If you’ve been diagnosed with hydronephrosis, you likely have questions about what this means for your kidney health and what treatment options are available. Hydronephrosis, swelling of the kidney due to urine backup, ranges from mild cases that resolve with treatment to more serious situations requiring urgent intervention.
The good news is that with prompt diagnosis and appropriate care, many patients can protect their kidney function and prevent permanent damage.
What is Hydronephrosis?
Hydronephrosis is a condition where one or both kidneys become swollen because urine cannot drain properly from the kidney to the bladder. Think of it like a backed-up drain. When urine can’t flow freely through the urinary tract, it accumulates in the kidney, causing it to enlarge.
This swelling puts pressure on the delicate kidney tissues. If left untreated, hydronephrosis can damage the kidney and potentially lead to permanent loss of kidney function. However, it’s important to understand that hydronephrosis itself is not a disease; it’s a symptom of an underlying blockage or obstruction in the urinary system.
Hydronephrosis can affect people of all ages, from infants to older adults. It can occur in one kidney (unilateral hydronephrosis) or both kidneys (bilateral hydronephrosis). Bilateral hydronephrosis is generally more serious and requires more urgent treatment since both kidneys are affected.
Hydronephrosis Exists on a Spectrum
Hydronephrosis is classified based on severity:
Mild Hydronephrosis:
- Slight kidney swelling that may not cause noticeable symptoms
- Often detected incidentally during imaging for other conditions
- May resolve with minimal intervention, depending on the cause
Moderate Hydronephrosis:
- Noticeable swelling with symptoms like flank pain or urination changes
- Requires treatment to prevent progression and protect kidney function
- Risk of kidney damage increases the longer it goes untreated
Severe Hydronephrosis:
- Significant swelling with potential for rapid kidney damage
- Often causes pronounced symptoms, though not always
- Requires urgent medical care to prevent permanent kidney injury
Important to know: Only imaging studies and medical evaluation can determine where your case falls on this spectrum. Never assume your case is mild based on symptoms alone; some people with severe hydronephrosis experience minimal pain initially, especially if the condition developed gradually.
What Causes Hydronephrosis?
Hydronephrosis results from conditions that obstruct urine flow anywhere along the urinary tract. Common causes include:
- Kidney Stones: One of the most frequent causes, especially in adults. Stones can lodge in the ureter (the tube connecting the kidney to the bladder) and block urine flow completely or partially.
- Enlarged Prostate (Benign Prostatic Hyperplasia): In men over 50, an enlarged prostate can compress the urethra and prevent proper urine drainage from the bladder, causing backup into the kidneys.
- Urinary Tract Infections (UTIs): Severe or recurrent infections can cause swelling and inflammation that obstructs urine flow, particularly in children.
- Pregnancy: The growing uterus can compress the ureters, particularly on the right side and especially in the third trimester. This is usually temporary and resolves after delivery.
- Tumors or Masses: Growths in the kidney, ureter, bladder, or nearby organs (like the colon, uterus, or prostate) can create blockages. These may be benign or cancerous.
- Congenital Abnormalities: Some people are born with structural issues in their urinary system, such as ureteropelvic junction (UPJ) obstruction or posterior urethral valves in boys.
- Strictures: Narrowing of the ureter or urethra due to scarring from previous surgery, injury, radiation therapy, or chronic infection.
- Blood Clots: Rarely, clots in the urinary tract can obstruct normal urine flow.
- Vesicoureteral Reflux (VUR): A condition where urine flows backward from the bladder into the kidneys instead of flowing out through the urethra.
- Neurogenic Bladder: Nerve damage from conditions like diabetes, spinal cord injury, or multiple sclerosis can affect bladder control, leading to incomplete emptying and urine backup.
Signs and Symptoms
Recognizing the symptoms of hydronephrosis early is crucial for preventing permanent kidney damage. However, symptoms can vary significantly depending on how quickly the condition develops and its severity.
- Flank Pain: Pain in the side or back, typically between the ribs and hip. This may be sudden and severe (in acute cases) or dull and constant (in chronic cases).
- Abdominal Pain: Discomfort or pain in the belly area, which may radiate to the groin.
- Changes in Urination: Difficulty starting urination, decreased urine output, frequent urge to urinate with little output, or weak urine stream.
- Blood in Urine (Hematuria): Urine may appear pink, red, brown, or cola-colored. This may be visible or only detected through urine testing.
- Painful Urination: Burning or discomfort when urinating, often indicating an accompanying infection.
- Fever and Chills: May indicate an infection alongside the blockage, which requires immediate medical attention.
- Nausea and Vomiting: Often accompany severe cases or when kidney stones are present.
- Recurrent Urinary Tract Infections: Frequent UTIs can be a sign of underlying hydronephrosis, especially in children.
Important Note: Some people with hydronephrosis, particularly chronic cases that develop slowly, may have no symptoms at all. The condition might only be discovered during imaging tests for other health issues. This is why symptoms alone can’t tell you how serious your case is.
When to Seek Immediate Medical Care:
Seek emergency medical attention if you experience:
- Severe, sudden pain in your side or back
- High fever (above 101°F/38.3°C)
- Complete inability to urinate
- Bloody urine with pain
- Severe nausea and vomiting
These symptoms could indicate a serious obstruction, infection, or other complication requiring urgent treatment.
Treatment Options for Hydronephrosis
Treatment for hydronephrosis focuses on two primary goals: relieving the obstruction to prevent further kidney damage and treating the underlying cause. Your treatment plan will be tailored to the cause of your hydronephrosis, its severity, and your overall health.
Step 1: Immediate Relief of the Obstruction
For cases causing symptoms or showing signs of kidney function decline, relieving the obstruction quickly is the priority.
