Hydronephrosis - Symptoms, Causes, Grading & Treatment

Hydronephrosis occurs when one or both kidneys enlarge due to urine build-up from a blockage or obstruction in the urinary tract. This prevents urine from draining properly. 

It can be located anywhere throughout the urinary tract, from the kidneys to the bladder. If not addressed quickly, it can cause damage to the affected kidney and lead to loss of renal function.

Hydronephrosis v/s Urinary Tract Dilation v/s Renal Pelvis Dilation

The primary difference between hydronephrosis, urinary tract dilation, and renal pelvis dilation lies in the specific area affected and the extent of the condition.

• It refers to swelling and dilation of the entire kidney collecting system.

• Urinary tract dilation is a broader term that can include dilation anywhere along the urinary system, from the kidneys to the bladder.

• Renal pelvis dilation refers to the enlargement of only the renal pelvis. It is the funnel-like structure where urine collects before entering the ureter.

It can be classified into different types depending on where the blockage occurs and what is causing it:

1. Unilateral Hydronephrosis: This category affects only one kidney. A blockage in the ureter usually causes it.

2. Bilateral Hydronephrosis: It involves both the kidneys. It is less common but more severe as it may result in a total loss of kidney function if not treated promptly.

3. Congenital Hydronephrosis: Detected since birth due to abnormalities in the development of the urinary tract. It is often diagnosed during prenatal ultrasounds.

4. Acquired Hydronephrosis: Develop due to kidney stones, tumours, or urinary tract infections.

Grades of Hydronephrosis

The hydronephrosis grading system helps healthcare providers determine the severity of the condition and build a suitable treatment strategy. This ensures that the interventions are suitable for the severity of the condition and the patient's individual needs.

The symptoms of hydronephrosis differ based on the severity and cause of the obstruction. Some common signs and indications include:

1. Pain: Individuals may experience intense or sudden lower back, side, or abdomen discomfort. It may worsen after consuming fluids as the swollen kidney stretches further.

2. Fatigue: Chronic hydronephrosis can decrease kidney function, resulting in a general sense of weakness. This may be due to the accumulation of toxins that the kidneys cannot filter effectively.

3. Vomiting: As the condition progresses, some people may experience nausea due to the increased pressure on surrounding organs. A general feeling of malaise or weakness can accompany these symptoms.

4. Fever and Chills: If it leads to a urinary tract infection, individuals may experience a high body temperature. UTIs occur when bacteria multiply in the stagnant urine, causing inflammation and infection.

5. Urinary Symptoms: Frequent or painful urination or the feeling of incomplete bladder emptying may occur. Blood in the urine (hematuria) can also indicate the disease.

6. Abdominal Swelling: In severe hydronephrosis cases, particularly foetal hydronephrosis, the abdomen is swollen. This occurs when the enlarged kidney or blocked ureter causes a bulge in the abdominal area.

Hydronephrosis is a condition characterised by inflammation of one or both kidneys due to the accretion of urine. It is primarily caused by:

• An obstruction or blockage in the urinary tract which prevents the normal passage of urine.

• Vesicoureteral reflux (VUR), where urine moves in reverse from the bladder back into the ureters and kidneys.

In normal circumstances, urine should only flow in one direction, from the kidneys to the bladder. However, when the valve-like mechanism at the junction of the ureter and bladder fails to function properly, urine can reflux back into the kidney.

"I often diagnose hydronephrosis in patients presenting with flank pain or recurrent urinary tract infections. In India, one of the leading causes is urinary tract obstruction, often due to kidney stones or strictures. It's essential to address these quickly to prevent long-term kidney damage and ensure the patient's well-being."

- Dr. Deepak Sharma
Urologist

Recognising the facilitators associated with disease can help individuals maintain urinary tract health. Here are some factors that can increase the likelihood of developing the disease:

1. Congenital Abnormalities: Structural defects in the urinary system, such as ureteral strictures or posterior urethral valves, which can obstruct urine flow. These irregularities may not cause symptoms until later in life.

2. Urinary Tract Stones: The formation of stones in the kidney, ureters, or bladder can block the passage of urine, leading to its buildup in the kidney. Individuals with a history of the same are more likely to develop the condition.

3. Benign Prostatic Hyperplasia (BPH): As men age, their prostate gland may enlarge, compressing the urethra and obstructing urine flow. It is one of the common causes of hydronephrosis in older men.

4. Pelvic Tumours: Cancerous growths in the pelvic region, such as bladder, prostate, or cervical tumours, can compress the ureters or urethra. This may lead to urinary obstruction and hydronephrosis formation.

