Sie sind auf Seite 1von 6

Unilateral hydronephrosis

Definition Unilateral hydronephrosis is swelling of one kidney due to a backup of urine. Causes, incidence, and risk factors Hydronephrosis is a condition that occurs with a disease and is not a disease itself. Treatment and prognosis for unilateral hydronephrosis depend what is causing the kidney swelling. Conditions that are often associated with unilateral hydronephrosis include: Acute unilateral obstructive uropathy Chronic unilateral obstructive uropathy Vesicoureteric reflux (backflow of urine from bladder to kidney) Nephrolithiasis (kidney stones) Hydronephrosis that occurs without a known cause during pregnancy

Unilateral hydronephrosis occurs in approximately 1 in 100 people. Symptoms Flank pain Abdominal mass Nausea and vomiting Urinary tract infection Fever Dysuria Increased urinary frequency Increased urinary urgency

Note: Sometimes unilateral hydronephrosis does not have symptoms. Signs and tests Unilateral hydronephrosis is usually identified with tests such as the following: Intravenous pyelogram (IVP) Isotope renography (radio-isotope scan of the kidneys) Ultrasound of the kidneys or abdomen CT scan of the kidneys or abdomen Abdominal MRI

Treatment Treatment may include: A ureteral stent (tube that allows the ureter to drain into the bladder) A nephrostomy tube (allows the blocked urine to drain through the back) Antibiotics for infections

Patients who have only one kidney, who have immune-compromising disorders such as diabetes or HIV, or who have received a transplant should be treated promptly.

Preventative antibiotics may be prescribed to decrease the risk of urinary tract infections in patients who have long-term hydronephrosis. Expectations (prognosis) Prolonged hydronephrosis results in the eventual loss of kidney function. Complications If hydronephrosis is left untreated, the affected kidney may be permanently damaged. kidney insufficiency or kidney failure is rare with unilateral hydronephrosis because the other kidney usually functions normally. However, if the patient has only one functioning kidney, kidney failure will occur. Prevention Prevention of the disorders associated with unilateral hydronephrosis will prevent this condition. References Walsh PC. Campbell's Urology. 8th ed. St. Louis, Mo: WB Saunders; 2002. Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004.

Hydronephrosis is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney. Signs and symptoms The signs and symptoms of hydronephrosis depends upon whether the obstruction is acute or chronic. Unilateral hydronephrosis may even occur without symptoms. Blood tests can show raised creatinine and electrolyte imbalance. Urinalysis may show an elevated pH due to the secondary destruction of nephrons within the affected kidney. Symptoms that occur regardless of where the obstruction lies include loin or flank pain. An enlarged kidney may be palpable on examination. Where the obstruction occurs in the lower urinary tract, suprapubic tenderness (with or without a history of bladder outflow obstruction) along with a palpable

bladder are strongly suggestive of acute urinary retention, which left untreated is highly likely to cause hydronephrosis. Upper urinary tract obstruction is characterised by pain in the flank, often radiating to either the abdomen or the groin. Where the obstruction is chronic renal failure may also be present. If the obstruction is complete, an enlarged kidney is often palpable on examination. Etiology The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis. 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 Tests

Ultrasound picture of hydronephrosis caused by a left ureteral stone. Blood (U&E, creatinine) and urine (MSU, pH) tests should be taken. IVUs, ultrasounds, CTs and MRIs are also important tests. Ultrasound allows for visualisation of the ureters and kidneys and can be used to assess the presence of hydronephrosis and/or hydroureter. An IVU is useful for assessing the position of the obstruction. Antegrade or retrograde pyelography will show similar findings to an IVU but offer a therapeutic option as well. The choice of imaging depends on the clinical presentation (history, symptoms and examination findings). In the case of renal colic (one sided loin pain usually accompanied by a trace of blood in the urine) the initial investigation is usually an intravenous urogram. This has the advantage of showing whether there is any obstruction of flow of urine causing hydronephrosis as well as demonstrating the function of the other kidney.

