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Hydronephrosis

Steven C. Campbell, M.D., Ph.D. Contributors: Cafer Zorkun M.D., PhD;Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [1]

Synonyms and keywords: Obstructive nephropathy

Overview

Overview

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]


Synonyms and keywords:

Overview

Historical Perspective

Ureteral anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci and John Sampson.In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with renal scarring.

  • Ureteral anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci drawings and John Sampson dissections.
  • In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with renal scarring from bacterial infection and the development of hydronephrosis.
  • In 1952, Hutch performed the first antireflux surgery in paraplegic patients.
  • In 1717, the first to description of obstruction of the posterior urethra (PUO) was by Morgagni.

Classification

Grade 0 No renal pelvis dilation Anteroposterior diameter of less than 4 mm in fetuses
Grade 1 Mild renal pelvis dilation Anteroposterior diameter less than 10 mm in fetuses
Grade 2 Moderate renal pelvis dilation Anteroposterior diameter between 10 and 15 mm in fetuses
Grade 3 Renal pelvis dilation along with all calyces dilatation
Grade 4 Renal pelvis dilation along with all calyces dilatation

with thinning of the renal parenchyma

Pathophysiology

Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine. This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. The rise in ureteral pressure leads to marked changes in glomerular filtration, tubular function, and renal blood flow. The glomerular filtration rate (GFR) declines significantly within hours following acute obstruction. This significant decline of GFR can persist for weeks after relief of obstruction. In addition, renal tubular ability to transport sodium, potassium, and protons and concentrate and to dilute the urine is severely impaired.

Causes

Hydronephrosis is commonly caused by conditions that obstruct urine outflow anywhere between kidneys and urethral opening. It is also caused by non obstructive conditions in some cases. Most common causes of hydronephrosis are renal calculi, ureteropelvic junction obstruction, vesicoureteric reflux, carcinoma involving urinary tract, prostate enlargement and cancer, blood clots retention and external compression from pelvic and abdominal tumors such as ovarian cysts, and retroperitoneal fibrosis.

Differentiating Hydronephrosis from other Diseases

Hydronephrosis must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, pyelonephritis, cystitis, ovarian cyst, pelvic tumor

Epidemiology and Demographics

The incidence and prevalence of hydronephrosis varies according to the underlying cause. Case fatality rate of hydronephrosis is 3.1 per 100 000 individuals.

Risk Factors

Common risk factors in the development of hydronephrosis include renal calculi, external compression from abdominal and pelvic masses and tumors such as prostate enlargement and cancer, cervical cancer, diabetes mellitus and neurogenic bladder, congenital anomalies of the kidney and urinary tract (CAKUT) such as vesicoureteric reflux, ureteropelvic junction obstruction and posterior urethral valves.

Screening

There is insufficient evidence to recommend routine screening for hydronephrosis.

Natural History, Complications and Prognosis

Common complications of hydronephrosis include infections, hyperkalemia, metabolic acidosis, and distal renal tubular acidosis, hypertension and renal failure.

Diagnosis

Diagnostic study of choice

Early diagnosis of hydronephrosis is important because most of the cases can be reversed if not treated promptly lead to irreversible renal injury.Hydronephrosis is usually diagnosed using an ultrasound scan.

History and symptoms

The majority of patients with hydronephrosis are asymptomatic.The most common symptoms of hydronephrosis include alteration in urine output, pain, hematuria and hypertension.

Physical examination

Patients with hydronephrosiscomplain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with abdominal distension, palpable kidney, costovertebral tenderness and palpable bladder may be seen.

Lab findings

Some patients with hydronephrosis may have elevated WBC count, serum creatinine, BUN, potassium levels and pyuria.

EKG

  • There are no EKG findings associated with hydronephrosis

X-ray

An x-ray may be helpful in the diagnosis of hydronephrosis. Findings on an x-ray suggestive of hydronephrosis include renal enlargement, cortical thinning and rim sigh.

Echocardiogram and Ultrasound

Early diagnosis of hydronephrosis is important because most of the cases can be reversed if not treated promptly lead to irreversible renal injury.Hydronephrosis is usually diagnosed using an ultrasound scan.

CT scan

Abdominal CT scan may be helpful in the diagnosis of hydronephrosis. Findings on CT scan suggestive of hydronephrosis include dilation of the proximal ureter, identification of the site of obstruction and calyceal blunting.

