Hydronephrosis is a disorder when kidneys swell due to incomplete emptying of urine. The feeling of pressure and pain is typical signs. Urologists use shock wave lithotripsy and surgery to reduce swelling and restore kidney function. In addition, drug therapy might help patients.
Hydronephrosis is a disease when urine cannot properly flow from the kidneys to the bladder. In this case, the kidneys swell and stretch. The disorder can occur anywhere in the urinary tract, from the kidneys to the ureters, bladder, or urethra.
Hydronephrosis is not a primary disease. Instead, it is a secondary condition resulting from another underlying disorder. According to the data, hydronephrosis appears in 0.6 to 4.5% of the population and can happen in people of any age. As a rule, only one kidney is affected, but sometimes both are involved. In addition, the condition affects about 1 in 100 babies.
Swollen kidney puts pressure and is dangerous because it decreases kidney function. Typically, the kidneys filter waste from the blood and excrete it with urine. Kidney damage, increased renal pressure and later kidney failure can occur if not treated promptly.
Urologists distinguish several stages of hydronephrosis:
- The first stage (initial) is a slight accumulation of urine, but the kidney has a standard size and functions well.
- In the second degree (progressive), the kidney tissues become thinner, and organ function decreases by 30-40%. In this case, the kidney is heavily loaded, and the organ can wear out.
- Third degree (terminal) - the kidney is in critical condition and can not cope with the urine outflow. As a result, renal failure develops with a high probability.
What is the primary cause of hydronephrosis?
Various diseases inside or outside the urinary tract cause obstruction and block the urine flow from the kidneys, causing swollen kidneys. These disorders are as follows:
- Kidney stones;
- Blood clots;
- Urinary retention;
- Narrowing of the urinary tract;
- Benign prostatic hyperplasia;
- Nerve damage in case of brain tumours, spinal injuries;
- Tumours of the genitourinary organs and organs located near the urinary tract;
- Muscle problems (when a damaged muscle connecting the urethra to the bladder does not work correctly, causing urine to flow back into the kidney).
In addition, in females, hydronephrosis can occur during pregnancy when the uterus or bladder prolapses. At the same time, in kids, this is often associated with structural changes in the body (congenital anomalies).
What are the symptoms of swollen kidney?
In adults, hydronephrosis may cause no symptoms, or it does, depending on the cause. When symptoms occur, they may include:
- Pain in the back, abdomen, or side;
- Nausea and vomiting;
- Oedema in the morning;
- Frequent and painful urination;
- High blood pressure;
- Rare urination;
- Weakness, fever;
- Blood in the urine.
With sudden hydronephrosis, patients may experience renal colic - a sharp pain associated with the stone moving through the urinary tract.
When swollen kidney occurs in infants, they usually have no signs. However, as the disorder progresses, the following symptoms may appear multiple urinary tract infections, fever, blood in the urine, poor nutrition, irritability, and restlessness.
How is hydronephrosis diagnosed?
Typically, doctors use a renal ultrasound to diagnose hydronephrosis.
Additional examinations may be needed if the kidneys appear swollen on an ultrasound image. These tests can help find the underlying cause of hydronephrosis:
- Urine tests check for infection (blood or bacteria in the urine);
- Blood tests indicate inflammatory markers, kidney function;
- A renal x-ray with contrast (urography) shows how urine moves from the kidneys to the bladder, whether there are narrowings, stones, tumours, obstructions, or backflow of urine.
- Computed tomography with contrast assesses the degree of renal oedema and visualizes congenital anomalies and the area of blockage.
Treatment of hydronephrosis
Therapy depends on the underlying cause of hydronephrosis and the severity of the disease. First, doctors remove urine using a catheter to reduce the feeling of pressure and the risk of kidney damage.
In acute hydronephrosis, urologists perform a percutaneous nephrostomy, which removes the accumulated urine directly from the kidney and reduces pressure.
In some cases, doctors can treat hydronephrosis with medication. For example, if the reason is an infection, physicians prescribe antibiotics. With reflux (reverse urine flow), urologists operate to correct it.
If the cause of hydronephrosis is a stone disease, treatment options include:
- Shock wave lithotripsy uses a high-energy shock wave to break stones into small pieces, which are then passed out through urination.
- A ureteroscopy uses a thin tube inserted into the urethra to break up and remove stones.
- Surgery is effective for large stones (greater than 2 cm).
Insertion of stents into the narrowed urethra eliminates the problem.
With the threat of developing severe complications, doctors recommend nephrectomy (kidney removal). Later, a healthy one from another person can be transplanted instead of a removed kidney.
Infants with severe hydronephrosis usually require surgery. It is due to the ducts that connect the kidney and bladder may be blocked. Then doctors perform pyeloplasty and correct the defect. It is the most effective surgical treatment for children.
The prognosis for hydronephrosis varies. With timely treatment, the forecast is good. The success rate of surgery is over 95%. However, if the disease affects both kidneys and is diagnosed at an advanced stage, the prognosis is poor. The most favourable forecast is observed in children
Should I have surgery for hydronephrosis?
Whether surgery is needed for hydronephrosis depends on its cause. However, an operation is the only effective treatment option in most cases, for example, with stones, tumours, constrictions, etc.
What treatment for hydronephrosis is available?
Treatment consists of passing urine through a urinary catheter. Currently available techniques include shock wave lithotripsy (removal of stones using a high-energy shock wave), dilatation of the urinary tract with balloon dilatation or stents, open surgery for tumours, large stones, and others.
Is hydronephrosis dangerous?
Yes. Hydronephrosis is dangerous because it gradually causes the failure of kidney function. As a result, kidney infections, high blood pressure and kidney failure can occur in the worst case.
What are doctors responsible for hydronephrosis treatment?
Urologists are responsible for treating hydronephrosis. All diseases and conditions related to the urinary system (kidneys, ureters, bladder) are treated by urologists. If surgery is needed, then surgeons are involved in the treatment.
Can I get cured of hydronephrosis?
In most cases, yes. Treatment options vary for different causes. In mild cases, urologists provide non-invasive or minimally invasive surgery. Operations have a 95% success level. In advanced cases, surgeons remove the damaged organ and transplant a healthy donor kidney.
Where can I get Hydronephrosis treatment?
What are the best clinics for Hydronephrosis treatment?
Who are the best doctors for Hydronephrosis?
Prof. Dr. med. Jurgen Gschwend from University Hospital rechts der Isar Munich
Prof. Dr. Torremade Barreda Josep from Teknon Medical Centre Barcelona
Dr. Luis Garcia Aparicio from Teknon Medical Centre Barcelona
Prof. Dr. med. Martin Kriegmair from Urological Clinic Munich-Planegg
Prof. Dr. med. Laszlo Kovacs from Urological Clinic Munich-Planegg