Bilateral hydronephrosis

  • Definition
    • Bilateral hydronephrosis is the enlargement of the parts of the kidney that collect urine. Bilateral means both sides.

  • Alternative Names
    • Hydronephrosis - bilateral

  • Causes
    • Bilateral hydronephrosis occurs when urine is unable to drain from the kidney into the bladder. Hydronephrosis is not itself a disease. It occurs as a result of a problem that prevents urine from draining out of the kidneys, ureters, and bladder.

      Disorders linked with bilateral hydronephrosis include:

      • Acute bilateral obstructive uropathy - sudden blockage of the kidneys
      • Bladder outlet obstruction - blockage of the bladder, which does not allow drainage
      • Chronic bilateral obstructive uropathy - a gradual blockage of both kidneys is most often from common singular obstruction
      • Neurogenic bladder - poorly functional bladder
      • Posterior urethral valves - flaps on the urethra that causes poor emptying of the bladder (in boys)
      • Prune belly syndrome - poorly emptying bladder that causes distention of the belly
      • Retroperitoneal fibrosis - increased scar tissue that blocks the ureters
      • Uteropelvic junction obstruction - blockage of the kidney at the point where the ureter enters the kidney
      • Vesicoureteric reflux - backup of the urine from the bladder up to the kidney
      • Uterine prolapse - when the womb (uterus) drops down and presses into the vaginal area
  • Symptoms
    • Signs of a problem are often found in a baby before birth during a pregnancy ultrasound.

      A urinary tract infection in a newborn baby can signal a blockage in the kidney. An older child who gets repeat urinary tract infections should also be checked for blockage.

      A higher than normal number of urinary tract infections is often the only symptom of the problem.

      Common symptoms in adults may include:

      • Back pain
      • Nausea, vomiting
      • Fever
      • Need to urinate often
      • Decreased urine output
  • Exams and Tests
  • Treatment
    • Placing a tube into the bladder (Foley catheter) may open the blockage. Other treatments include:

      • Draining the bladder
      • Relieving pressure by placing tubes in the kidney through the skin
      • Placing a tube (stent) through the ureter to allow urine to flow from the kidney to bladder

      The underlying cause of the blockage needs to be found and treated once the buildup of urine is relieved.

  • Outlook (Prognosis)
    • Surgery performed while the baby is in the womb or shortly after birth can have good results in improving kidney function.

      Return of renal function can vary, depending on the length of obstruction.

  • Possible Complications
    • Kidney damage may result from conditions that cause hydronephrosis.

  • When to Contact a Medical Professional
    • This problem is often found by the health care provider.

  • Prevention
    • An ultrasound during pregnancy can show a blockage in the baby's urinary tract. This allows the problem to be treated with early surgery.

      Other causes of blockage, such as kidney stones, can be detected early if people notice warning signs of kidney problems.

      It is important to pay attention to general problems with urination.

  • References
    • Elder JS. Obstruction of the urinary tract. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 534.

      Frokiaer J, Zeidel ML. Urinary tract obstruction. In: Taal MW, Chertow GM, Marsden PA et al, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 37.

      Hsu THS, Nakada SY. Management of upper urinary tract obstruction In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 41.

      Singh I, Strandhopy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 40.