Hydronephrosis

Overview

Hydronephrosis is swelling of the kidney caused by a build-up of urine when normal urine flow from the kidney to the bladder is partially or completely blocked. The blockage may occur in the kidney, ureter, or at the junction where the ureter connects with the bladder. It can affect one or both kidneys and may occur suddenly or develop gradually.

It can happen in infants as well os timely consultation with a paediatric surgeon is important.

Common causes include kidney stones, ureteric narrowing, urinary tract abnormalities, enlarged prostate, infections, or pressure from nearby structures. Mild hydronephrosis may improve once the underlying cause is addressed, while significant or prolonged blockage can damage kidney function. Therefore, timely hydronephrosis treatment is important.

At Sarvodaya Hospital, urologists and paediatric surgeons provide comprehensive evaluation and treatment for kidney swelling and urinary obstruction, using appropriate imaging, minimally invasive procedures, ureteral stents, nephrostomy when required, and surgery for selected cases.

Symptoms of Hydronephrosis

• Pain in the side or back
• Abdominal discomfort
• Fever and feeding issues in infants
• Pain that may radiate towards the groin
• Nausea or vomiting
• Frequent urination
• Pain while urinating
• Blood in the urine
• Fever or chills when infection is present
• Reduced urine output in severe obstruction

Causes of Hydronephrosis

Hydronephrosis occurs when urine cannot drain normally from the kidney.

• Kidney Stones : A stone can become lodged in the urinary tract and obstruct urine flow, resulting in pressure build-up and kidney swelling.
• Ureteric Narrowing : Scar tissue or narrowing of the ureter can restrict urine passage and gradually cause hydronephrosis.
• Urinary Tract Abnormalities : Structural problems present from birth can interfere with normal urine drainage, particularly in children.
• Enlarged Prostate : In men, an enlarged prostate can obstruct urine flow from the bladder and contribute to urinary tract pressure.
• Urinary Tract Tumours : Growths involving the urinary system or nearby organs can sometimes compress or block the ureter.
• Pregnancy : Changes in the urinary tract during pregnancy may temporarily affect urine drainage and cause mild hydronephrosis.

Diagnosis of Hydronephrosis

A detailed evaluation helps identify the location and cause of obstruction while assessing kidney function and determining the appropriate treatment.

• Antenatal Ultrasound: Many times hydronephrosis is detected during pregnancy scans. Therefore antenatal scans are very much important. Later, after birth, ultrasound of the baby is performed to understand the extent of swelling.
• Ultrasound : Kidney and urinary tract ultrasound is commonly used to detect kidney swelling, assess urine drainage, and identify possible causes without radiation exposure.
• CT Scan : CT imaging provides detailed views of the kidneys and urinary tract and can identify kidney stones, obstruction, anatomical abnormalities, or other causes of hydronephrosis.
• MRI / MR Urography : MRI-based imaging provides detailed information about the urinary tract and surrounding tissues and may be useful when further evaluation is required.
• Urine Tests : Urine examination helps identify blood, infection, or other abnormalities that may be contributing to urinary symptoms.
• Blood Tests : Kidney function tests, including creatinine and other blood investigations, help determine whether urinary obstruction has affected kidney function.
• Renal Function Tests: In selected patients, specialised tests can assess how effectively each kidney is functioning and help guide treatment decisions.

Treatment Options & Technology for Hydronephrosis

Kidney hydronephrosis treatment focuses on restoring urine drainage and addressing the condition responsible for the blockage. Treatment depends on the severity, location, cause, kidney function, and presence of infection.

