Hydronephrosis is swelling of one or both kidneys due to urine accumulating and not being able to flow into the bladder. This condition can be experienced by everyone of all age groups, even in fetuses (antenatal hydronephrosis).

If detected and treated quickly, hydronephrosis rarely causes long-term complications. Conversely, if left alone, this condition risks causing infection and scarring in the kidneys which can lead to kidney failure.

Treatment of hydronephrosis aims to treat medical conditions that cause obstructed urine flow. Treatment methods can be by administering drugs or surgical procedures.

Causes of Hydronephrosis

Kidneys have a number of important functions, including filtering out excess water, salt, and metabolic waste. The rest of the filter is then excreted through the urine.

If there is a blockage or obstruction in the urinary tract (ureter), the urine that should be excreted accumulates in the kidneys. This condition can cause swollen kidneys or hydronephrosis.

Generally, hydronephrosis is the result of a disease or other medical condition that the patient suffers from. Some of these diseases or conditions are:

  • Kidney stones that come out of the kidneys and block the ureters
  • Cancer or tumors around the urinary tract, bladder, pelvis, or stomach
  • Blood clots that form in the kidneys or ureters
  • Scar tissue that appears as a result of infection, surgery, or radiotherapy, causing narrowing of the ureters
  • Vesicoureteral reflux (VUR), which is a condition when urine from the bladder returns to the kidneys, can be due to congenital abnormalities, enlarged prostate , or narrowing of the urinary tract (urethra)
  • Uterine prolapse or descent
  • Disorders of the nerves or muscles of the bladder
  • Urine retention
  • Pregnancy

Meanwhile, the causes of hydronephrosis in newborns are generally found on prenatal ultrasound examinations, including:

  • Birth defects such as branching ureters (ectopic ureters), spina bifida, or abnormalities of the urethral valves ( posterior urethral valves )
  • Blockage (obstruction) that prevents urine from flowing out of the kidney
  • Uretocele is the formation of a pouch in the ureter that can block the ureter
  • Disorders in the bladder muscle that cause urine to flow back into the kidneys

In some cases, it is not known what causes hydronephrosis in newborns.

Hydronephrosis before birth will generally heal on its own after the baby is born. Meanwhile, mild hydronephrosis in children usually does not affect kidney function and can heal within a certain time.

Symptoms of Hydronephrosis

In some cases, hydronephrosis may not cause any symptoms at all. Meanwhile, in symptomatic hydronephrosis, the complaints that arise depend on the cause, including:

  • Pain in the back and pelvis, which may radiate to the lower abdomen or groin
  • Nausea and vomiting
  • Pain when urinating (dysuria)
  • Hematuria
  • Fatigue or malaise
  • Infrequent urination
  • Not being able to completely empty the bladder
  • Symptoms of a urinary tract infection include dark urine, a weak stream of urine, chills, fever, or a burning feeling when passing urine

Hydronephrosis in newborns usually doesn't cause symptoms, but it can also result in an enlarged abdomen or symptoms of a urinary tract infection, such as fever, fussiness, and refusal to feed.

Whereas in children, symptoms of hydronephrosis that can arise include low back or stomach pain, bed wetting , fever, nausea, vomiting, and growth and development disorders.

When to see a doctor

Immediately check with your doctor if you or your child has symptoms of hydronephrosis. Acute hydronephrosis generally causes severe pain that requires emergency treatment.

If symptoms of hydronephrosis appear accompanied by signs of urinary tract infection, fever, and decreased urine production (oliguria), seek immediate assistance to the nearest hospital.

Hydronephrosis diagnosis

The doctor will first ask about the symptoms experienced and the medical history of the patient and his family. Next, the doctor will carry out a physical examination by gently feeling, pressing, and tapping the back of the patient's waist.

In male patients, the doctor may perform a digital rectal examination to detect enlargement of the prostate gland. While in female patients, a pelvic examination is needed to detect disorders of the uterus or ovaries.

Furthermore, the doctor will carry out several supporting examinations to confirm the diagnosis, such as:

  • Blood tests, to detect infection through a complete blood count, including kidney function tests
  • Urine test , to see if there is blood, crystal stones, or bacterial infection in the urine
  • Intravenous urography, to see the condition of the urinary tract through X-rays and the help of contrast agents
  • Scan with ultrasound or CT scan , to see a more detailed picture of the kidneys

Hydronephrosis Treatment

The treatment method for hydronephrosis will be adjusted to the cause and severity. In mild and moderate hydronephrosis, treatment is sometimes enough with antibiotics to prevent urinary tract infections.

Some treatment methods for hydronephrosis are:

  • Catheterization
    If swelling of the kidneys occurs due to blockage of the ureter, the doctor can place a catheter to drain urine into the bladder. You can also install a nephrostomy channel to drain urine from the kidneys directly outside the body.
  • Medicines
    Doctors can give antibiotics and pain relievers to treat pain due to urinary tract infections (UTI).
  • Surgery
    Surgery is performed to treat hydronephrosis caused by kidney stones or an enlarged prostate. This procedure is also done if the urinary tract is blocked by scar tissue or blood clots.

In hydronephrosis caused by cancer, doctors can perform surgery combined with chemotherapy or radiotherapy .

Treatment for pregnant women

In pregnant women, hydronephrosis generally does not require special treatment, because it will improve within a few weeks after delivery.

Treatment of the fetus and baby

Fetuses diagnosed with hydronephrosis in the womb generally do not require specific treatment. This is because hydronephrosis can improve before the fetus is born, or heal by itself within a few months after birth.

However, scans still need to be done for several weeks after delivery to prevent complications. If hydronephrosis doesn't get better on its own, the doctor will give antibiotics or carry out surgical procedures if needed.

Hydronephrosis complications

Untreated hydronephrosis can result in increased pressure on the kidneys. This condition can reduce the ability of the kidneys to filter blood and remove waste, and cause electrolyte balance disturbances in the body.

Another complication that can arise due to hydronephrosis is kidney infection. In some cases, kidney infection can cause permanent kidney damage that can lead to kidney failure .

Please note, kidney failure can still occur if only one kidney can function normally.

Hydronephrosis prevention

Hydronephrosis can be prevented by living a healthy lifestyle, avoiding its causes, and undergoing treatment if you have a disease that can cause hydronephrosis.

In people who have a history of kidney stones , prevention can be done by following a special diet, maintaining body fluids, and avoiding risk factors that can cause recurrent kidney stones.

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