MRI

Abdomen MRI may be helpful in the diagnosis of hydronephrosis. Findings on MRI suggestive of hydronephrosis include renal perfusion and renal diffusion during acute ureteral obstruction.

Other Imaging findings

There are no other imaging findings associated with hydronephrosis.

Other diagnostic studies

There are no other diagnostic studies associated with hydronephrosis.

Treatment

Medical therapy

The goal of treatment for hydronephrosis is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.The initial care for the patient is aimed at minimizing pain and preventing urinary tract infections. Otherwise, surgical intervention may be required.

Surgery

Primary prevention

There are no established measures for the primary prevention of hydronephrosis

Secondary prevention

There are no established measures for the secondary prevention of hydronephrosis

References

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Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Ureteral anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci and John Sampson. In 1950s, Hodson and Edwards was the first to discover the association between association of vesicourtheral reflux with renal scarring.

Historical Perspective

Discovery

Landmark Events in the Development of Treatment Strategies

  • In 1952, the first antireflux surgery was developed by Hutch to treat VUR.[5]
  • In 1958, a new surgical procedure to treat VUR was developed by Politano and Leadbetter.

References

  1. ↑ DeCotiis, K.N.; Penna, F.J.; Koyle, M.A.; Caldamone, A.A. (2017). “Vesicoureteral reflux: A historical perspective”. African Journal of Urology. 23 (1): 1–4. doi:10.1016/j.afju.2016.10.001. ISSN 1110-5704.
  2. ↑ Schultheiss D, Grünewald V, Jonas U (June 1999). “Urodynamics in the anatomical work of Leonardo da Vinci (1452-1519)”. World J Urol. 17 (3): 137–43. PMID 10418086.
  3. ↑ Schultheiss, Dirk; Grünewald, Volker; Jonas, Udo (1999). “Urodynamics in the anatomical work of Leonardo da Vinci (1452-1519)”. World Journal of Urology. 17 (3): 137–143. doi:10.1007/s003450050121. ISSN 0724-4983.
  4. ↑ Dewan, P. A. (1997). “Congenital posterior urethral obstruction: the historical perspective”. Pediatric Surgery International. 12 (2–3): 86–94. doi:10.1007/BF01349970. ISSN 0179-0358.
  5. ↑ DeCotiis, K.N.; Penna, F.J.; Koyle, M.A.; Caldamone, A.A. (2017). “Vesicoureteral reflux: A historical perspective”. African Journal of Urology. 23 (1): 1–4. doi:10.1016/j.afju.2016.10.001. ISSN 1110-5704.

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Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

According to the society of Fetal Urology, hydronephrosis may be graded based on ultrasound findings into 4 types.

Classification

  • According to the society of Fetal Urology and alternative hydronephrosis grading system (AGS), hydronephrosis can be graded based on ultrasound findings into 4 types.[1][2][3][4][5][6]
Grade 0 No renal pelvis dilation Anteroposterior diameter of less than 4 mm in fetuses
Grade 1 Mild renal pelvis dilation Anteroposterior diameter less than 10 mm in fetuses
Grade 2 Moderate renal pelvis dilation Anteroposterior diameter between 10 and 15 mm in fetuses
Grade 3 Renal pelvis dilation along with all calyces dilatation
Grade 4 Renal pelvis dilation along with all calyces dilatation

with thinning of the renal parenchyma

References

  1. ↑ Belarmino JM, Kogan BA (January 2006). “Management of neonatal hydronephrosis”. Early Hum. Dev. 82 (1): 9–14. doi:10.1016/j.earlhumdev.2005.11.004. PMID 16427220.
  2. ↑ Emamian SA, Nielsen MB, Pedersen JF, Ytte L (September 1993). “Sonographic evaluation of renal appearance in 665 adult volunteers. Correlation with age and obesity”. Acta Radiol. 34 (5): 482–5. PMID 8369185.
  3. ↑ Kadioglu A (February 2010). “Renal measurements, including length, parenchymal thickness, and medullary pyramid thickness, in healthy children: what are the normative ultrasound values?”. AJR Am J Roentgenol. 194 (2): 509–15. doi:10.2214/AJR.09.2986. PMID 20093617.
  4. ↑ Huntington DK, Hill SC, Hill MC (August 1991). “Sonographic manifestations of medical renal disease”. Semin. Ultrasound CT MR. 12 (4): 290–307. PMID 1892691.
  5. ↑ Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S (May 2002). “Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty”. J. Urol. 167 (5): 2159–63. PMID 11956470.
  6. ↑ Onen A (June 2007). “An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis”. J Pediatr Urol. 3 (3): 200–5. doi:10.1016/j.jpurol.2006.08.002. PMID 18947735.