- Catheterization: A thin, flexible tube (catheter) inserted through the urethra into the bladder to drain urine. This is typically used when the blockage is at the bladder or urethra level, such as with an enlarged prostate.
- Ureteral Stent: A small, flexible tube placed inside the ureter to bypass the blockage and allow urine to drain from the kidney to the bladder. Stents are commonly used for kidney stones, strictures, or tumors compressing the ureter. They’re typically temporary, though some patients may need them for extended periods.
- Nephrostomy Tube: A tube inserted through the skin directly into the kidney to drain urine into an external collection bag. This is used when other drainage methods aren’t suitable or when the obstruction can’t be bypassed internally. While it requires more care, it effectively protects kidney function while the underlying problem is addressed.
Step 2: Treating the Underlying Cause
Once immediate drainage is established (if needed), treating the root cause becomes the focus. For example:
For Kidney Stones:
- Small stones (less than 5mm) may pass naturally with increased fluid intake, pain management, and medications that help relax the ureter
- Shock wave lithotripsy (SWL) uses sound waves to break stones into smaller pieces that can pass more easily
- Ureteroscopy involves inserting a small scope through the urethra and bladder to remove or break up stones
- Percutaneous nephrolithotomy is used for larger stones, involving a small incision in the back to access and remove the stone
For Enlarged Prostate:
- Alpha-blocker medications relax prostate muscles and improve urine flow
- 5-alpha reductase inhibitors shrink the prostate over time
- Minimally invasive procedures like transurethral resection of the prostate (TURP), laser therapy, or prostatic urethral lift
- Open or robotic prostatectomy for very large prostates
For Tumors or Masses:
- Surgical removal of benign tumors or cysts compressing the urinary tract
- Cancer treatment including surgery, radiation therapy, chemotherapy, or immunotherapy depending on the type, stage, and location
- Palliative stenting to maintain drainage if the tumor cannot be removed
For Urinary Tract Infections:
- Antibiotics tailored to the specific bacteria causing the infection
- Drainage of any abscesses that have formed
- Investigation of underlying causes that may predispose to recurrent infections
For Pregnancy-related Hydronephrosis:
- Usually no treatment is needed as the condition typically resolves after delivery
- Monitoring to ensure kidney function remains stable
- Stent placement only if severe symptoms develop or kidney function declines
Step 3: Monitoring and Follow-up Care
After treatment, ongoing monitoring ensures the obstruction hasn’t recurred and kidney function is stable or improving:
- Regular ultrasounds or CT scans to check for recurring swelling
- Blood tests to monitor kidney function (creatinine, BUN, GFR)
- Urinalysis to detect infections or other issues early
- Blood pressure monitoring, as kidney problems can affect blood pressure
Your follow-up schedule will depend on the cause of your hydronephrosis, the severity of kidney damage, and your response to treatment.
When Surgery is Necessary
Some cases require surgical intervention to definitively correct the problem:
- Removing tumors or obstructing masses
- Repairing congenital abnormalities
- Reconstructing damaged portions of the urinary tract
- Creating alternative drainage routes when normal pathways can’t be restored
Most surgical procedures for hydronephrosis are now performed using minimally invasive techniques, such as laparoscopic or robotic surgery, which typically result in less pain, shorter hospital stays, and faster recovery compared to traditional open surgery.
What You Can Do to Protect Your Kidney Health
While medical treatment is essential, there are important steps you can take to support your kidney health and reduce the risk of complications:
- Stay Well-hydrated: Drinking plenty of water helps prevent kidney stones and promotes healthy urine flow. Aim for 8-10 glasses of water daily unless your doctor advises otherwise. Your urine should be pale yellow. If it’s darker, you may need more fluids.
- Follow Your Treatment Plan Completely: Take all prescribed medications exactly as directed, attend every follow-up appointment, and complete all recommended imaging studies. Don’t stop medications early, even if you feel better.
- Manage Underlying Health Conditions: If you have diabetes, keep your blood sugar well-controlled. If you have high blood pressure, work with your doctor to maintain healthy levels. Both conditions can affect kidney health.
- Maintain a Kidney-friendly Diet: Limit sodium (salt) intake, maintain appropriate protein intake based on your kidney function, and follow any specific dietary recommendations from your healthcare team. A dietitian who specializes in kidney disease can be invaluable.
- Don’t Ignore New or Worsening Symptoms: Report any changes to your doctor immediately, including new pain, changes in urination, fever, or swelling. What seems minor could indicate a problem needing prompt attention.
- Be Cautious with Medications: Always discuss any new medications or supplements with your doctor. Certain drugs can harm kidneys, especially NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen. Avoid these unless specifically approved by your nephrologist.
- Practice Good Urinary Habits: Don’t hold urine for extended periods; urinate when you feel the need. Complete emptying of the bladder helps prevent infections and backup.
- Attend All Follow-up Appointments: Even if you feel fine, regular monitoring is essential to catch any recurrence early and ensure your kidney function remains stable.
- Know Your Numbers: Understand your kidney function levels (creatinine, GFR) and ask your doctor to explain what they mean. Tracking these over time helps you and your healthcare team catch problems early.
- Avoid Smoking and Limit Alcohol: Smoking damages blood vessels, including those in the kidneys. Excessive alcohol can also harm kidney function and interfere with medications.
Expert Kidney Care When You Need It Most
At The Kidney & Hypertension Center, our experienced nephrologists provide comprehensive care for hydronephrosis, from diagnosis to treatment and long-term monitoring. With convenient locations throughout the Cincinnati area and Greater Ohio, expert kidney care is always nearby.
Don’t wait to address hydronephrosis; early evaluation and treatment provide the best opportunity to preserve kidney function. Whether you’ve just been diagnosed or need ongoing kidney care, our team is ready to help.
