Hydronephrosis is the swelling of the kidney due to urine build-up. This condition is caused by any obstruction that blocks the normal flow of urine from the kidneys to the urinary bladder, resulting in dilation and distention of the kidney.
Hydroureteronephrosis is the term that specifically describes the swelling and dilation of the ureter.
It may involve the dilation of the ureter as well as the renal pelvis and calyx.
This article is your guide to understanding Hydroureteronephrosis. You will understand more about the condition, its types, symptoms, causes, and complications.
You will also learn about its diagnosis and explore treatment methods and prevention measures. So let’s get started.
Take a quick look at the urinary system in the body and its working.
Table of Contents
The Urinary System
The urinary system consists of the following parts- two kidneys, a pair of ureters, the urinary bladder and the urethra. All these organs work together to clear out body wastes and fluids.
The kidneys consist of numerous filtration units that filter the blood to remove metabolic wastes, excess water, and salts. The ureter is a narrow tube that connects the kidney to the urinary bladder, to allow passage of the urine.
The renal pelvis, which is a part of the kidney, collects the urine. From here, it flows down the ureters and accumulates in the urinary bladder.
The pressure on the bladder when it is full gives us the urge to urinate, thereby eliminating the body wastes in the form of urine through the urethra.
An obstruction in the passage of urine through any of these organs or its reverse flow results in urine build-up. This exerts pressure on the kidneys and ureters, which result in swelling.
Types Of Hydroureteronephrosis
Hydroureteronephrosis may be classified as non- obstructive or obstructive type.
a. In case of non- obstructive hydroureteronephrosis, the ureters and kidney may be swollen due to distension or internal pressure, and not because of a blockage.
b. Obstructive hydroureteronephrosis can occur due to the following types of obstructions:
- Narrowing of the ureter: The ureter can become constricted due to some reasons including tumor formation, impairment from surgeries, renal tuberculosis, and loss of ability to relax muscles in the region.
- Mass formation: Formation of stone, trapped blood clot or necrotic papilla within the ureter can cause a blockage. Developing carcinoma of the bladder or cervix can also cause narrowing of the tube.
- External pressure on the ureter: Distention of the urinary bladder may result in backward pressure exerted on the ureter. Other causes of narrowing include retroperitoneal fibrosis or pressure from lymph nodes.
Hydroureteronephrosis may be unilateral, affecting one kidney or bilateral, affecting both.
Symptoms Of Hydroureteronephrosis
The following are the symptoms of hydroureteronephrosis:
- Swelling of abdomen
- Flank pain
- Pain or discomfort during urination
- Pain in the lower back, which may be sudden or persistent.
- Change in frequency of urination- could be less or more than normal
- Feeling weak
- Nausea
- Vomiting
- Sweating
- Urinary tract infection (UTI)
- Fever
- Loss of control over urination
- Blood or pus discharge in urine
Fever could be a sign of infection in the urinary tract, which is a common complication associated with this condition.
Children and babies affected by hydroureteronephrosis suffer from abdominal swelling and pain, reduced frequency and flow of urine, urinary infections, and skin rashes in some cases.
Some people may not experience any symptoms at all.
The cause of hydroureteronephrosis, the duration, and persistence of the blockage, the extent of urine accumulation, the location of the constriction, are some factors that affect the symptoms displayed.
The symptoms of the condition can be classified as acute or chronic.
i. Acute hydroureteronephrosis is caused by a sudden obstruction causing quick urine build-up and symptoms including pain develop quickly. In this case, the pain would be experienced in the flanks and is likely to be severe and intermittent. The pain may also gradually extend down to the groin.
ii. Chronic hydroureteronephrosis develops gradually, with pain and symptoms that are displayed over weeks or even months. Some people may experience mild symptoms or none at all.
Symptoms may be experienced on only one side of the body (unilateral, where it affects one kidney) or both sides (bilateral, where both kidneys are affected).
What Causes Hydroureteronephrosis?
1. Unilateral Hydroureteronephrosis Can Develop Due To The Following Factors
i. Stone formation in the kidney or ureter, which are the hard depositions of salts and minerals from urine. These block the free flow of urine
ii. Injury, birth defects or impairments after surgery or radiation therapy, can cause constriction of the ureter tuberculosis, that affects the urinary tract
iii. Tumor formation in the region surrounding the kidneys or ureters
iv. Structural deformations that may occur during fetal development
v. Damage to muscles associated with the ureter
vi. Improper position of a blood vessel that puts pressure on the ureter
2. Bilateral Hydroureteronephrosis Develops When The Passage Of Urine From Both The Kidneys Is Affected
Factors that lead to this condition include:
i. Bladder stone formation
ii. Tumor or blood clot formation within the bladder
iii. Conditions or disorders that exert too much pressure on the bladder
iv. Neurogenic bladder, where the nerves controlling the bladder are disrupted
v. Muscular disorders that cause abnormal contractions of muscles in the bladder
vi. Urethral atresia
vii. Failure of the one-way valve in the bladder, which causes the urine in it to flow backward, a condition known as vesicoureteric reflux.
