How is hydronephrosis diagnosed?

Written by Zhou Qi
Nephrology
Updated on January 09, 2025
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Strictly speaking, hydronephrosis cannot be considered an independent disease; it is merely a descriptive term in imaging, and is the result of many causes and various etiologies. It occurs because urine produced by the kidneys cannot smoothly pass through the ureters and bladder to be excreted from the body, leading to fluid accumulation in the renal pelvis and calyces. This may be caused by prostate enlargement, tumors in the urinary system, urinary system stones, or chronic inflammation and scarring of the ureters. Generally, hydronephrosis can be detected through imaging techniques, including urinary system ultrasound or CT, which can confirm the diagnosis.

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Written by Zhou Qi
Nephrology
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What is hydronephrosis?

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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Written by Li Liu Sheng
Nephrology
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How is hydronephrosis detected?

The kidneys have a very strong compensatory ability. In the early stages of hydronephrosis, the amount of fluid may not be large, or the duration may not be long, and usually, the patient may have no symptoms. Hydronephrosis is often discovered during health examinations or through ultrasound or CT scans performed during hospital stays. Of course, if the hydronephrosis persists for too long and the volume is very large, the patient can gradually feel discomfort or a distended sensation in the lower back or upper abdomen. Moreover, if the hydronephrosis is caused by kidney stones, the patient often experiences severe back pain, and there might even be visible blood in the urine. Hydronephrosis can also lead to symptoms of urinary tract infections such as frequent urination, urgent urination, and painful urination. Prolonged hydronephrosis can lead to a decline in kidney function, resulting in symptoms like fatigue, loss of appetite, and poor overall health. Therefore, it is crucial for patients to undergo regular ultrasound examinations of the kidneys to detect hydronephrosis early.

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Will people with hydronephrosis have edema?

Hydronephrosis can potentially cause patients to exhibit symptoms of edema. Urine is produced by the kidneys and is expelled from the body through the urinary system, including the ureters and bladder. If there is an obstructive issue in the urinary system, the urine produced by the kidneys cannot be excreted smoothly, leading to hydronephrosis. When a large amount of fluid cannot be excreted, it eventually causes edema in the body. However, if the patient has hydronephrosis on only one side and the other kidney is healthy, the healthy kidney can fully compensate for the entire kidney function and sufficiently excrete fluids. Therefore, patients with unilateral hydronephrosis often do not show obvious signs of edema. But if a patient has bilateral hydronephrosis, and urine produced by both kidneys cannot be excreted, the patient will exhibit signs of edema.

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symptoms of hydronephrosis infection

In cases of hydronephrosis, urinary tract infections are common, and these infections primarily manifest as pyelonephritis. The presence of fluid in the kidneys indicates that urine cannot be excreted smoothly, leading to an obstruction in the urinary tract. Therefore, bacteria can easily multiply in this area because normal urine, if it can be excreted smoothly, also serves to flush the urinary system, preventing the growth of bacteria. Thus, when fluid accumulates, pyelonephritis can easily occur, with the main symptoms being back pain and fever. If cystitis is also present, the patient will experience symptoms such as frequent urination, urgent urination, and painful urination. Hydronephrosis may be caused by issues such as urinary system stones or tumors, which can also lead to clinical symptoms like back pain and hematuria.

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Written by Li Liu Sheng
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Is hydronephrosis of both kidneys serious?

Clinically, bilateral hydronephrosis is serious, as it can lead to expansion of the renal pelvis. Long-term bilateral hydronephrosis can compress the renal parenchyma, leading to the development of chronic obstructive nephropathy, and thus cause chronic renal failure. Additionally, because urine cannot be expelled from the body in a timely manner in bilateral hydronephrosis, it is easy to combine with bacterial infections, which can lead to acute pyelonephritis. Patients may experience chills, fever, and severe back pain, as well as hematuria and general fatigue. Therefore, it is essential to identify the cause of bilateral hydronephrosis and treat it based on the nature of the hydronephrosis. Usually, the causes of bilateral hydronephrosis are related to stones, but tumorous diseases, bladder stones, or urethral strictures are also common causes.