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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine. This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. The rise in ureteral pressure leads to marked changes in glomerular filtration, tubular function, and renal blood flow. The glomerular filtration rate (GFR) declines significantly within hours following acute obstruction. This significant decline of GFR can persist for weeks after relief of obstruction. In addition, renal tubular ability to transport sodium, potassium, and protons and concentrate and to dilute the urine is severely impaired.

Pathophysiology

  • The obstruction may arise from either inside or outside the urinary tract or may come from the wall of the urinary tract itself.
  • Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder. Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurological deficits.
  • Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urinary tract.[1][2]

Genetics

Associated Conditions

Gross Pathology

Specimen of a kidney that has undergone extensive dilation due to hydronephrosis. Note the extensive atrophy and thinning of the renal cortex
.

Microscopic Pathology

On microscopic histopathological analysis,findings of hydronephrosis include:

  • Degenerative changes in the glomeruli and tubules of the renal cortex.
  • Dilated lumen of distal tubules and collecting ducts
  • Necrosis

References

  1. ↑ Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T (August 2017). “Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment”. Adv Clin Exp Med. 26 (5): 857–864. PMID 29068584.
  2. ↑ Vercellini P, Buggio L, Somigliana E (December 2017). “Role of medical therapy in the management of deep rectovaginal endometriosis”. Fertil. Steril. 108 (6): 913–930. doi:10.1016/j.fertnstert.2017.08.038. PMID 29202965.
  3. ↑ Izquierdo L, Porteous M, Paramo PG, Connor JM (July 1992). “Evidence for genetic heterogeneity in hereditary hydronephrosis caused by pelvi-ureteric junction obstruction, with one locus assigned to chromosome 6p”. Hum. Genet. 89 (5): 557–60. PMID 1634233.
  4. ↑ Fryns JP, Kleczkowska A, Moerman P, Vandenberghe K (June 1993). “Hereditary hydronephrosis and the short arm of chromosome 6”. Hum. Genet. 91 (5): 514–5. PMID 8357406.
  5. ↑ Neas KR, Chia N, Clarke M, Peters G, Adès LC (July 2003). “A case of partial trisomy 4p syndrome presenting as severe hydronephrosis in utero”. Clin. Dysmorphol. 12 (3): 179–81. doi:10.1097/01.mcd.0000072162.33788.8d. PMID 14564156.
  6. ↑ Wojciechowska M, Bieniaś B, Sobieszczańska-Droździel A, Wieczorkiewicz-Płaza A, Beń-Skowronek I, Sikora P (April 2018). “[Recurrent urolithiasis as a symptom of primary hyperparathyroidism in a 16-year-old boy]”. Pol. Merkur. Lekarski (in Polish). 44 (262): 208–210. PMID 29775451.
  7. ↑ Hong IK, Chung MH, Bin JH, Lee KY, Kim JS, Kim CH, Suh JS (March 2018). “Prediction of vesicoureteral reflux in children with febrile urinary tract infection using relative uptake and cortical defect in DMSA scan”. Pediatr Neonatol. doi:10.1016/j.pedneo.2018.03.001. PMID 29576374.
  8. ↑ Dudek-Warchoł T, Warchoł S, Bombiński P, Toth K, Szmigielska A, Krzemień G (April 2018). “Pyonephrosis as the first symptom of congenital hydronephrosis in a 6-year old girl”. Pol. Merkur. Lekarski. 44 (262): 196–200. PMID 29775448.
  9. ↑ Morris JK, Springett AL, Greenlees R, Loane M, Addor MC, Arriola L, Barisic I, Bergman J, Csaky-Szunyogh M, Dias C, Draper ES, Garne E, Gatt M, Khoshnood B, Klungsoyr K, Lynch C, McDonnell R, Nelen V, Neville AJ, O’Mahony M, Pierini A, Queisser-Luft A, Randrianaivo H, Rankin J, Rissmann A, Kurinczuk J, Tucker D, Verellen-Dumoulin C, Wellesley D, Dolk H (2018). “Trends in congenital anomalies in Europe from 1980 to 2012”. PLoS ONE. 13 (4): e0194986. doi:10.1371/journal.pone.0194986. PMC 5886482. PMID 29621304. Vancouver style error: initials (help)
  10. ↑ Rachidi SA, Zeriouel A (2018). “[Renal tumor or pseudotumoral xanthogranulomatous pyelonephritis]”. Pan Afr Med J (in French). 29: 67. doi:10.11604/pamj.2018.29.67.14611. PMC 5987130. PMID 29875948.
  11. ↑ Yumoto T, Kondo Y, Kumon K, Masaoka Y, Hiraki T, Yamada T, Naito H, Nakao A (June 2018). “Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report”. Medicine (Baltimore). 97 (23): e11022. doi:10.1097/MD.0000000000011022. PMC 5999472. PMID 29879068.

