Bilateral Hydronephrosis: An Overview

Introduction

Bilateral hydroureteronephrosis entails dilatation of the renal pelvis, calyces, and ureter; it develops as a result of urinary tract obstruction and causes a buildup of back pressure in the urinary tract. Despite being clinically quiet in most instances, it might be detected as an unintended discovery when a different cause is being investigated. It only manifests with symptoms and signs in a small percentage of people. The most frequent reason is renal calculus. However, there are several other etiologies that are dependent on age and sex. Males have a higher incidence of non-calculus hydronephrosis than females do. The most crucial initial test for evaluating patients with hydronephrosis is ultrasonography.

What Is Bilateral Hydronephrosis?

A blockage or obstruction in the urinary system causes both kidneys to swell in a disease known as bilateral hydronephrosis. The blockage causes urine to back up and build up in the kidneys, which causes both kidneys to expand and swell. If left untreated, this might potentially cause kidney damage and possibly acute renal failure. Numerous conditions, such as kidney stones, tumors, an enlarged prostate, congenital anomalies, and urinary tract infections, can result in bilateral hydronephrosis. Depending on the underlying reason, this illness may be treated with medication, surgery, stent implantation, or dialysis.

What Are the Causes of Bilateral Hydronephrosis?

Numerous conditions that result in an obstruction or blockage in the urinary system might lead to bilateral hydronephrosis. Typical reasons include:

1. Kidney Stones: These are hard mineral and salt deposits that can impede urine flow when they develop in the kidneys.

2. Malignant and Benign Tumors: They can develop in the urinary tract, including the kidneys, bladder, or ureters, and they can restrict the flow of urine.

3. Prostate Enlargement: it can constrict the urethra, obstructing urine flow and causing bilateral hydronephrosis.

4. Congenital Abnormalities: Some people are born with structural flaws in the urinary system, such as ureteropelvic junction blockage or vesicoureteral reflux, which can prevent urine from flowing normally.

5. UTs (Urinary Tract Infections): Severe or repeated UTIs can damage the urinary system by inflaming it and scarring it, which can result in obstructions.

6. Neurogenic Bladder: Diseases such as nerve or spinal cord injury can impair bladder control and result in urine retention, which can induce hydronephrosis.

7. Pregnancy: When a woman is pregnant, her expanding uterus might squeeze her urinary system, temporarily resulting in bilateral hydronephrosis.

8. Medication: Some medicines, including anticholinergic ones, can increase the risk of urinary tract blockage.

What Are the Symptoms of Bilateral Hydronephrosis?

Depending on the underlying reason and the severity of the ailment, bilateral hydronephrosis symptoms might change. Sometimes, there may be no symptoms at all, particularly if the blockage is minor or in the early stages. However, if the illness worsens, these signs and symptoms might appear:

1. Abdominal Pain or Discomfort: A typical sign of abdominal pain or discomfort is dull or severe pain in the flank area (the sides of the abdomen).

2. Swelling in the Abdomen: Due to the enlarged kidneys and urine buildup, bilateral hydronephrosis can result in abdominal swelling or bloating.

3. Vomiting and Nausea: If the situation is severe, the strain on the kidneys and the urinary system might result in nausea and vomiting.

4. Frequent Urination: People with bilateral hydronephrosis may find that they need to pee more frequently.

5. Pain or Burning During Urination: Infection of the urinary system brought on by the blockage may result in symptoms like pain, burning, or discomfort when urinating.

6. Blood in the Urine: Hematuria, or blood in the urine, can occasionally result from bilateral hydronephrosis. The color of the urine might be pink, red, or brownish.

7. Urinary Tract Infections: Recurrent urinary tract infections can develop as a result of the kidneys' inability to remove urine quickly enough, resulting in symptoms including frequent urination, urgency, and pain.

How to Diagnose Bilateral Hydronephrosis?

Here are a few typical tests used to assess and identify bilateral hydronephrosis:

1. Medical History and Physical Exam: The physician will ask the patient about the symptoms, medical background, and any other pertinent information. Additionally, a physical examination will be done to look for any abdominal discomfort or edema.

2. Urinalysis: The presence of blood, infection, or other abnormalities will be checked for in a urine sample. This may reveal any kidney impairment or underlying urinary tract infection.

3. Blood Testing: Blood tests are carried out to evaluate kidney function and find any anomalies or indications of renal impairment. Examples of these tests are serum creatinine and blood urea nitrogen (BUN).

4. Imaging Exams

• Ultrasound: This non-invasive imaging procedure employs sound waves to produce pictures of the urinary system and kidneys. It can be used to evaluate the degree of hydronephrosis, discover any obstructions, and visualize the size and shape of the kidneys.

• Computed Tomography (CT) Imaging: The kidneys, ureters, and bladder may be clearly seen in cross-sectional detail in computed tomography (CT) imaging. It can assist in determining the obstruction's location and root cause.

• Magnetic Resonance Imaging (MRI): Magnetic resonance imaging (MRI) creates precise pictures of the kidneys and urinary system using strong magnets and radio waves. It can offer insightful details on the anatomy and any potential blockages.

1. Voiding Cystourethrogram (VCUG): This examination evaluates the anatomy and physiology of the bladder and urethra in children. To see the urinary tract while urinating, contrast dye and X-rays are used.

2. Nuclear Renal Scan: A tiny quantity of radioactive material is injected into the circulation during a nuclear renal scan, and the kidneys then absorb the radioactive material.

What Is the Treatment for Bilateral Hydronephrosis?

The underlying cause and the degree of the ailment determine the course of treatment for bilateral hydronephrosis. The main objectives of therapy are to control any symptoms or consequences and to remove the blockage while maintaining renal function. The following are some typical therapies for bilateral hydronephrosis:

1. Addressing the Root Problem: It is important to identify the precise etiology of bilateral hydronephrosis. For instance:

• Medication, dietary modifications, or treatments like extracorporeal shock wave lithotripsy (ESWL) or surgical removal may be necessary for kidney stones.

• Chemotherapy, radiation treatment, or surgery may all be required for tumors.

• Surgery, less invasive techniques, or prescription drugs may all be used to treat an enlarged prostate.

2. Drainage and Blockage Relief:

• To get around the obstruction and enable the free flow of urine, a small tube called a stent may be put into the ureter in some circumstances.

• To alleviate pressure and drain urine from the kidney, a nephrostomy tube may be introduced through the back into the kidney if the obstruction is severe or if the installation of a stent is not possible.

• To drain urine and remove the blockage, this treatment includes making a temporary access point through the skin into the kidney.

3. Medications:

• If a urinary tract infection is also present, antibiotics will be recommended to treat the infection.

• To ease the discomfort or pain brought on by bilateral hydronephrosis, painkillers may be advised.

4.Intervention by Surgery: In certain circumstances, surgery may be required to address the underlying anatomical defect that is the source of the hydronephrosis. Tumor removal, urinary tract repair or reconstruction, and congenital anomalies might all fall under this category.

5. Complications Management: Additional therapies like dialysis or kidney transplantation may be required if bilateral hydronephrosis has damaged or destroyed one or both kidneys.

Conclusion

A blockage in the urinary system can cause bilateral hydronephrosis, which is characterized by the swelling of both kidneys. In order to avoid renal problems and injury, prompt diagnosis is essential. Depending on the underlying reason, there are several treatment methods available, including clearing the blockage, treating any accompanying disorders, and managing symptoms. To create a specialized treatment plan and guarantee optimum kidney health, constant collaboration with medical specialists is necessary.