Hydronephrosis represents a pathological enlargement of the renal pelvis and renal caliceal system. It is also known as aqueous sac kidney and results from chronic urinary retention. In the long term, the increase in pressure in the renal cavity system can lead to destruction of kidney tissue.
What is hydronephrosis?
Hydronephrosis is the term used to describe a “sac-like” dilation (dilatation) of the urinary collecting basin or renal cavity system. The condition is a result of urinary outflow obstruction with resulting impairment or destruction of kidney tissue. Therefore, it is also called urinary stasis kidney or water sack kidney. The problem here is a lack of drainage of urine, which results in a progressive expansion of the kidneys. Depending on the localization, there is then not only a sac-like expansion of the renal cavity system, but also of the ureters. Hydronephrosis is thus the result of urinary hypertension. Only in about 10% of cases are both kidneys affected. As the disease progresses, there is a marked reduction in kidney function. If hydronephrosis becomes chronic, permanent damage to the renal parenchyma can occur, i.e. a loss of function of the renal tissue. Reduced filtering capacity and, in the worst case, renal failure can be the long-term consequences. Hydronephrosis does not necessarily present with symptoms immediately; possible initial signs may include flank, back, or abdominal pain, as well as dizziness, vomiting, or cramps.
Causes
There are a variety of causes of urinary retention kidney. The classification of the same is basically based on the localization of their occurrence; it is also crucial whether they are located outside or inside the urinary collecting basin. The most common causes include mechanical constriction, e.g. due to kidney stones in the urinary system. This causes narrowing of the ureters and urine stasis. This obstruction of outflow leads to renal pelvic outlet stenosis, for example. The group of mechanical causes of hydronephrosis also includes bladder cancer, bladder stones or a narrowing of the bladder neck. Causes localized outside the urinary system may include tumors that constrict the ureters and thereby impair urinary outflow, such as prostate or uterine cancer. Other triggers of hydronephrosis can be malformations that cause urine to flow back into the kidneys: In this so-called vesicoureterorenal reflux, the ureter does not close (properly) after urination and reflux occurs. More rarely, urinary retention kidney also results from neuromuscular diseases and resulting bladder emptying disorders. This can occur in multiple sclerosis, quadriplegia, or other neurogenic diseases (especially paralysis). In rare cases, drug abuse may also be causally related to hydronephrosis.
Typical symptoms and signs
- Flank pain
- Abdominal pain
- Back pain
- Muscle cramps
- Dizziness
- Vomiting
- Sweating
Diagnosis and course
Hydronephrosis does not have to result immediately in concise symptoms. Acute hydronephrosis may cause symptoms similar to renal colic: severe, colicky pain in the flank, abdomen, and back, possibly associated with cramping. Blood in the urine is also a possible symptom in the acute course of the disease. Chronic development of hydronephrosis is more gradual – here, symptoms may be equally accompanied by pain, but may also resemble renal failure: dizziness, nausea, vomiting, feeling of weakness, muscle spasms and localized feeling of pressure, as well as disturbances in the digestive tract are possible. Imaging procedures include sonography of the abdomen, urinary tract, and bladder. This also allows the extent of hydronephrosis to be assessed. For further clarification of the cause of hydronephrosis, computer tomography of the abdomen and urethroscopy are possible, as well as angiography and excretory urography. Laboratory tests can be used not only to measure blood in the urine, but also the creatinine value, which provides information about the filtering capacity of the kidney, among other things.If hydronephrosis remains undiagnosed for a long time and the disease progresses, the late consequences are high blood pressure (hypertension) and renal insufficiency, as well as permanent damage to the kidney.
Complications
In the long term, hydronephrosis can cause severe and irreversible damage to the tissues around the kidneys. In this case, the affected person primarily suffers from various pains, but they occur in the area of the kidneys and the back. In most cases, this pain spreads to other regions of the body. The muscles cramp and epileptic seizures may occur. Furthermore, patients complain of vomiting and dizziness. Not infrequently, these complaints lead to a panic attack or sweating. Due to the constant pain, many patients are irritable and can no longer enjoy everyday life. They withdraw from active life and the patient’s resilience drops significantly. Disturbances of the digestive tract may also occur. In the worst case, the affected person suffers kidney failure, making them dependent on a donor kidney or dialysis. Without treatment, renal failure causes the patient to die. The treatment does not lead to any further complications. However, its success depends strongly on the severity of hydronephrosis and does not lead to a positive course of the disease in every case. Life expectancy may also be reduced by hydronephrosis.
When should you see a doctor?
If symptoms such as abdominal pain or muscle cramps are noticed, hydronephrosis may be present. A visit to the doctor is indicated if signs of disease increase or have not subsided after three to four days at the latest. If further symptoms occur, a doctor must be consulted. In particular, intense back pain as well as nausea and vomiting are clear warning signs that must be investigated. If it is indeed a urinary retention kidney, immediate treatment is necessary. Patients who notice blood in their urine or have problems urinating should talk to their primary care physician. This is especially true if another condition is already present. Typical causes of hydronephrosis are kidney stones, bladder stones or bladder cancer. Malformations or neuromuscular diseases can also cause hydronephrosis. If any of these conditions are present, unusual symptoms must be seen by a physician the same day. The initial examination may be performed by the primary care physician. Subsequently, a urologist or a nephrologist should be consulted, depending on the nature and severity of the symptoms. With severe symptoms, the patient should go to the hospital.
