What is hydronephrosis?

Written by Zhou Qi
Nephrology
Updated on September 10, 2024
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The so-called hydronephrosis is a morphological description, referring to an obstruction in the urinary system caused by various reasons. After the kidneys produce urine, it cannot be normally delivered to the bladder. This leads to fluid accumulation in the renal pelvis and calyces, which can be detected through imaging as hydronephrosis. The causes of hydronephrosis are numerous. The most common cause is acquired obstruction, primarily due to urinary system stones, scarring from injuries, or tumors in the urinary system compressing the ureter, which often results in urinary tract obstruction. In addition, some congenital causes can also lead to urinary tract obstruction. Examples include segmental dysfunction of the ureter, intrinsic stenosis of the ureter, and twisting of the ureter. However, these congenital obstruction causes are relatively rare.

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Nephrology
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How is hydronephrosis caused?

The causes of hydronephrosis can be divided into congenital, acquired, and external factors. Among these, acquired causes are the most common, primarily referring to obstructions in the urinary tract, such as stones that block the ureter, leading to hydronephrosis, inflammation, or ischemic damage. Scarring of the ureter can also result in hydronephrosis. Tumors or polyps in the renal pelvis and ureter may also cause obstructions leading to fluid accumulation. External causes mainly include diseases of retroperitoneal organs, such as abscesses, bleeding, tumors in the retroperitoneum, and pelvic tumors, like rectal cancer. Congenital causes mainly involve intrinsic narrowing of the ureter, ectopic vessels causing compression, and high insertion of the ureter, which are less common.

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Nephrology
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What is the best treatment for hydronephrosis?

The most common cause of hydronephrosis is due to kidney stones or ureteral stones blocking the urethra, leading to poor drainage of urine from the kidneys. Generally, if hydronephrosis occurs, the first step is to check the renal ultrasound and, if necessary, undergo cystography to determine the cause of the hydronephrosis. If it is confirmed to be stones, it is important to check the size of the stones. If the stone is smaller than five millimeters, you can drink more water, exceeding 3000 milliliters per day. This can help flush the stones out through the urine by being more active and jumping around. If the stone is relatively large, it may require extracorporeal shock wave lithotripsy or ureteroscopic stone removal. Generally, for hydronephrosis, it is still recommended to drink plenty of water and eat a light diet, avoiding spicy and irritating foods.

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Nephrology
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Should people with hydronephrosis avoid certain foods?

Although there are many causes leading to hydronephrosis in patients, most hydronephrosis is related to stones, meaning that hydronephrosis occurs in patients due to ureteral kidney stones. Therefore, dietary restrictions are necessary for patients with hydronephrosis in daily life. If the hydronephrosis is caused by calcium oxalate stones, patients should avoid consuming foods that are high in calcium and oxalates, such as nuts, legumes, spinach, and beets. If the hydronephrosis is due to the formation of uric acid stones, patients should also avoid consuming excessive amounts of animal organs, such as pork liver and kidneys, avoid seafood, and try not to drink beer, as these contain a high amount of purines, which can easily lead to stone formation. Additionally, if patients with hydronephrosis also have renal insufficiency, they should follow a low-salt diet and avoid consuming particularly salty foods, including various pickles, etc.

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Nephrology
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Is hydronephrosis serious?

Whether the condition of hydronephrosis is serious depends on various factors such as the duration of hydronephrosis, the cause, the extent of fluid accumulation, and more. For example, some patients may have mild hydronephrosis in only one kidney and it may have developed recently; generally, this condition is not very serious. Some patients might have urinary obstructions caused by urinary system stones, and the issue could be resolved using extracorporeal shock wave lithotripsy or surgical stone removal, making the condition not serious. However, in some cases, the cause could be bladder cancer or a tumor near the urinary system compressing the ureter, and if the tumor is difficult to remove, the hydronephrosis might be hard to manage. Long-term fluid accumulation might lead to kidney failure, and these scenarios are considered quite serious.

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Is hydronephrosis with hematuria serious?

Whether hematuria in patients with hydronephrosis is serious cannot actually be determined by the amount of blood in the urine. It is important to identify the cause and assess kidney function, because hydronephrosis can lead to serious consequences, mainly kidney failure. If the hydronephrosis persists for a long time, it can compress the renal cortex and cause kidney shrinkage, leading to chronic kidney failure. The dangers of hematuria mainly include: first, it may cause significant bleeding, leading to anemia. Second, this type of hematuria could be caused by certain conditions, such as bleeding caused by a tumor in the urinary system, which is quite serious. Whereas bleeding caused by urinary tract infections or urinary system stones, in terms of the nature of the cause, is not considered very serious. However, significant bleeding can also lead to severe anemia and even shock, which would be more serious.