Many stones are not visible on plain xray or IVU but 99% of stones are visible on CT and therefore CT is becoming a common choice of initial investigation. MRI is less commonly used, often when there is a reason to avoid radiation exposure, eg in pregnancy. Complications Left untreated bilateral obstruction (obstruction occurring to both kidneys rather than one) has a poor prognosis. Treatment Treatment of hydronephrosis focuses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies, and whether it is acute or chronic. Acute obstruction of the upper urinary tract is usually treated by the insertion of a nephrostomy tube. Chronic upper urinary tract obstruction is treated by the insertion of a ureteric stent or a pyeloplasty. Lower urinary tract obstruction (such as that caused by bladder outflow obstruction secondary to prostatic hypertrophy) is usually treated by insertion of a urinary catheter or a suprapubic catheter.

Bilateral hydronephrosis

Definition Bilateral hydronephrosis is the distention of the pelvis and calyces of both kidneys. (See also unilateral hydronephrosis.) Causes, incidence, and risk factors Bilateral hydronephrosis develops when the pelvis and calyces (the urine-collecting structures of the kidneys) of both kidneys become distended because urine is unable to drain from the kidney down the ureters into the bladder. (Bilateral means both sides.) Hydronephrosis is not itself a disease, but rather a physical result of whatever disease is keeping urine from draining out of the kidneys, ureters, and bladder. The symptoms, treatment, and expected outcome are those of the responsible disease.

Disorders associated with hydronephrosis include: acute bilateral obstructive uropathy chronic bilateral obstructive uropathy vesicoureteric reflux uteropelvic junction obstruction posterior ureteral valves neurogenic bladder bladder outlet obstruction prune belly syndrome

Advances in fetal ultrasound have given specialists the ability to diagnose obstructive uropathy (problems caused by the blockage of the urinary system) in the fetus before birth. Unilateral (one side only) or bilateral (both sides) obstruction of the urinary tract can be diagnosed by fetal ultrasound. Fetal conditions such as uteropelvic junction obstruction, posterior ureteral valves, and prune belly syndrome can be diagnosed while the fetus is in the uterus. Newborns who have been previously diagnosed with obstruction while still in the uterus can receive prompt surgical correction of the defects, often with good results. Experimental surgery on the fetus while in the uterus, which can relieve the obstruction or decrease the pressure on the kidney in the fetus, is being studied. Future techniques can be expected to result in better kidney function than the good results that are already expected. Symptoms Signs of hydronephrosis is generally observed during routine fetal ultrasound studies done during routine pregnancies and as such there are no symptoms in the fetus. In the newborn, any diagnosed urinary tract infection is reason to suspect some type of obstructive problem in the kidney. In the older child, repeat urinary tract infections are cause for evaluation of possible obstruction. Unfortunately, with the exception of an increased number of urinary tract infections, obstruction of the urinary tract is often without symptoms. Signs and tests Bilateral hydronephrosis may be apparent on: IVP Renal scan Ultrasound of the abdomen or kidneys CT scan of the abdomen or kidneys

Treatment Treating bilateral hydronephrosis includes two facets: relieving obstruction and treating the underlying disorder responsible for the hydronephrosis. Bilateral hydronephrosis results usually (but not always) due to a blockage below the level of the bladder. Thus, placing a Foley catheter may relieve the obstruction. Draining the bladder or relieving pressure through percutaneous nephrostomy tubes are other options. Once the obstruction is dealt with, then attention must be paid to treat the underlying cause (such as an enlarged prostate).

Expectations (prognosis) If an obstruction is detected in a fetus, surgery shortly after birth will optimize the function of the kidneys. Early discovery and intervention in any type of obstructive process will improve the outcome. Complications Renal insufficiency or failure may develop as a complication of many of the disorders associated with hydronephrosis. Calling your health care provider This disorder is usually discovered by the health care provider. Prevention A fetal ultrasound can reveal an obstruction of the urinary tract and allow for early surgery with better outcomes in the newborn. Other causes of obstruction, such as kidney stones, can be diagnosed early if individuals recognize early warning signs of obstruction and kidney disease.