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]Vindhya BellamKonda, M.B.B.S [3]

Overview

Hydronephrosis is commonly caused by conditions that obstruct urine outflow anywhere between kidneys and urethral opening. It is also caused by non obstructive conditions in some cases. Most common causes of hydronephrosis are renal calculi, ureteropelvic junction obstruction, vesicoureteric reflux, carcinoma involving urinary tract, prostate enlargement and cancer, blood clots retention and external compression from pelvic and abdominal tumors such as ovarian cysts, and retroperitoneal fibrosis.

Causes

Life-threatening Causes

  • Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of hydronephrosis, however, complications resulting from untreated hydronephrosis are common.

Common Causes

  • Hydronephrosis is most commonly caused by urinary tract obstruction anywhere from kidneys to the urethral opening. It is also caused by non-obstructive conditions.
  • The following table summarizes the common causes of hydronephrosis.
Kidneys[1][2][3][4] Renal calculi

Carcinoma involving kidneys

Sloughed renal papilla due to renal papillary necrosis

Ureter[5][6][7][8][9][10][11][12][13][14][15][16][17][18] Ureteral calculi

Retroperitoneal fibrosis

Blood clots retention

Transitional cell carcinoma of the ureter

Sloughed papilla and renal papillary necrosis obstructing the ureter

Infections

Ureteral strictures by trauma, iatrogenic injury, radiation

Ureteropelvic junction obstruction

Ureterovesical junction obstruction

Endometriosis

Extrinsic tumors and masses causing compression and hydronephrosis (eg, inguinal hernia, retroperitoneal lymph nodes, retroperitoneal tumors, prostate cancer, cervical and endometrial tumors, tuboovarian abscess and abdominal malignancies)

Tuberculosis (ureteritis cystica)

Bladder[19][20][21][22][23][24][25][26][27][28] Bladder cancer (eg, transitional cell carcinoma of the bladder)

Bladder calculi

Neurogenic bladder

Vesicoureteral reflux

Inflammation of the bladder (eg, radiation, endometriosis)

Bladder hypertrophy

Bladder-neck obstruction

Cystocele

Urethra[29][30][31] Urethral strictures (eg, Bacterial urethritis, Indwelling urinary catheter, prostate surgeries, cystoscopy)

Prostate enlargement (Benign prostatic hyperplasia and hypertrophy)

Urethral valves (Posterior urethral valves, and anterior urethral valves)

Less Common Causes

Less common causes of disease name include:

References

  1. ↑ Mehmet NM, Ender O (May 2015). “Effect of urinary stone disease and its treatment on renal function”. World J Nephrol. 4 (2): 271–6. doi:10.5527/wjn.v4.i2.271. PMC 4419137. PMID 25949941.
  2. ↑ Maruyama T, Kubo M, Shinchou M, Hashimoto T, Mitsui Y, Ueda Y, Suzuki T, Higuchi Y, Qui J, Kondoh N, Nojima M, Yamamoto S, Shima H, Hirota S (November 2008). “[Case with renal pelvic carcinoma with giant hydronephrosis]”. Hinyokika Kiyo (in Japanese). 54 (11): 727–31. PMID 19068727.
  3. ↑ Abe T, Nakayama J, Kishikawa H, Sekii K, Yoshioka T, Itatani H (February 2005). “[Renal cell carcinoma with hydronephrosis due to pelviureteric junction obstruction: a case report]”. Hinyokika Kiyo (in Japanese). 51 (2): 109–12. PMID 15773364.
  4. ↑ Graeb DA, Uhrich P (September 1980). “Diffuse renal transitional cell carcinoma and hydronephrosis”. AJR Am J Roentgenol. 135 (3): 620–1. doi:10.2214/ajr.135.3.620. PMID 6773391.
  5. ↑ Ochi F, Furuno K, Chong PF, Tezuka J, Mizuno Y, Aoki T, Ishii E (June 2017). “Bilateral hydronephrosis due to obstructive ureteral stone associated with norovirus gastroenteritis”. Clin Case Rep. 5 (6): 936–938. doi:10.1002/ccr3.952. PMC 5458008. PMID 28588843.
  6. ↑ Iravani O, Tay EW, Bay BH, Ng YK (December 2014). “Unilateral ureteric stone associated with gross hydronephrosis and kidney shrinkage: a cadaveric report”. Anat Cell Biol. 47 (4): 267–70. doi:10.5115/acb.2014.47.4.267. PMC 4276901. PMID 25548725.
  7. ↑ Hamano H, Kawa S, Ochi Y, Unno H, Shiba N, Wajiki M, Nakazawa K, Shimojo H, Kiyosawa K (April 2002). “Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis”. Lancet. 359 (9315): 1403–4. PMID 11978339.
  8. ↑ Dholakia AM, Howarth FH (September 1979). “The urinary tract in haemophilia”. Clin Radiol. 30 (5): 533–8. PMID 466958.
  9. ↑ Cho KS, Hong SJ, Cho NH, Choi YD (October 2007). “Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma”. Urology. 70 (4): 662–6. doi:10.1016/j.urology.2007.06.1106. PMID 17991533.
  10. ↑ Kamath S, Moody MP, Hammonds JC, Wells IP (April 2005). “Papillary necrosis causing hydronephrosis in renal allograft treated by percutaneous retrieval of sloughed papilla”. Br J Radiol. 78 (928): 346–8. doi:10.1259/bjr/12933217. PMID 15774597.
  11. ↑ Ganzer R, Franz T, Rai BP, Siemer S, Stolzenburg JU (August 2015). “[Management of ureteral strictures and hydronephrosis]”. Urologe A (in German). 54 (8): 1147–56. doi:10.1007/s00120-015-3870-8. PMID 26182896.
  12. ↑ Sountoulides P, Mykoniatis I, Dimasis N (2014). “Palliative management of malignant upper urinary tract obstruction”. Hippokratia. 18 (4): 292–7. PMC 4453800. PMID 26052193.
  13. ↑ Grice PT, Nkwam N (April 2018). “Inguinal hernia causing extrinsic compression of bilateral ureters leading to chronic obstructive uropathy”. J Surg Case Rep. 2018 (4): rjy062. doi:10.1093/jscr/rjy062. PMC 5888468. PMID 29644043.
  14. ↑ Lund B, Hansen HH (October 1989). “Hydronephrosis in advanced ovarian carcinoma”. Gynecol. Oncol. 35 (1): 27–30. PMID 2676751.
  15. ↑ Hu G, Luo M, Xu Y (2015). “Giant hydronephrosis secondary to ureteropelvic junction obstruction in adults: report of a case and review of literatures”. Int J Clin Exp Med. 8 (3): 4715–7. PMC 4443244. PMID 26064410.
  16. ↑ Zhang D, Li H, Gan W (April 2016). “Hydronephrosis associated with ureteral metastasis of prostate cancer: A rare case report”. Mol Clin Oncol. 4 (4): 597–598. doi:10.3892/mco.2016.775. PMC 4812183. PMID 27073671.
  17. ↑ Wang P, Wang XP, Li YY, Jin BY, Xia D, Wang S, Pan H (2015). “Hydronephrosis due to ureteral endometriosis in women of reproductive age”. Int J Clin Exp Med. 8 (1): 1059–65. PMC 4358548. PMID 25785093.
  18. ↑ Colbert G, Richey D, Schwartz JC (July 2012). “Widespread tuberculosis including renal involvement”. Proc (Bayl Univ Med Cent). 25 (3): 236–9. PMC 3377289. PMID 22754123.
  19. ↑ Haleblian GE, Skinner EC, Dickinson MG, Lieskovsky G, Boyd SD, Skinner DG (December 1998). “Hydronephrosis as a prognostic indicator in bladder cancer patients”. J. Urol. 160 (6 Pt 1): 2011–4. PMID 9817312.
  20. ↑ Ofluoglu Y, Aydin HR, Kocaaslan R, Adanur S, Ziypak T (October 2013). “A cause of renal dysfunction: a giant bladder stone”. Eurasian J Med. 45 (3): 211–3. doi:10.5152/eajm.2013.41. PMC 4261423. PMID 25610281.