Treatment and therapy
The therapy of hydronephrosis necessarily depends on the particular cause. The most important goal, of course, is to permanently restore the flow of urine from the kidney to the bladder and, in acute cases, to effectively treat the patient’s pain. If the cause of the urinary obstruction is mechanical, the first priority is to remove the obstruction to flow. This can be done by endoscopic or surgical removal. In any case, it is important to prevent infections in the urinary system. In the case of kidney stones as the cause of the water sack kidney, not only is pain therapy performed, but measures are also used to remove the kidney stones from the urinary system. If they cannot be eliminated naturally, shock waves are used to break up the kidney stones in the urinary system. Alternatively, if this is not possible, various methods of renal pelvoplasty are available. Depending on the progress of hydronephrosis, surgical rerouting (recanalization) of the urinary tract may be performed. Here, the treating physician has several options: A stent (vascular prosthesis) can be implanted and thus, similar to a bypass, a “new” ureter can be created. Or he may decide to surgically relocate the ureter intraperitoneally, i.e. within the abdominal cavity. If these options are not feasible, the creation of an artificial bladder outlet (urostomy) may also be a therapeutic alternative. All these measures are aimed at restoring and permanently guaranteeing the essential outflow of urine and the excretion of urinary substances to a sufficient degree. If the above-mentioned therapeutic measures are no longer possible and the course of the disease or the damage to the kidney has progressed too far, kidney removal may also be necessary.
Outlook and prognosis
The prognosis of hydronephrosis depends on its cause as well as prompt treatment. If treatment is successful within a few days or weeks, the kidney tissue may recover completely. No kidney damage remains. However, without treatment, renal insufficiency may develop, which can no longer be completely cured. In very severe cases, there is even a threat of total loss of kidney function. Hydronephrosis is not that rare, however. Newborns and infants often develop it as a result of congenital disorders. In pregnant women it often occurs when the uterus exerts pressure on the urethra, and in men the so-called water sack kidney develops due to diseases of the prostate. Therefore, in addition to pregnant women, older men are usually affected. For women, in contrast to men, the prognosis of hydronephrosis is usually very good. In almost all women, the kidney returns to normal after pregnancy without any treatment at all. Very often, the disease is not even noticed at first because the kidneys dilate only slowly. Rarely, however, high blood pressure develops in the course of hydronephrosis. In some cases, the loss of urine production and, as already mentioned, damage to the kidneys is also possible. Treatment of hydronephrosis depends on the particular cause. If the urinary outflow obstruction is quickly eliminated, there is usually no need to worry about consequential damage.
Prevention
Because a very wide range of causes can be considered in hydronephrosis, immediate prevention is very difficult. In any case, the general health of the kidneys and bladder can be influenced insofar as attention is paid to an adequate water intake – and this from childhood to old age. The consumption of alcohol in only small measure is to be regarded in this connection as just as beneficial. A healthy lifestyle and sufficient consumption of water are certainly the best preventive measures with regard to this disease.
Aftercare
In most cases of hydronephrosis, the measures or options for aftercare are very limited or non-existent. In this case, the affected person is primarily dependent on early detection and treatment of the disease so that further complications can be prevented. This also prevents a further worsening of the symptoms. In the worst case, however, hydronephrosis leads to complete destruction of the kidneys, which can also result in the death of the affected person. The treatment itself always depends on the exact cause of this disease, so that no general prediction can be made. In some cases, medication can be taken to alleviate the symptoms. It is important to ensure that the medication is taken regularly and in the correct dosage. If there are any uncertainties or questions, a doctor should be consulted first. A doctor should also always be consulted first if there are questions about side effects or interactions with other medications. In some cases, hydronephrosis also requires psychological treatment. Contact with other sufferers of the disease can also be useful in this regard, as it can lead to an exchange of information.
This is what you can do yourself
Hydronephrosis requires immediate medical examination or care. If the causative kidney congestion is not advanced, alternative remedies can be used to relieve discomfort and relieve the congestion. One effective household remedy is apple cider vinegar. Mixed with acacia honey and mineral water, it dissolves kidney stones and can prevent hydronephrosis. Homeopathy offers the remedy “Berberis vulgaris“, which is used for various ailments of the excretory organs. Matricaria chamomilla or real chamomile also helps with kidney pain. Urinary stones can be treated with Lycopodium. In addition, Schüssler salts are useful, especially Natrium Phosphoricum as well as Lithium chloratum. The use of homeopathic remedies should first be discussed with a doctor. If hydronephrosis has already formed, medical treatment is required. The patient can support pain therapy or treatment by means of shock waves by taking it easy and not putting any further strain on the kidney. The medical professional in charge will answer exactly which measures should be taken.In general, recommendations include a healthy and balanced diet, adequate hydration, and light physical activity.