5. Neurogenic Bladder Disorders: Impaired nerve function can disrupt the normal emptying of the bladder. This can cause urine to move back into the kidneys, developing the disease.

How to prevent hydronephrosis?

The prevention involves maintaining a healthy urinary tract. Here are some proactive measures to consider:

1. Hydration: Drinking adequate water throughout the day assists in flushing out bacteria and prevents the formation of urinary tract stones. Aim to consume a minimum of 6-8 glasses of water daily.

2. Practise Good Hygiene: Maintain cleanliness in the genital area to reduce the risk of urinary tract infection. Wipe from front to back after using the restroom, and avoid holding in urine for extended periods.

3. Manage Underlying Conditions: Health issues, such as benign prostatic hyperplasia or neurogenic bladder disorders, can increase the risk of the condition. Monitor the condition regularly and adjust the treatment strategy as necessary.

4. Avoid Urinary Tract Irritants: Substances like alcohol, caffeine, and spicy foods can impact the bladder and increase the likelihood of urinary tract problems. Limiting their consumption may help prevent the onset of conditions that lead to the disease.

5. Early Diagnosis: If experiencing symptoms of a urinary tract infection or obstruction, such as pain, frequent urination, or difficulty urinating, consult a healthcare provider promptly.

Diagnosing hydronephrosis involves a combination of physical examination, imaging scans and laboratory tests to evaluate the severity and underlying cause of the condition. Here are some diagnosis approaches: 

1. Physical examination: The healthcare provider will palpate the abdomen and flank area to check for tenderness, swelling, or a palpable mass. They may also assess the overall health status to identify any potential complications.

2. Imaging studies: Hydronephrosis ultrasound is often the first-line imaging modality for diagnosing the disease. CT scans or MRIs are used to provide detailed images that help pinpoint the location and cause of the obstruction.

3. Urinalysis: A urine sample is collected and examined for blood, protein, or bacteria. This may suggest the presence of a urinary tract infection or other possible underlying conditions.

4. Renal function tests: Blood tests, including serum creatinine and blood urea nitrogen (BUN), are performed to evaluate kidney function and assess the degree of damage. These tests can also help monitor the patient's response to treatment.

How to prepare for a doctor consultation?

Preparing for a consultation with a urologist regarding hydronephrosis is crucial for ensuring a productive and informative visit. Gathering this information can help individuals make the most of their appointments:

• Document the frequency and severity of hydronephrosis symptoms, including pain, urinary changes, and fever. 

• List any prior urinary tract infections, surgeries, procedures, and pertinent medical conditions.

• Gather and bring copies of recent imaging studies, laboratory results, or medical records of your urinary system. 

• Share any family history of urinary tract disorders or congenital abnormalities with the healthcare provider.

• Prepare a comprehensive list of current medications, supplements, and herbal remedies being taken, including dosages and frequencies.

Questions to Ask the Doctor

To maximise the visit, individuals should come prepared with a list of questions and concerns. Here are some common queries:

• What is the underlying cause of the hydronephrosis, and how severe is the condition?

• What are the available conservative and surgical treatment options and their associated risks and benefits?

• How long will the recovery process take, and what potential complications of hydronephrosis should be monitored?

• Will hydronephrosis impact daily activities or quality of life, and what lifestyle modifications may be necessary?

• What specific follow-up tests or procedures will be required to monitor the condition and assess treatment effectiveness?

The choice of hydronephrosis treatments depends on the underlying cause, severity of the condition, and individual patient factors. Here are some options to consider when managing the disease.

1. Ayurvedic Treatments: Ayurveda focus on natural remedies and holistic management to minimise hydronephrosis symptoms and promote healing. Patients may find these approaches helpful:

   • Herbal formulations: Combinations of herbs such as Punarnava, Gokshura, Varun, and Palaash may help reduce swelling and improve kidney function.

   • Medicated oils: Applying warm, medicated oils to the lower abdomen and back may help alleviate pain and promote urine flow.

   • Dietary modifications: Consuming foods that support kidney health, such as barley, horse gram, and pomegranate, while avoiding irritants like alcohol and caffeine.

   • Lifestyle changes: Incorporating stress-reducing techniques, such as meditation and yoga, to support overall well-being and kidney function.

2. Homoeopathic Treatments: Homeopathy aims to stimulate the body's natural healing processes by using highly diluted substances that mimic the symptoms of the disease. Approaches like these may help:

• Berberis vulgaris: This herb addresses burning pain during urination and helps dissolve kidney stones, a common cause of the disease.

