Hydronephrosis

Question 1

Define hydronephrosis

Answer 1

Dilatation of renal pelvis or calyces

Question 2

Aetiology of hydronephrosis

Answer 2

Unilateral:
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

Bilateral:
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Question 3

Symptoms of hydronephrosis

Answer 3

Flank pain
Fever
LRTI
Distended abdomen
Inability to urinate
Haematuria

Question 4

Signs of hydronephrosis on examination

Answer 4

Obs:
- Tachypnoea
- Tachycardia
- Hypotension
- Fever
General
- Altered mental state
Abdo
- Distended abdomen
- Palpable bladder
- Enlarged/hard prostate

Question 5

Investigations for hydronephrosis

Answer 5

Urine dip: ?infection

U&Es: ?renal function
FBC: ?infection

US: hydronephrosis (first line)
IV urogram: assess position
Antegrade/retrograde pyelography: for treatment
CT: is suspecting renal colic

Question 6

Management for hydronephrosis

Answer 6

Remove the obstruction and drainage of urine
Acute upper urinary tract obstruction: nephrostomy tube
Chronic upper urinary tract obstruction: ureteric stent or a pyeloplasty

± antibiotics e.g. cefotaxime IV

Question 7

Complications of hydronephrosis

Answer 7

Urethral trauma
Post-obstructive diuresis
Severe sepsis and septic shock
Chronic kidney disease

Question 8

Prognosis of hydronephrosis

Answer 8

Obstructive uropathy can result in permanent renal damage, but the majority of patients recover completely if the obstruction is relieved promptly