  21. ↑ Gormley EA (November 2010). “Urologic complications of the neurogenic bladder”. Urol. Clin. North Am. 37 (4): 601–7. doi:10.1016/j.ucl.2010.07.002. PMID 20955911.
  22. ↑ Hodges SJ, Patel B, McLorie G, Atala A (October 2009). “Posterior urethral valves”. ScientificWorldJournal. 9: 1119–26. doi:10.1100/tsw.2009.127. PMC 5823193. PMID 19838598.
  23. ↑ Mattoo TK (September 2011). “Vesicoureteral reflux and reflux nephropathy”. Adv Chronic Kidney Dis. 18 (5): 348–54. doi:10.1053/j.ackd.2011.07.006. PMC 3169795. PMID 21896376.
  24. ↑ Jung LY, Kang KP, Kim W, Park SK, Lee S (June 2012). “Masked hydronephrosis”. Korean J. Intern. Med. 27 (2): 244. doi:10.3904/kjim.2012.27.2.244. PMC 3372815. PMID 22707903.
  25. ↑ Efe E, Bakacak M, Serin S, Kolus E, Ercan O, Resim S (2014). “Hormonal treatment for severe hydronephrosis caused by bladder endometriosis”. Case Rep Urol. 2014: 891295. doi:10.1155/2014/891295. PMC 4251884. PMID 25506035.
  26. ↑ Iqbal S, Raiz I, Faiz I (March 2017). “Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder”. Malays J Med Sci. 24 (2): 106–115. doi:10.21315/mjms2017.24.2.14. PMC 5566069. PMID 28894411.
  27. ↑ Tazi MF, Riyach O, Ahallal Y, Mellas S, Khallouk A, El Fassi MJ, Farih MH (2012). “Giant Urinary Bladder and Bilateral Giant Hydronephrosis due to Bladder Neck Obstruction: One Case Report and Literature Review”. Case Rep Urol. 2012: 817519. doi:10.1155/2012/817519. PMC 3350214. PMID 22606637.
  28. ↑ Oksay T, Ergun O, Capar E, Koşar A (2011). “Bilateral hydronephrosis secondary to cystocele”. Ren Fail. 33 (5): 537–9. doi:10.3109/0886022X.2011.569104. PMID 21446783.
  29. ↑ Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). “Urethral stricture: etiology, investigation and treatments”. Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.
  30. ↑ Sarmina I, Resnick MI (April 1989). “Obstructive uropathy in patients with benign prostatic hyperplasia”. J. Urol. 141 (4): 866–9. PMID 2467012.
  31. ↑ Godwin OI, Ayotunde OO (December 2007). “Posterior Urethral Valves with Severe Unilateral Vesicoureteral Reflux in a 3-year-old Boy”. Ann Ib Postgrad Med. 5 (2): 73–6. PMC 4110994. PMID 25161437.
  32. ↑ Kale H, Narlawar RS, Rathod K (2002). “Renal fungal ball: an unusual sonographic finding”. J Clin Ultrasound. 30 (3): 178–80. PMID 11948574.
  33. ↑ Tran VH, Nelson M, Nogar J, Bramante RM (July 2014). “Bilateral hydronephrosis and cystitis resulting from chronic ketamine abuse”. West J Emerg Med. 15 (4): 382–4. doi:10.5811/westjem.2014.4.20571. PMC 4100838. PMID 25035738.
  34. ↑ Rasmussen PE, Nielsen FR (March 1988). “Hydronephrosis during pregnancy: a literature survey”. Eur. J. Obstet. Gynecol. Reprod. Biol. 27 (3): 249–59. PMID 3280355.
  35. ↑ Nakata S, Ohtsuka Y, Koya T, Nakano K, Takahashi H (January 2007). “[A case of combination with proliferative cystitis and pelvic lipomatosis causing bilateral hydronephrosis]”. Nippon Hinyokika Gakkai Zasshi (in Japanese). 98 (1): 37–40. PMID 17302294.
  36. ↑ Batura D, Saxena VK (July 1997). “RETROCAVAL URETER – A RARE CAUSE OF HYDRONEPHROSIS (A Case Report)”. Med J Armed Forces India. 53 (3): 223–225. doi:10.1016/S0377-1237(17)30722-0. PMC 5530977. PMID 28769490.
  37. ↑ Kállai L, Torda I, Bély M, Fischer G, Philipp V, Mavrogenis S, Nemere G (June 2001). “Pyeloureteral junction stenosis and ureteral valve causing hydronephrosis”. Scand. J. Urol. Nephrol. 35 (3): 245–7. PMID 11487081.
  38. ↑ Livne PM, Gonzales ET (March 1985). “Congenital bladder diverticula causing ureteral obstruction”. Urology. 25 (3): 273–6. PMID 3919483.
  39. ↑ Rasouly HM, Lu W (2013). “Lower urinary tract development and disease”. Wiley Interdiscip Rev Syst Biol Med. 5 (3): 307–42. doi:10.1002/wsbm.1212. PMC 3627353. PMID 23408557.
  40. ↑ Samal SK, Rathod S (2015). “Prune Belly syndrome: A rare case report”. J Nat Sci Biol Med. 6 (1): 255–7. doi:10.4103/0976-9668.149218. PMC 4367054. PMID 25810678.
  41. ↑ Tomita K, Kakizawa Y, Yoshida M (March 1991). “[A case of true phimosis with bilateral hydroureteronephrosis and bilateral vesicoureteral reflux]”. Hinyokika Kiyo (in Japanese). 37 (3): 283–5. PMID 2069110.

