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Hydronephrosis—Adult

Pronounced: hi-dro neff-ro-sis

Definition

Hydronephros is a build-up of urine in the kidneys. The kidney tubes swell from the excess urine pressure. It can happen when urine cannot drain into the bladder of if the bladder not draining well. The condition may affect one or both kidneys. Hydronephrosis is not a disease, but a symptom of a problem with the urinary system.

Kidney, Ureter, Bladder, and Kidney Stone


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Causes

Hydronephrosis in adults is usually caused by a blockage, which can occur with many types of obstruction, such as:

  • Kidney stones
  • Blood clots
  • Abnormal growths
  • Scar tissue from an injury or surgery
  • An enlarged prostate
  • Swelling due to a urinary tract infection

It can also happen when poor bladder function causes a higher urine pressure that backs up into the kidney.

Risk Factors

Factors that may increase your chance of hydronephrosis include:

  • Defect in the urinary system that is present at birth
  • Scarring of the ureters, the tubes that carry urine from the kidneys to the bladder
  • Cancers in the pelvic area (bladder, cervix, colon, or prostate)
  • Persistent kidney or urinary tract infections
  • Blood-clotting disorders
  • Benign prostatic hyperplasia
  • Neurogenic bladder
  • Injury to structures in the urinary system, such as from surgery or trauma
  • Enlarged uterus during pregnancy
Symptoms

Hydronephrosis may or may not cause any symptoms. If symptoms occur, they may include:

  • Pain in the back, waist, lower abdomen, or groin
  • Persistent pain with urination or urinary frequency from urinary tract infections
  • Increased urge to urinate or urinary incontinence
  • Incomplete urination
  • Fever
  • Nausea and vomiting
  • Unexplained itching
Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. It may include a pelvic or rectal exam to feel for blockages. You may be referred to a urologist and/or nephrologist for further diagnosis and treatment.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Imaging tests may be done to evaluate the urinary system. This can be done with:

Treatment

A catheter may be inserted into the bladder to drain excess urine from the kidney. Some causes of hydronephrosis may also be managed with observation, such as pregnancy and kidney stones.

Treatment options include:

Medications

Depending on the cause, hydronephrosis may be treated with:

  • Antibiotics for infection
  • Medications for neurogenic bladder or to reduce excess uric acid excretion
Surgery

Surgery is not always needed, but it may be necessary in some cases. Procedures may include:

  • Removing the blockage or correcting a defect in the urinary system
  • Stent—A tube is placed from the kidney to the bladder to allow urine to drain past a blocked ureter.
  • Nephrostomy—A catheter is placed into the kidney. The catheter is attached to a urine collection bag.
  • Nephrectomy—Removal of part or all of the kidney (rare).
Prevention

In general, the causes of hydronephrosis cannot be prevented. Prompt treatment of conditions that cause hydronephrosis reduces the risk of complications, such as kidney failure.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

National Kidney Foundation
http://www.kidney.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Kidney Foundation of Canada
http://www.kidney.ca

References:

Hydronephrosis. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/articles/hydronephrosis. Updated March 18, 2014. Accessed April 26, 2017.

Hydronephrosis. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/hydronephrosis. Published 2015. Accessed April 25, 2017.

Hydronephrosis. NHS Choices website. Available at: http://www.nhs.uk/Conditions/Hydronephrosis/Pages/Introduction.aspx. Updated June 23, 2015. Accessed April 25, 2017.

Nephrolithiasis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Updated January 15, 2017. Accessed April 25, 2017.

Obstructive uropathy. Merck Manual Professional Version website. https://www.merckmanuals.com/professional/genitourinary-disorders/obstructive-uropathy/obstructive-uropathy. Updated April 2016. Accessed April 26, 2017.



Last reviewed April 2017 by EBSCO Medical Review BoardMichael Woods, MD FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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