• Treating the Underlying Cause: Small kidney stones may pass naturally, while larger stones, strictures, or other obstructions may require medication, endoscopic treatment, or surgery.
• Ureteral Stent: A ureteral stent for hydronephrosis is a thin tube placed inside the ureter to maintain urine flow from the kidney to the bladder when an obstruction prevents normal drainage.
• Nephrostomy: Nephrostomy for hydronephrosis involves placing a drainage tube directly into the kidney through the skin. It may be recommended when urine needs to be drained urgently, or a ureteral stent cannot adequately relieve obstruction.
• Endoscopic Procedures: Urologists may use minimally invasive instruments to treat stones, strictures, or other blockages. Procedures such as ureteroscopy can help restore urine flow without conventional open surgery.
• Stone Treatment: Depending on stone size and location, treatment may include medication, ureteroscopy, laser stone fragmentation, or other minimally invasive stone-removal procedures.
• Surgical Treatment : Complex or persistent obstruction may require reconstructive surgery to correct narrowing or anatomical abnormalities and restore normal urinary drainage.
• Advanced Urology Technology : Ultrasound, CT Urography, MRI/MR Urography, Ureteroscopy, Laser Technology, Fluoroscopy, and image-guided drainage procedures support accurate diagnosis and minimally invasive management of urinary obstruction.

Benefits of Early Hydronephrosis Treatment

Timely treatment can protect kidney function and prevent complications associated with prolonged urinary obstruction.

• Protects Kidney Function: Relieving urinary obstruction reduces pressure within the kidney and helps prevent progressive damage to kidney tissue and declining renal function.
• Restores Urine Flow: Appropriate treatment addresses the underlying blockage and helps restore normal urine drainage from the kidney towards the bladder.
• Reduces Infection Risk: Urine that cannot drain properly can increase the risk of urinary infections. Early treatment helps reduce urinary stasis and associated complications.
• Relieves Pain and Discomfort: Treating the obstruction can reduce pressure-related flank, abdominal, or groin pain and improve overall comfort.
• Prevents Long-Term Complications: Early evaluation and treatment can reduce the likelihood of persistent kidney damage, recurrent infections, and worsening urinary obstruction.

Complications if Left Untreated

• Progressive Kidney Damage
• Recurrent Urinary Infections
• Kidney Function Loss
• Kidney Stones
• Severe Infection
• Permanent Urinary Tract Damage

Role of Early Intervention by Paediatric Surgeon

• Helps identify the cause early: Evaluates whether hydronephrosis is related to a congenital urinary abnormality, ureteric obstruction, reflux, or another condition.
• Protects developing kidney function: Early monitoring and appropriate treatment help reduce prolonged pressure on the kidney and minimise the risk of damage.
• Supports timely treatment: Determines whether observation, medication, urinary drainage, endoscopic treatment, or surgery is appropriate for the child's condition.
• Monitors kidney growth and function: Regular ultrasound and kidney function assessment help track whether hydronephrosis is improving or progressing.
• Addresses urinary obstruction when required: Selected children may require procedures to restore normal urine drainage and prevent further kidney damage.

Prevention & Lifestyle Modifications

• Stay Adequately Hydrated: Drinking an appropriate amount of water supports normal urine production and may help reduce the risk of certain urinary tract problems.
• Prevent Kidney Stones: Following dietary advice, maintaining adequate fluid intake, and managing factors that contribute to stone formation can reduce the likelihood of recurrent obstruction.
• Treat Urinary Infections Promptly: Seeking medical care for urinary infection symptoms can help prevent complications, particularly when urinary drainage is already impaired.
• Do Not Ignore Urinary Symptoms : Persistent difficulty urinating, blood in urine, recurrent infections, or unexplained flank pain should be evaluated before complications develop.
• Attend Follow-Up Appointments : People with previous urinary obstruction, kidney stones, or structural urinary problems should follow their urologist's recommendations for monitoring.

When Should You See a Doctor?

You should consult a urologist if you experience persistent flank or abdominal pain, blood in the urine, recurrent urinary infections, difficulty passing urine, or unexplained changes in urination.

Seek urgent medical care when urinary symptoms occur with fever, chills, severe pain, vomiting, or significantly reduced urine output, as obstruction combined with infection can require prompt treatment.

Pre- and Post-Treatment Care

Before Treatment

• Complete urological assessment
• Kidney function testing
• Urine examination
• Ultrasound or CT imaging
• Identification of the underlying obstruction
• Evaluation for urinary infection

After Treatment

• Take prescribed medicines as directed
• Maintain appropriate fluid intake according to medical advice
• Attend scheduled imaging and kidney function checks
• Follow dietary recommendations where applicable
• Complete follow-up after stent or nephrostomy placement
• Report fever, severe pain, or reduced urine output promptly