Are your kidneys swollen? Could this be hydronephrosis? Let's talk!

Do you sometimes feel nauseous with severe pain in your side, stomach, or back? Or do you have pain when you urinate , or blood in your urine? These could be symptoms of a condition called hydronephrosis, which is swelling of the kidneys . Shall we talk about this in simple terms?

What is Hydronephrosis?

Simply put, hydronephrosis is a condition where there is a blockage in the flow of urine from your kidneys to your bladder, causing one or both kidneys to swell. Think of it like a blocked water pipe, which fills with water and swells. Doctors sometimes call this 'upper urinary tract dilation'.

Let's take a moment to remind ourselves how our urinary system works. It's like a cleaning system that removes waste from our body.

• There are two kidneys , and these are what filter and separate the toxins and waste products in the blood.
• Then there are two ureters , two tubes that carry urine from the kidneys to the bladder.
• There is a bladder , which is like a bag that collects and stores urine.
• Finally, there is the urethra , the tube that carries urine collected in the bladder out of the body.

Hydronephrosis occurs when there is an obstruction somewhere in this system, between the kidney and the ureter.

Hydronephrosis can come in different forms. It can come on suddenly, or it can develop gradually over time . The obstruction can be complete or partial. If it affects only one kidney, it is called 'unilateral hydronephrosis', and if it affects both kidneys, it is called 'bilateral hydronephrosis'. The amount of swelling can also vary from a small swelling to a large swelling.

How common is this situation?

Hydronephrosis can affect anyone of any age. It is estimated that about one in 100 adults will develop the condition at some point in their lives.

This can develop in small babies, especially while they are still in the mother's womb. It is called 'antenatal hydronephrosis'. It occurs in about 1% of pregnancies. But in most cases, it gets better on its own before the baby is born.

What are the symptoms of hydronephrosis?

The symptoms of hydronephrosis usually depend on the cause. Most of the time , there are no symptoms at all . As I mentioned earlier, antenatal hydronephrosis, which occurs in the baby in the womb, usually does not show symptoms until after the baby is born.

But if symptoms do appear, they may include:

• A sudden, severe pain: in your side, stomach, or back.
• Nausea or vomiting .
• Feeling pain when urinating.
• Blood in the urine.
• Developing a urinary tract infection ( UTI ).
• A feeling that the bladder has not completely emptied even after urinating.
• Urinating more or less than normal.

Now, when you have hydronephrosis, because the urine is trapped inside the body, there is a greater chance of bacteria growing in the urinary tract and causing a urinary tract infection (UTI). If this happens, you may experience symptoms like:

• Fever, chills, and fatigue.
• Burning and pain when urinating.
• Urine that is not clear and looks dark in color.

What are the causes of hydronephrosis?

The main cause of hydronephrosis is a blockage, or obstruction, in the passage of urine somewhere in our urinary system. There are many possible causes for this.

Causes affecting adults:

• Kidney stones: These are hard stones made up of calcium and oxalate. They can become lodged in the kidneys or urinary tract.
• Ureteral obstruction: A blockage in your ureters.
• Tumors: Tumors in the bladder, prostate gland, uterus , or other organs near the urinary system can cause obstruction of urine flow.
• Benign prostatic hyperplasia (BPH): In men, an enlarged prostate gland can cause pressure on the urethra and make it difficult to urinate.
• Narrowing of the urethra: The urethra can become narrow due to an injury, infection, birth defect, or surgery.
• Nerve or muscle problems: These can affect the function of your kidneys or ureters.
• Urinary retention: Inability to completely empty urine from the bladder.
• Vesicoureteral reflux: The backflow of urine from the bladder into the kidneys.
• Ureterocele: This is a protrusion of the lower part of the ureter into the bladder.

Reasons specific to women:

For those with a uterus, that is, women, hydronephrosis can also be caused by specific factors such as:

• Pregnancy: As the baby grows, the uterus also grows, which can put pressure on the ureters and obstruct the flow of urine.
• Uterine prolapse: The uterus falling down from its normal position.
• Cystocele – fallen bladder: The wall between the bladder and the vagina weakens, causing the bladder to drop into the vagina.

Causes affecting the baby in the womb (antenanatal):

The following factors can cause antenatal hydronephrosis in the fetus:

• Increased amount of urine produced by the fetus.
• An obstruction to the flow of urine somewhere in the urinary system.
• Urine flows back from the bladder to the kidneys.

What are the possible complications of hydronephrosis?

If hydronephrosis becomes severe, it can damage the kidneys and lead to kidney failure. In that case, you may need to undergo dialysis or a kidney transplant.

