneys, ureters, bladder and urethra, allows to identify where the obstruction resides.
• CT ( computed tomography ). It provides three-dimensional images relating to the internal organs of the human body. If there are tumors at the origin of hydronephrosis, these are traced. TAC uses ionizing radiation, therefore it is considered a moderately invasive examination.

DIAGNOSIS OF FETAL HYDRONEFROSIS

Fetal hydronephrosis is recognized by routine ultrasounds to which the mother is subjected during pregnancy.

Treatment

The choice of the most appropriate treatment depends on the causes triggered and the severity of the hydronephrosis itself.

In most cases, surgery is required. The first step is to remove the accumulation of urine in the kidney, to avoid the onset of an infection; the second step is to remove the obstruction of the urinary tract; the third definitive passage is dedicated to treating the causes, such as kidney stones or a possible tumor in the reproductive organs.

The sooner action is taken, the better the patient will benefit. This indication is valid for both unilateral and bilateral hydronephrosis.

A hydronephrosis not properly treated, as we have seen, can cause sepsis and severe kidney damage (atrophy and kidney failure).

In summary, the goals of hydronephrosis therapy are:

• Remove urine stagnation and the enormous pressure it causes inside the involved kidney (swelling)
• Prevent renal atrophy and the spread of bacterial infections
• Remove the occlusion in the urinary tract
• Treat the causes of hydronephrosis with the most appropriate care

URINE DRAINAGE

Urine drainage, accumulated in the renal pelvis, is essential to reduce internal pressure in the kidney and to relieve the painful sensation. Moreover, it avoids the spread of bacterial infections, first in the renal organ, and then in the blood (sepsis).

There are at least two urinary drainage techniques and their application depends on where the obstruction is.

• Urinary bladder catheter . This practice involves inserting a catheter through the urethra into the bladder. Through the catheter, urine drainage is provided, especially when the occlusion is in the final tract of the urinary tract.
• Nephrostomy . It consists of inserting a small tube into the kidney, precisely into the renal pelvis. The tube is inserted through a small skin incision and allows the drainage of the stagnated urine.

SURGICAL TREATMENT: THE URETERAL STENT

Once drained, urine must be allowed to flow normally back into the urinary tract.

To do this, the surgical technique used is called the ureteral stent . The ureteral stent consists of inserting a small tube into the occluded ureter.

It serves to keep the canal patent, thus allowing the urine to pass through the involved urinary duct again.

Main side effects of the ureteral stent:

• Location of the tube
• Urinary tract infections
• Injury of the ureter and consequent scarring
• Incontinence
• Renal pain

Usually, the ureteral stent is a temporary measure, waiting for the causes of hydronephrosis to be resolved (kidney stones, tumors, etc.).

This is an effective intervention, but in some it can cause complications.

THE TREATMENT OF CAUSES

After drainage and removal of the obstruction, the third fundamental step consists in treating the causes. Therefore, at this juncture, the therapeutic choice varies from patient to patient.

In presence of:

• Kidney stones : the so-called bombardment or lithotripsy is used.
• Prostatic hyperplasia : drugs are used (especially if benign) and, in more serious situations (malignant tumor), surgical prostate removal is used.
• Reproductive organs : need chemotherapy, radiotherapy and surgical removal of tumor tissues.

HYDRONEFROSI IN PREGNANCY

At the end of pregnancy, hydronephrosis resolves spontaneously, therefore it is not necessary to intervene in an invasive manner, except by periodically practicing urine drainage.

FETAL HYDRONEONE

Most cases of fetal hydronephrosis do not require specific treatments. In fact, the kidney disorder almost always resolves itself at birth or in a short time.

If at the origin of hydronephrosis there is the so-called primary vesico-ureteral reflux, two countermeasures could be required: antibiotics, against possible kidney infections, and the injection of a particular liquid substance, to prevent reflux.

Rarely, fetal hydronephrosis requires surgery for its resolution; surgery that, when necessary, is similar to that of adults.

Prognosis and prevention

The prognosis is variable, as it depends on numerous factors, such as:

• Causes of hydronephrosis
• Involvement of one or both kidneys
• Severity of obstruction that blocks the urinary tract
• Form of hydronephrosis, acute or chronic
• When intervening with appropriate care

To clarify what has just been said, it is useful to give some examples.

For a patient with kidney stone hydronephrosis, the prognosis is positive, as kidney stones are effectively treated today. Conversely, for an individual with hydronephrosis from a malignant prostate tumor, the prognosis will be decidedly worse, even if appropriate treatment exists.

Timeliness and speed of action are fundamental: intervening at the beginning of the disorder means anticipating and preventing complications (kidney infections, sepsis, renal atrophy, kidney failure, etc.); on the contrary, delaying the diagnosis and therapeutic intervention means reducing the efficiency of the treatment and consequently worsening the prognosis.

PREVENTION

A balanced diet prevents kidney stones, consequently also kidney disorders. The same goes for tumors: a healthy lifestyle in general removes the risk of cancer and their possible complications. All this can help prevent hydronephrosis, with excellent results.