Due to the close positioning of the urinary and reproductive systems, any conditions or disorders in the reproductive organs can affect the working of the urinary system.
Causes Of Hydroureteronephrosis In Women Include
a. Pregnancy
During pregnancy, the uterus expands and takes up more space to accommodate the growing fetus. This expansion exerts pressure on the kidneys and ureter, hindering normal flow of urine.
This is what commonly causes hydroureteronephrosis in pregnant women. Hormonal changes during this phase may also affect the functioning of muscles in the bladder.
Hydroureteronephrosis due to pregnancy occurs in most women, and it usually resolves after delivery.
b. Uterine Prolapse
This is a condition where the uterus gets dislocated from its normal position.
c. Cystocele
This is caused by the weakening of the wall between the urinary bladder and the vagina, which results in the bladder sinking or falling into the vagina.
d. Cancer Of The Ovary Or Cervix
The growths of tumor cells exert pressure on the urinary tract.
Causes Of Hydroureteronephrosis In Men Include
a. Benign Prostatic Hypertrophy (BPH)
The prostate gland located beside the urethra may enlarge with progressing age. This condition is known as benign prostatic hypertrophy. While the growth is noncancerous, it may affect the urinary tract organs.
b. Prostate Cancer
Cancer cells exert pressure on the urinary tract, disrupting its normal functioning.
Risk Factors Of Hydroureteronephrosis
People at risk of developing hydroureteronephrosis include:
- Pregnant women, due to the expansion of the uterus.
- Sexually active women, due to their higher risk of contracting urinary infections.
- Males above the age of 50, due to conditions associated with the prostate gland, discussed above.
- People with cancer in organs surrounding the urinary system.
- Individuals with recurring stone in the urinary tract
When To Seek Medical Help?
If left untreated, hydroureteronephrosis can cause atrophy and even permanent failure of the organs in the urinary tract.
Hence, it is essential to get an accurate diagnosis and seek appropriate treatment at the right time. Early identification of the condition can prevent potential complications.
Look out for symptoms such as difficulty or inability to urinate, blood in urine, change in frequency of urination, pain in lower back, and fever.
The appearance, duration, and persistence of these symptoms may vary across individuals. However, they require immediate medical attention.
Diagnosis
The doctor would ask you about the symptoms, their duration, severity, and persistence. They would also study your medical history. They would conduct a physical examination particularly in the region around the urinary tract, to identify swelling, lumps, or discomforts.
Blood tests may be used to detect changes in levels of urea, creatinine, or electrolytes to understand the functioning of the kidney. This also helps to identify infections. Urine analysis can help to identify any abnormalities in urine including changes in pH and presence of blood cells and bacteria.
Imaging tests may be conducted to establish the presence and cause of hydroureteronephrosis. These tests also help doctors to identify the exact location of the obstruction. The type of imaging tests used would depend on the medical history, symptoms, and results of other examinations.
These include:
- MRI
- CT scan
- X-rays
- Ultrasound scan of abdomen
- Intravenous Pyelogram- which uses a special dye injected into the vein, to view the urine flow through the urinary tract.
- Isotope renography- this involves the injection of a radioactive substance into the vein to study urine movement using a gamma camera.
Men may be required to undergo a rectal exam to assess enlargement of the prostate.
Women may require a pelvic exam to assess any issues with the uterus and ovaries.
Hydroureteronephrosis in newborns can be identified through renal ultrasound done within a few days after birth.
Hydroureteronephrosis in an unborn child may be detected through regular ultrasounds during pregnancy. Nearly half of the prenatally diagnosed cases of this condition resolve by the time the child is born.
Treatment For Hydroureteronephrosis
Treatment for hydroureteronephrosis involves removing any obstruction, restoring the normal functioning of the urinary system and proper flow of urine. It focuses on reducing the swelling and relieving pressure build-up on the urinary tract.
The mode of treatment would also depend on whether the condition is acute or chronic, what caused it and location of the obstruction.
Stone formation in the kidney or ureter may usually resolve by itself.
Oral alkalinization therapy is a treatment method that dissolves uric acid kidney stones.
Shockwave therapy is a means of stone removal, where large stones are broken up into smaller sizes that can pass through the urine. However, severe cases may require stone removal through surgery.
Infections in the urinary tract can be treated using antibiotics.
Chronic urinary tract obstruction can be treated by inserting a stent through the ureter and bladder, to bypass the obstruction and allow passage of urine.
