Hydronephrosis occurs when the renal pelvis or calyces are dilated due to the filling of urine as a result of obstruction. Depending if the obstruction is chronic or acute, unilateral or bilateral, partial or complete, the signs and symptoms of hydronephrosis can vary. If it occurs suddenly, it can result in intense pain in the flank area. Hydronephrosis that developed gradually can result in no pain or a dull discomfort. Other associated symptoms include nausea, vomiting, anuria, decreased urine output, fever, hematuria, pyuria, and more.
Complete obstruction can result in kidney failure. For diagnosis purposes, a blood test may show elevated creatinine or urea. Urinalysis can also show that there is elevated pH level. On physical examination of the patient, a palpable flank or abdominal mass may be felt due to enlargement of the kidney. Imaging such as ultrasonography, intravenous urogram, computed tomography, or magnetic resonance imaging can also be helpful. A grading system for hydronephrosis based on severity of the condition is also used.
The goal of treatment aims to remove the obstruction and draining urine that has accumulated. An acute obstruction in the upper urinary tract can be treated through the insertion of a nephrostomy tube while a chronic obstruction involves pyeloplasty or insertion of a ureteric stent. In a lower urinary tract obstruction, a suprapubic or urinary catheter can be helpful.
Cause #1: Kidney Stones
Kidney stones or urolithiasis is a condition when a solid piece of material develops and lodges itself in the urinary tract. Typically, a stone can pass without causing symptoms. However, a stone more than 5 millimeters can result in blockage of the ureter leading to pain in the lower back, loin, or groin.
It can result in nausea, vomiting, hematuria, and dysuria. Risk factors of kidney stones include obesity, high urine calcium levels, calcium supplements, gout, hyperparathyroidism, inadequate fluids, and more. The stones form when the minerals are at a high concentration in the urine.