• Cantharis: Relieves intense burning sensations in the urinary tract and helps manage infections.

• Lycopodium: Useful for right-sided hydronephrosis with frequent urges to urinate and burning pain in the urethra.

• Sarsaparilla: Helps manage urinary retention and relieves kidney and bladder pain.

3. Non-Surgical Treatments: These approaches focus on relieving symptoms, addressing the underlying cause, and preventing complications associated with the disease. Some commonly used techniques are as follows:

   • Antibiotics: Prescribed to treat urinary tract infections that may contribute to or result from the disease.

   • Ureteral stenting: A thin, flexible tube is inserted into the ureter to allow urine to bypass the obstruction and drain from the kidney.

   • Percutaneous nephrostomy: A catheter is inserted through the skin into the kidney to drain urine directly, bypassing the obstruction.

   • Extracorporeal shock wave lithotripsy (ESWL): Uses high-energy shock waves to break up kidney stones causing the obstruction.

4. Surgical Treatments: In severe hydronephrosis cases, surgery may be necessary to remove the obstruction and restore normal urine flow. Here are some surgical options:

   • Pyeloplasty: Reconstructs the narrow segment of the ureter, allowing urine to drain more effectively from the kidney to the bladder.

   • Ureterolithotomy: Removes kidney stones causing the obstruction through an incision in the ureter.

   • Nephrectomy: In rare cases, removal of the affected kidney hydronephrosis may be necessary if it is severely damaged or non-functional.

   • Ureteral reimplantation: This procedure repositions the ureter to correct vesicoureteral reflux, a condition that allows urine to flow back into the kidney.

Postponing treatment for hydronephrosis can lead to the exacerbation of symptoms and the development of complications that may impair kidney function. The following risks are associated with delayed intervention:

1. Chronic Damage: Prolonged urine obstruction can cause irreversible harm to the kidneys. It compromises toxic filtration from the body and maintains fluid balance. This can lead to chronic disease and reduced kidney functionality.

2. Recurrent Urinary Tract Infections: Stagnant urine in the kidneys provides an ideal environment for bacterial growth, increasing the likelihood of frequent and severe infections. These infections can further cause kidney hydronephrosis and lead to more serious complications.

3. Kidney Stones: Untreated hydronephrosis may result in the formation of kidney stones, causing pain, bleeding, and further obstruction. The altered urine flow and mineral accumulation can create an environment conducive to stone development.

4. Renal Failure: In severe cases, neglecting hydronephrosis can cause the kidney to fail completely, necessitating dialysis or transplantation. 

5. Sepsis: If left untreated, hydronephrosis can lead to a life-threatening systemic infection called sepsis, causing organ failure and even death.

When to Call a Doctor for Hydronephrosis

Recognising hydronephrosis symptoms that warrant medical attention is crucial for effective diagnosis and treatment of the condition. Individuals should seek medical attention if they experience the following:

• Pain in the flank area that radiates to the groyne or lower abdomen

• Reduction in urine production or trouble emptying the bladder

• Visible swelling or a lump in the abdomen or back

• Frequent infections within a short period

Although there is no specific dietary regimen that can cure hydronephrosis, consuming a balanced and nutritious diet can support kidney health and prevent complications. The following hydronephrosis dietconsiderations are recommended:

1. Incorporating fruits and vegetables into your diet supplies vital vitamins and minerals that promote natural healing abilities of the body. Fruits like cranberries, blueberries, and cherries may be particularly beneficial for urinary tract health.

2. Probiotic-rich foods like yoghurt, kefir, sauerkraut, and kimchi help maintain healthy bacteria in the urinary tract.

3. To manage symptoms, it is best to cut down on caffeine, alcohol, spicy foods, and artificial sweeteners. It is advisable to avoid acidic foods like citrus fruits and tomatoes.

4. Incorporating whole grains like oats, quinoa, and brown rice into the diet provides fibre. It encourages bowel movements and prevents constipation.

5. Certain herbal teas, such as chamomile and corn silk, have anti-inflammatory and soothing properties.

Living with hydronephrosis can be challenging, but with proper diagnosis, treatment, and management, you can significantly improve your quality of life. If you suspect you have hydronephrosis, don't hesitate to seek medical attention.

Remember, you are not alone in this journey. For expert guidance and comprehensive treatment, turn to HexaHealth professionals who are dedicated to providing the best care for your kidney health. Our expertise ensures accurate hydronephrosis diagnosis and effective care.

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