Severe urine build-up may require draining of the bladder using a catheter or draining from the kidney through nephrostomy.
When the cause of the condition is a tumor, treatment will focus on its removal or size reduction to relieve pressure on surrounding organs. This can be done through chemotherapy, steroid or radiation therapy, or surgery.
Surgical means can be used to correct blockages. In case of blood clots or scar formations, the affected area may be removed entirely.
An enlarged prostate may call for surgical removal if that is what causes severe obstruction to urine flow.
You may be prescribed a renal diet with foods having low contents of sodium, potassium, phosphorus, and protein, along with increased intake of fruit and vegetables.
Hydroureteronephrosis during pregnancy is mild and usually would not require major treatments. Cases of persistent pain, loss of kidney function or infection require treatment. In most cases, the condition resolves on its own within a few weeks of childbirth.
Most cases of prenatally diagnosed hydroureteronephrosis get better and resolve after the baby is born.
Children diagnosed with primary vesicoureteral reflux usually get better with the growth of the child. The extent of distention and overall functioning would be regularly monitored through tests and scans.
However, the build-up of urine within the urinary tract poses the risk of infections, for which the doctor may prescribe antibiotics and advise measures to prevent infection.
Cases, where the child grows without any improvements in the condition or recurrent infections, may require surgery of the valve between the bladder and the ureter to restore the normal flow of urine.
Failure or permanent damage to the kidneys would require dialysis or kidney transplant.
What Are The Complications Of Hydroureteronephrosis?
When left untreated, pressure due to urine build-up reduces the working of the kidneys. It would be unable to filter the blood to remove waste, thereby affecting urine production.
Hydroureteronephrosis can lead to loss of kidney function and permanent failure of organs in the tract.
Early diagnosis is essential to a quick recovery and restoration of normal functioning.
Recovery from the condition depends on factors including the underlying cause, the duration, whether it is acute or chronic, and the organ or region affected.
People with two kidneys can survive and get along if either one of the kidneys fails, provided the other is healthy and functional. Damage to both kidneys is a dangerous situation.
Hydroureteronephrosis would be particularly risky for people with only one normally functioning kidney.
Severe hydroureteronephrosis can result in blood infection known as sepsis. With the failure of the kidneys to efficiently eliminate waste products from the body, toxins can build-up in the blood, and this condition could be fatal.
In the case of permanent failure of the kidneys resulting from hydroureteronephrosis, dialysis and kidney transplant are two alternatives.
Dialysis is a technique that uses artificial means to perform the kidneys’ function by cycling blood to filter out waste and excess water. The purified blood is then sent back into the body.
A kidney transplant involves replacing the permanently damaged kidney with a healthy one from a suitable donor.
Home Remedies To Get Rid Of Hydroureteronephrosis
Here are a few things you can do to maintain a healthy urinary system:
1. Lemon Juice
- Lemon juice is acidic and contains citrate, which reduces the chances of formation of kidney stones. Additionally, it aids in flushing out toxins from the body.
- You can consume lemon juice mixed with water to daily to cleanse the urinary tract.
- For best results, avoid adding sugar or any other sweeteners to the drink.
2. Parsley
- Parsley is a natural diuretic that promotes the healthy functioning of the kidneys.
- Add some crushed parsley to a cup of boiling water. Strain it after five minutes and consume this parsley tea.
- You can also try a drink made of a ¼ cup of parsley juice mixed with half a cup of water, lemon juice, and honey. You can drink this twice a day for a few weeks. These cleanse the kidneys and help in detoxification.
3. Ginger
- Ginger is found to cleanse the kidneys and liver, besides enhancing digestion.
- You can use ginger as a part of your daily cooking.
- You can also consume ginger tea two times a day. Prepare ginger tea by adding two teaspoons of freshly grated ginger to two cups of water.
- After about ten minutes, strain it and add honey and fresh lemon juice.
4. Fruits And Vegetables
- Fruits and vegetables contain high amounts of nutrients and antioxidants that help to remove metabolic wastes and toxins from the body.
- You can consider eating fruits like oranges, lemons, grapes, watermelon, pears, peaches and vegetables such as cucumber, carrot, celery, parsley, spinach, and lettuce.
- Some of these also have diuretic properties that facilitate urination. This can also reduce stone formation. Consuming their juices would also help to flush out wastes.
- Prepare a juice of celery, fresh parsley, cucumber, and carrot. Consuming one glass of this juice daily can improve the functioning of the urinary system.
5. Turmeric
- Turmeric is widely used for its cleansing properties. It is also an effective anti-inflammatory that can cure inflammations and infections of the urinary tract.
- You can prepare a drink by adding a half teaspoon of turmeric powder and grated ginger in boiling water.