But, don't panic! Most people recover from hydronephrosis and there is no permanent damage to the kidneys. So it's important to not panic and seek prompt treatment.

How is Hydronephrosis diagnosed?

It is very important to see a doctor and get a diagnosis quickly, as hydronephrosis can cause long-term damage to the kidneys.

This is how your doctor diagnoses the disease:

• Physical exam: Your doctor will ask about your symptoms and examine your kidneys and bladder area for pain and swelling. They will also ask about your past medical history and whether anyone in your family has had these conditions. If you are a man, a rectal exam may be done to check for an enlarged prostate gland. If you are a woman, a pelvic exam may be done to check for problems with your uterus or ovaries.
• Urine tests: A sample of your urine will be taken to check for blood, stones, bacteria, or infection. You may also need to use a catheter to collect urine.
• Blood tests: A complete blood count (CBC) may be done to check for infection. Tests such as creatinine, eGFR, and BUN may also be done to check kidney function.
• Imaging procedures: The main test is an ultrasound scan. Sometimes a CT scan or MRI scan may also be needed.

Did you know that an unborn baby can be diagnosed with hydronephrosis during the first trimester of pregnancy with an ultrasound scan? This is usually detected during the 20-week ultrasound scan. If it is detected, the mother will have several more ultrasound scans to monitor the baby. But most of the time, it will get better on its own.

What are the treatments for hydronephrosis?

The main goal of treatment is to restore the flow of urine from the kidneys and reduce swelling and pressure. Treatment depends on the underlying cause. Because that is the main problem.

Sometimes, minor cases that are not serious will get better on their own without treatment. Other times, your doctor may take a 'wait and see' approach. Surgery is another option your doctor may consider. You should discuss all of your treatment options with your doctor.

If hydronephrosis develops suddenly and is caused by an obstruction, your doctor may insert a nephrostomy tube through your skin into your kidney to drain excess urine. Or, they may insert a soft plastic tube called a ureteral stent to keep your ureters open so that urine can flow normally.

If the cause is stones in the kidneys or urinary tract, there are treatment options such as:

• Shock wave lithotripsy: This is the most common treatment for kidney stones. High-energy shock waves are used to break up or break up the stones into smaller pieces, making them easier to pass out of the body.
• Ureteroscopy: Your doctor will pass a thin tube through your urethra to break up and remove stones. This procedure is used for stones in the bladder or lower part of the ureters. It can also be used in combination with other procedures to break up stones.
• Surgery: If the kidney stones are very large or difficult to remove, your doctor may need to perform surgery to remove them. Surgery may also be necessary if there are tumors, scar tissue, or other types of obstructions.

If you have a urinary tract infection (UTI) or if your urethra is narrowed due to an infection, your doctor will prescribe antibiotics to treat the infection.

Can Hydronephrosis be prevented?

Since hydronephrosis is caused by an underlying condition, it can be prevented by either avoiding or treating the underlying cause. Identifying the factors that put you at risk for developing the condition can also help prevent it.

Conditions that increase the risk of developing hydronephrosis are:

• Kidney stones.
• Having a history of cancer of the urinary system.
• Previous surgeries related to the urinary system.
• Previous infections of the urinary system, such as urinary tract infections (UTIs).
• Blood clots.
• Enlargement of the prostate gland.
• Pregnancy (due to your uterus pushing into your pelvis).

Is hydronephrosis a serious problem?

Yes, this can be a serious problem if not treated promptly. However, most cases are mild or moderate. They do not cause major health problems. So don't worry.

Should you worry about hydronephrosis?

Don't worry too much about being diagnosed with hydronephrosis. In most cases, with treatment, you can live a normal life without any long-term complications. Talk to your doctor about any questions you have about hydronephrosis and your recovery. Your doctor will tell you if you need to make any lifestyle changes and how long it will take to fully recover.

When should you see a doctor?

If you have any of these symptoms, be sure to see a doctor:

• A sudden, severe pain in your side or back.
• Vomiting.
• Changes in your urination: urinating more or less than usual, pain when urinating, blood in the urine.
• If the fever is higher than 100.5 Fahrenheit (38 Celsius).

Finally, things to remember

Okay, so, the hydronephrosis we talked about today is a condition in which the kidneys become swollen due to urine. Anyone can develop this condition. Fortunately, early diagnosis and treatment can prevent complications. If you have any unusual symptoms, such as pain in the lower back or abdomen, nausea, vomiting, or a change in the amount or frequency of urination, be sure to see a doctor. Once the cause of hydronephrosis is identified, your doctor will explain the many treatment options available to you. There is nothing to worry about, early treatment is the most important thing.