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| Alternative Names: |
Hydronephrosis - bilateral
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| Causes, incidence, and risk factors: |
Bilateral hydronephrosis develops when the pelvis and calyces (urine collecting structures of the kidneys) of both kidneys become distended because urine is unable to drain from the kidney down the ureters into the bladder. Hydronephrosis is therefore not a separate disease entity; but rather a physical manifestation of the disease process that causes impairment of urine to drain out of the kidneys, ureters and bladder. Symptoms, treatment, and expected outcome are those of the associated diseases.
Disorders associated with hydronephrosis include: Advances in fetal ultrasound have given specialists the ability to diagnose obstructive uropathy (problems caused by the blockage of the urinary system) in the fetus before birth. Unilateral (one side only) or bilateral (both sides) obstruction of the urinary tract can be diagnosed by fetal ultrasound. Fetal conditions such as uteropelvic junction obstruction, posterior ureteral valves and prune belly syndrome can be diagnosed while the fetus is in the uterus. Newborn infants who have been previously diagnosed with obstruction while still in the uterus can receive prompt surgical correction of the defects, often with good outcomes.
Experimental surgery on the fetus while in the uterus is presently being studied which can relieve the obstruction or decrease the pressure on the kidney in the fetus. Future techniques can be expected to salvage better kidney function than the good results that are presently expected. |
| Symptoms: |
Fetal evidence of hydronephrosis is generally observed during routine fetal ultrasound studies done during routine pregnancies and as such there are no symptoms in the fetus.
In the newborn, any diagnosed urinary tract infection is reason to suspect some type of obstructive problem in the kidney. In the older child, repeat urinary tract infections are cause for evaluation of possible obstruction.
Unfortunately, with the exception of increased incidence of urinary tract infections, obstruction of the urinary tract is often without symptoms. |
| Signs and tests: |
| Bilateral hydronephrosis may be apparent on:
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| Treatment: |
| There is no separate treatment other than the treatment of the causative disorder. |
| Expectations (prognosis): |
| If obstruction is detected in the fetus, early surgical intervention shortly after birth will optimize kidney function. After surgery there is often an improvement, beyond the baseline, in renal function. Early discovery and intervention in any type of obstructive process will improve the outcome. |
| Calling your health care provider: |
| This disorder is usually discovered by the health care provider. |
| Prevention: |
| Fetal ultrasound studies can demonstrate obstruction of the urinary tract and allow for early surgical intervention with improved outcome in the newborn. Other causes of obstruction such as kidney stones, posterior ureteral valves can be diagnosed early if individuals recognize early warning signs of obstruction and kidney disease. |
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Review Date: 11/30/2001
Reviewed By: Andrew Koren, M.D., Department of Nephrology, NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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