- After letting it simmer for about ten minutes, strain and some lemon juice to it. This may be consumed daily.
6. Lemon Juice + Olive Oil
- Olive oil contains antioxidants and polyphenols that prevent and treat oxidation. It is also rich in oleic acid, which fights inflammation.
- Mix equal amounts of lemon juice and olive oil (about four tablespoons each). Drink this solution and then water. You can do this twice a day.
- The citric acid in the lemon juice breaks down stones in the urinary tract, while the olive oil provides lubrication to easily expel the stone.
7. Pomegranate Juice
- Pomegranate juice has the potential to prevent some types of kidney stones. The seeds and juice have astringent and anti-oxidation properties.
- You can include a whole pomegranate or a glass of pomegranate juice in your daily diet.
- Alternatively, make a paste with a tablespoon of pomegranate seeds. Consume this paste with horse gram soup daily to get rid of stones.
8. Basil
- Basil has many properties that help to maintain normal urine flow. It is considered as a tonic for the kidneys and helps to eliminate stone formations, which may lead to hydroureteronephrosis.
- Basil can treat problems in the urinary tract, strengthens the organs and enhances their working.
- A teaspoon of basil leaves juice and honey took daily can cure kidney stones. Chewing of some basil leaves daily can also help.
- You may also try basil tea, by adding around five basil leaves to boiling water. After 10 minutes, strain it, add some honey and consume the tea.
Dietary Modifications To Cure Hydroureteronephrosis
a. Sodium
While sodium is presently found in many types of foods, the excess of it can cause fluid build-up and high blood pressure.
A healthy urinary system works to eliminate excess sodium from the body. However, too much of it is not good. Sodium also makes you fell thirsty
Control your sodium intake. Avoid eating salty foods, limit the use of pickles and salted snacks. Use fresh ingredients to cook, rather than canned ones. Minimise the use of processed foods, since these tend to have a lot of salt and sugar added in them.
Depending on the severity of your condition and the cause, the doctor may advise a diet that limits potassium, phosphorus and fluid intakes.
b. Potassium
Adequate levels of potassium help in the working of muscles, also maintaining pH and electrolyte levels. However, people with kidney disease may need to limit their potassium intake.
Damaged kidneys may not be able to efficiently remove the excess potassium, a condition known as hyperkalemia. This leads to high levels of the mineral in the body, which affects the functioning of the heart.
Foods high in potassium include milk, dairy products, beans, fruits and vegetable such as banana, orange, melon, prunes, plantain, spinach, tomato, potato.
Foods with low potassium include fruits like apple, blueberries, cranberries, pears, plum, peaches, and vegetables like cabbage, onions, cucumber, cauliflower, and lettuce.
Control the intake of dairy products. Refrain from using salt substitutes, since these add high levels of potassium to the body. Control the use of canned food products.
c. Phosphorus
Phosphorus works along with vitamin D and calcium to maintain healthy bones. With the loss of kidney function, phosphorus build-up destroys the normal balance between phosphorus and calcium, causing reduction of calcium levels. This leads to weak and fragile bones.
People with kidney disease may be advised to reduce phosphorus intake.
Foods rich in phosphorus are milk and dairy products, cola drinks, bran cereals, peanut butter, nuts and whole grains.
d. Fluids
Although water is essential for survival, excess water consumption can be detrimental when you have problems with the urinary system.
The extra fluid is not removed and accumulates within the body. This can elevate blood pressure, damage the heart, cause difficulty in breathing and swelling.
You may be advised to reduce water consumption through drinking as well as foods with high water content such as soups, gelatin, ice cream, fruits, and vegetables. Reduced sodium intake will help to control feeling thirsty.
e. Vitamins
Sufficient vitamin intake is important to maintain a healthy urinary system. Fruits and vegetables are excellent sources of vitamins.
However, these also contain high amounts of water and minerals, excess of which may have negative effects on the normal functioning of the system.
Your doctor may prescribe doses of vitamins that you require to supplement your diet.
Prevention Of Hydroureteronephrosis
Prevention of this condition depends on avoiding the underlying cause. Accurate identification and treatment of the cause can prevent the development of hydroureteronephrosis and its potential complications.
Individuals prone to developing kidney stones may opt for special diets and take medications to avoid the condition. This needs to be done under medical guidance.
Watch out for symptoms that we have discussed in the above sections. Fever is not a symptom that can be ignored. It could be an indicator of the underlying cause and its severity, which requires immediate consultation.
Keep yourself hydrated by ensuring adequate intake of fluids.
Check your use of medications. Excess of these can put you at the risk of kidney failure and other problems of the urinary tract.
Maintain a good diet and a healthy lifestyle in general.