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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

The incidence and prevalence of hydronephrosis varies according to the underlying cause. Case fatality rate of hydronephrosis is 3.1 per 100 000 individuals.

Epidemiology and Demographics

Incidence

Prevalence

Case-fatality rate/Mortality rate

  • The case-fatality rate/mortality rate of hydronephrosis is approximately 3.1 per 100 000 individuals

Age

Race

Gender

Region

References

  1. ↑ Gökçe Mİ, Esen B, Gülpınar B, Hüseynov A, Özkidik M, Süer E (June 2017). “Evaluation of postoperative hydronephrosis following semirigid ureteroscopy: Incidence and predictors”. Turk J Urol. 43 (2): 171–175. doi:10.5152/tud.2017.80106. PMC 5503437. PMID 28717542.
  2. ↑ Dagrosa L, Moses R, Pais VM (January 2017). “Incidence and implications of silent hydronephrosis following percutaneous nephrolithotomy”. Clin. Nephrol. 87 (2017) (1): 29–32. doi:10.5414/CN108926. PMID 27900939.
  3. ↑ Goldberg H, Bachar GN, Majadla R, Yossepowitch O, Baniel J, Ram E (March 2018). “How Prevalent is Hydronephrosis Secondary to Acute Appendicitis: A Cross-Sectional Study”. Isr. Med. Assoc. J. 20 (3): 141–144. PMID 29527849.

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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]Vindhya BellamKonda, M.B.B.S [3]

Overview

Common risk factors in the development of hydronephrosis include renal calculi, external compression from abdominal and pelvic masses and tumors such as prostate enlargement and cancer, cervical cancer, diabetes mellitus and neurogenic bladder, congenital anomalies of the kidney and urinary tract (CAKUT) such as vesicoureteric reflux, ureteropelvic junction obstruction and posterior urethral valves.

Risk Factors

Common Risk Factors

Common risk factors in the development of hydronephrosis include:[1][2][3][4][5][6]

References

  1. ↑ Iravani O, Tay EW, Bay BH, Ng YK (December 2014). “Unilateral ureteric stone associated with gross hydronephrosis and kidney shrinkage: a cadaveric report”. Anat Cell Biol. 47 (4): 267–70. doi:10.5115/acb.2014.47.4.267. PMC 4276901. PMID 25548725.
  2. ↑ Gormley EA (November 2010). “Urologic complications of the neurogenic bladder”. Urol. Clin. North Am. 37 (4): 601–7. doi:10.1016/j.ucl.2010.07.002. PMID 20955911.
  3. ↑ Riyach O, Ahsaini M, Kharbach Y, Bounoual M, Tazi MF, El Ammari JE, Mellas S, Fassi Mel J, Khallouk A, Farih MH (February 2014). “Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature”. J Med Case Rep. 8: 42. doi:10.1186/1752-1947-8-42. PMC 3930078. PMID 24513237.
  4. ↑ Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T (August 2017). “Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment”. Adv Clin Exp Med. 26 (5): 857–864. PMID 29068584.
  5. ↑ Rodriguez MM (2014). “Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT)”. Fetal Pediatr Pathol. 33 (5–6): 293–320. doi:10.3109/15513815.2014.959678. PMC 4266037. PMID 25313840.
  6. ↑ Muram D, Oxorn H, Curry RH, Drouin P, Walters JH (February 1981). “Postradiation ureteral obstruction: a reappraisal”. Am. J. Obstet. Gynecol. 139 (3): 289–93. PMID 7468696.


