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 elevated 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 to 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.

Aetiology

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. Intrinsic obstructions (those that occur within the tract) include blood clots, stones, along with tumours of the kidney, ureter and bladder. Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic tumours, strictures of the ureters, and neurological defecits.

Complications

Left untreated bilateral obstruction (obstruction occurring to both kidneys rather than one) has a poor prognosis.

Treatment

Treatment of hydronephrosis focusses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific tretment 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.

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Pyelectasis, hydronephrosis: Ultrasound helps predict future urologic surgery - Obstetrics
From OB/GYN News, 4/15/02 by Nancy Walsh

NEW ORLEANS -- Much more specific information on outcomes now can be given to pregnant women whose fetuses have urinary tract abnormalities detected on ultrasound.

Only about 4% of cases of isolated pyelectasis will ultimately require surgery, Dr. Max Maizels said at the annual meeting of the Society for Maternal-Fetal Medicine.

Hydronephrosis, by contrast, typically requires surgical correction in approximately 30% of cases. "Those two terms often are used interchangeably in the literature, he said, explaining that pyelectasis is dilation of the renal pelvis, while hydronephrosis also is characterized by caliceal dilation.

These risk estimates result from a collaborative program including prenatal and postnatal specialists from various institutions in Chicago. Since 1998, Dr. Maizels and his colleagues prospectively collected data on all pregnancies referred for fetalurologic evaluation with the goal of refining their ability to predict outcome.

A total of 169 cases were referred; 132 of these were pyelectasis, and 38 were hydronephrosis, said Dr. Maizels of the division of urology at Children's Memorial Hospital, Chicago.

By analyzing these cases, the investigators were able to determine other features of the kidneys and bladder that can be used to further refine the prediction of the need for surgery. "For example, if pyelectasis is present but the bladder is normal in size, the risk remains at 4%. But if the bladder is enlarged, the risk increases to 33%," Dr. Maizels said. And if hydronephrosis is accompanied by other abnormalities such as elongation of the kidneys, there's a 90% chance of needing surgery, he reported in a poster session at the meeting, which was cosponsored by the American College of Obstetricians and Gynecologists.

Increased risk also exists if the pyelectasis increases over time, or if it appears to fluctuate. Dilation of the kidney seen on an ultrasound can appear to normalize on a follow-up scan a month later, and the assumption is made that this represents improvement. "Actually, it doesn't," he said.

This fluctuation can be a result of vesicoureteral reflux, a condition in which the fetus voids back into the kidneys rather than into the amniotic fluid, he said.

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