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ALL / Nephrology

Hydronephrosis

Hydronephrosis

Causes of hydronephrosis include:
  • Unilateral causes – PACT
    • Pelvic-ureteric junction (PUJ) obstruction (congenital or acquired)
    • Aberrant renal vessels causing extrinsic compression
    • Calculi (ureteric stones)
    • Tumours of the renal pelvis or ureter
  • Bilateral causes – SUPER
    • Stenosis of the urethra
    • Urethral valves (posterior urethral valves in males)
    • Prostatic enlargement (benign or malignant)
    • Extensive bladder tumour causing outflow obstruction
    • Retroperitoneal fibrosis

Investigation
  • Ultrasound – first-line: confirms hydronephrosis and assesses kidney size and cortical thickness
  • IVU (Intravenous urogram) – defines site and degree of obstruction
  • Antegrade or retrograde pyelography – diagnostic and therapeutic
  • If renal colic suspected: CT KUB (non-contrast) – detects most calculi

Management
  • Relieve obstruction and drain urine
    • Unilateral acute obstruction: Unilateral nephrostomy to decompress the affected kidney
    • Bilateral obstruction or renal failure: Bilateral nephrostomies (if stenting not feasible)
    • Chronic obstruction: Ureteric stent or pyeloplasty depending on cause

The CT shows massive hydronephrosis and a small calculus in the left kidney. A single large calculus is present distally in the left ureter with accompanying hydroureter.
+PassMedicine Notes
Causes of hydronephrosis include:
  • Unilateral causes – PACT
    • Pelvic-ureteric junction (PUJ) obstruction (congenital or acquired)
    • Aberrant renal vessels causing extrinsic compression
    • Calculi (ureteric stones)
    • Tumours of the renal pelvis or ureter
  • Bilateral causes – SUPER
    • Stenosis of the urethra
    • Urethral valves (posterior urethral valves in males)
    • Prostatic enlargement (benign or malignant)
    • Extensive bladder tumour causing outflow obstruction
    • Retroperitoneal fibrosis
Investigation
  • Ultrasound – first-line: confirms hydronephrosis and assesses kidney size and cortical thickness
  • IVU (Intravenous urogram) – defines site and degree of obstruction
  • Antegrade or retrograde pyelography – diagnostic and therapeutic
  • If renal colic suspected: CT KUB (non-contrast) – detects most calculi
Management
  • Relieve obstruction and drain urine
    • Unilateral acute obstruction: Unilateral nephrostomy to decompress the affected kidney
    • Bilateral obstruction or renal failure: Bilateral nephrostomies (if stenting not feasible)
    • Chronic obstruction: Ureteric stent or pyeloplasty depending on cause
xrb234.jpg The CT shows massive hydronephrosis and a small calculus in the left kidney. A single large calculus is present distally in the left ureter with accompanying hydroureter.

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