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Differentiating Hydronephrosis from other Diseases

Differentiating Hydronephrosis from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Hydronephrosis must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, pyelonephritis, cystitis, ovarian cyst, pelvic tumor

Differentiating hydronephrosis from other Diseases

Hydronephrosis must be differentiated from pelvic cyst[1], renal sinus lymphangiectasia[2], ovarian cyst, pelvic tumor, ureteral polyp[3], pyelonephritis, cystitis.

References

  1. ↑ Han D, Ma G, Wei L, Ren C, Zhou J, Shen C, He T (May 2017). “Preliminary study on the differentiation between parapelvic cyst and hydronephrosis with non-calculous using only pre-contrast dual-energy spectral CT scans”. Br J Radiol. 90 (1073): 20160632. doi:10.1259/bjr.20160632. PMC 5605099. PMID 28281789.
  2. ↑ Indiran V, Prabhu PS, Maduraimuthu P (January 2016). “Isolated Renal Sinus Lymphangiectasia-Close Mimic of Pelviureteric Junction Obstruction and Hydronephrosis”. Urology. 87: e11–2. doi:10.1016/j.urology.2015.10.008. PMID 26494296.
  3. ↑ Chopra A, Teele RL (December 1980). “Hydronephrosis in children: narrowing the differential diagnosis with ultrasound”. J Clin Ultrasound. 8 (6): 473–8. PMID 6777404.
Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Common complications of hydronephrosis include infections, hyperkalemia, metabolic acidosis, and distal renal tubular acidosis, hypertension and renal failure.

Natural History, Complications, and Prognosis

Natural History

Complications

Common complications of hydronephrosis include:[2][3][4][5][6]

Prognosis

References

  1. ↑ Sarhan OM, El Helaly A, Al Otay AH, Al Ghanbar M, Nakshabandi Z (March 2018). “Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?”. Can Urol Assoc J. 12 (3): E137–E141. doi:10.5489/cuaj.4587. PMC 5869039. PMID 29283090.
  2. ↑ Kozeny GA, Hurley RM, Vertuno LL, Bansal VK, Zeller WP, Hano JE (1986). “Hypertension, mineralocorticoid-resistant hyperkalemia, and hyperchloremic acidosis in an infant with obstructive uropathy”. Am. J. Nephrol. 6 (6): 476–81. doi:10.1159/000167258. PMID 3565506.
  3. ↑ Chandar J, Abitbol C, Zilleruelo G, Gosalbez R, Montané B, Strauss J (February 1996). “Renal tubular abnormalities in infants with hydronephrosis”. J. Urol. 155 (2): 660–3. PMID 8558697.
  4. ↑ Lee JH, Choi HS, Kim JK, Won HS, Kim KS, Moon DH, Cho KS, Park YS (April 2008). “Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection”. J. Urol. 179 (4): 1524–8. doi:10.1016/j.juro.2007.11.090. PMID 18295269.
  5. ↑ King LR, Kazmi SO, Belman AB (October 1974). “Natural history of vesicoureteral reflux. Outcome of a trial of nonoperative therapy”. Urol. Clin. North Am. 1 (3): 441–55. PMID 4610948.
  6. ↑ Mesrobian HG (September 2010). “Urinary proteome analysis and the management of ureteropelvic junction obstruction”. Pediatr. Nephrol. 25 (9): 1595–6. doi:10.1007/s00467-010-1521-2. PMID 20407913.
  7. ↑ Perlman S, Roitman L, Lotan D, Kivilevitch Z, Pode-Shakked N, Pode-Shakked B, Achiron R, Dekel B, Gilboa Y (February 2018). “Severe fetal hydronephrosis: the added value of associated congenital anomalies of the kidneys and urinary tract (CAKUT) in the prediction of postnatal outcome”. Prenat. Diagn. 38 (3): 179–183. doi:10.1002/pd.5206. PMID 29314159.
  8. ↑ Renda R (April 2018). “Renal outcome of congenital anomalies of the kidney and urinary tract system: a single-center retrospective study”. Minerva Urol Nefrol. 70 (2): 218–225. doi:10.23736/S0393-2249.17.03034-X. PMID 29161808.

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Diagnosis

Diagnosis

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Treatment

Treatment

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