Hydronephrosis

definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management

1. PRESENTED BY-
NEHA BHARTI
NURSING TUTOR
M.Sc (N) MEDICAL SURGICAL
NURSING
SMVDCoN, KAKRYAL

2. Hydronephrosis is swelling of one or
both kidneys.

3. Kidney swelling happens when urine
can't drain from a kidney and builds up in
the kidney as a result.
This can occur from a blockage in the
tubes that drain urine from the kidneys
(ureters) or from an anatomical defect
that doesn't allow urine to drain properly.

4. Hydronephrosis can happen at any age.
Hydronephrosis in children may be
diagnosed during infancy or sometimes
during a prenatal ultrasound before the
baby is born.

5. Normally, urine goes from the kidney to
the tube that drains the kidney (ureter),
to the bladder and then out of the body.

But, sometimes urine backs up or
remains inside the kidney or in the
ureter. That's when hydronephrosis can
develop.

Some common causes of hydronephrosis
include:

6. PARTIAL BLOCKAGE IN
THE
URINARY TRACT

Urinary tract blockages
often form where the
kidney meets the ureter,
at a point called the
uretero- pelvic junction.

Less commonly,
blockages may occur
where the ureter meets
the bladder at what's
called the ureterovesical
junction.

VESICOURETERAL
REFLUX

Vesicoureteral reflux
happens when urine
flows backward
through the ureter from
the bladder up into the
kidney. Normally, urine
flows only one way in
the ureter.

Urine flowing the
wrong way makes it
difficult for the kidney
to empty properly and
causes the kidney to
swell

7. Less-common causes of hydronephrosis
include kidney stones, a tumor in the
abdomen or pelvis.

8. Hydronephrosis may be

Unilateral involving just one kidney or

Bilateral involving both kidneys.

9. UNILATERAL
HYDRONEPHROSIS

Unilateral hydronephrosis
usually results from a
blockage in one of
ureters, or where the
renal pelvis (the wide,
urine-collecting system of
each kidney) joins the
narrow ureter.
BILATERAL
HYDRONEPHROSIS

Both kidneys will be
affected by
hydronephrosis if there
is a blockage in or near
the bladder.

10. Normally, the kidney filters waste
products from blood and disposes of it in
the urine. The urine drains into individual calyces
(single -calyx) that form the renal pelvis.
This empties into the ureter, a tube that
connects the kidney to the bladder.
The urethra is the tube that empties the
bladder.

11. The main function of kidneys is to filter
the blood and eliminate the waste
materials from the body.

In this process, they also absorb the
useful materials such as glucose.

The waste materials eliminate in the form
of urine that goes out through a tube
called urethra.

12. DUE TO ANY CAUSE OR
FACTOR
UPJ OBSTRUCTION WILL OCCUR AND
JUNCTION IS BLOCK
URINE BECOMES BACKED UP CAUSES A
BUILD-UP OF URINE INSIDE THE KIDNEY,
PUTTING PRESSURE ON THE KIDNEY AND
CAUSES THE KIDNEY PLUMBING TO DILATE
IT MAY ALSO CAUSE URINARY
INFECTION, KIDNEY STONES OR PAIN .
THIS LEADS TO INFLAMMATION AND
SWELLING OF THE KIDNEY.

13. There may or may not be direct symptoms of
hydronephrosis depending upon the underlying
cause.

1.ACUTE HYDRONEPHROSIS:

When the blockage happens quickly, patient
may experience a severe pain (renal colic)in
back or side, between ribs and hip.

The pain will be on the side of the affected
kidney or on both sides if both kidneys are
affected.

14. Other symptoms can include:
Swelling in abdomen .
Fever
Urinary tract infection
Pain during urination
Blood seen in the urine

15. 2. CHRONIC HYDRONEPHROSIS:

Chronic hydronephrosis develops over
time and there may be no specific
symptoms. If hydronephrosisis‘ caused by
a slow-developing blockage, patient may
have the same symptoms as acute
hydronephrosis, no symptoms at all, or a
dull, aching pain in side that comes and
goes.

16. These are very nonspecific and may
include
weakness,
malaise,
nausea and vomiting.

If electrolyte abnormalities occur because
the kidneys are unable to regulate sodium,
potassium, and calcium, there may be
heart rhythm disturbances and muscle
spasms.

17. Tests for diagnosing hydronephrosis may include:

A blood test to evaluate kidney function

A urine test to check for signs of infection or urinary
stones that could cause a blockage

An ultrasound imaging exam, during which doctor
can view the kidneys, bladder and other urinary
structures to identify potential problems

A voiding cysto- urethrogram, an X-ray exam that
uses a special dye to outline the kidneys, ureters,
bladder and urethra, capturing images before and
during urination

18. Depending on the results from initial
testing, doctor may recommend additional
imaging exams, such as a

Computerized tomography (CT) scan or

Magnetic resonance imaging (MRI).

19. The goal of treatment for
hydronephrosisis to restart the free flow
of urine from the kidney and decrease
the swelling and pressure that builds up
and decreases kidney function.

The initial care for the patient is aimed at
minimizing pain and preventing urinary
tract infections. Otherwise, surgical
intervention may be required.

20. The timing of the procedure depends upon
the underlying cause of hydronephrosis and
hydro- ureter and the associated medical
conditions that may be present.


For example, patients with a kidney stone
may be allowed 1-2 weeks to pass the stone
with only supportive pain control if urine
flow is not completely blocked by the stone.

21. If, however, the patient develops an
infection or if they only have one kidney,
surgical intervention may be done
emergently to remove the stone.

22. Shock wave lithotripsy (SWL or extra
corporeal shock wave lithotripsy) is the
most common treatment for kidney
stones.

Shockwaves from outside the body are
targeted at a kidney stone causing the
stone to fragment into tiny pieces that are
able to be passed out of the urinary tract
in the urine.