Hydronephrosis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Hydronephrosis is a disease of dilation or swelling of the kidneys caused by the accumulation of urine fluid in the cells and tissues of the kidneys.
Normally, the kidneys will filter metabolic waste from the blood and excrete it through the urine. Furthermore, urine that comes from the renal pelvis will flow to the kidney calyx and then will flow to the ureter, which is the channel that connects the kidney and bladder.
From the bladder, urine should be emptied through the urethra. However, in patients with hydronephrosis, there is an obstruction to the outflow of urine.
This obstructed urine flow can cause pressure on the intraluminal kidney and lead to enlargement of the renal chambers and thinning of the kidneys.
This condition will interfere with kidney function. This is because the pressure from the fluid that accumulates in the kidneys will reduce the rate of blood filtration and damage kidney cells.
If this condition is not treated immediately, over time it will cause kidney damage.
Meanwhile, based on the radiological appearance of the kidneys, there are four degrees of hydronephrosis, namely:
1. Grade 1 Hydronephrosis
Dilated renal pelvis without dilated calyces. Calyx experience accumulation ( blunting )
2. Grade 2 Hydronephrosis
Dilatation of the renal pelvis and major calyces. Calix horizontal ( flattening )
3. Grade 3 Hydronephrosis
Dilatation of the renal pelvis, major calyces and minor calyces. No cortical thinning. Protruding calyces ( clubbing )
4. Grade 4 hydronephrosis
Dilatation of the renal pelvis, major calyces, and minor calyces. As well as the thinning of the cortex, with a ballooning or bulging image
Symptom
In the early stages of hydronephrosis, sufferers usually do not show any symptoms. However, blockage of the flow due to stones can cause complaints of pain in the waist.
If an infection occurs, symptoms of hydronephrosis can arise, such as:
- Pain when urinating
- Fever
- shivers
- Nauseous
- Itching of the skin
- Loss of consciousness
In end-stage disorders, kidney function has decreased so that toxins that should be removed from the kidneys can accumulate in the body. This can cause symptoms of nausea, itching, and decreased consciousness.
Reason
There are several causes of hydronephrosis, including:
1. Obstruction
Obstruction can be caused by causes within the urinary tract (intraluminal, eg congenital valve in the posterior ureter, stones, tumors of the renal pelvis, ureters, urinary bladder and urethra), ureteral or urethral structures, pressure from outside the urinary system (eg due to tumors around the urinary tract). urinary).
2. Neuromuscular disorders
Neuromuscular disorders, or the inability of the nervous system and muscles to work optimally, can also trigger hydronephrosis.
For example, due to spina bifida, paraplegia, tabes dorsalis, and multiple sclerosis.
3. Pregnancy
During pregnancy, there may be physiological dilation of the ureters and pelvis. However, these abnormalities may return after delivery.
Risk Factors
Until now, there are no known risk factors for hydronephrosis. However, boys are four to five times more likely to be born with hydronephrosis than girls.
In addition, hydronephrosis does not run in families, although some causes of hydronephrosis can be inherited genetically.
Diagnosis
To make a diagnosis of hydronephrosis, doctors will usually carry out the following steps.
1. Medical Interview
During a medical interview, the doctor will ask about the symptoms and complaints that the patient feels. For example, is there low back pain, pain when urinating, or fever?
2. Physical Examination
The doctor will also physically examine the patient. For example, if there are stones, the patient may feel pain when tapped on the back of the waist.
3. Urine and Blood Examination
The doctor can also check for blood in the urine, which can be caused by kidney stones, infection, or other factors.
4. Radiological Examination
The doctor may also recommend an Ultrasonography (USG) examination, a CT scan, and an MRI to see the kidney structure in more detail.
5. Cystoscopy
Diagnosis can also involve a cystoscopy, which uses a long tube with a light and camera at the end (cystoscope). This method allows the doctor to see inside the bladder and urethra.
Treatment
The key to treating hydronephrosis is getting rid of it as soon as possible to avoid permanent damage to the kidneys.
If the blockage is caused by a stone, then the stone needs to be taken to expedite the flow of urine. Small stones and small amounts can pass through the urine.
Meanwhile, for large and multiple stones, medical measures can be taken to break up the stones and remove them.
However, if the cause of hydronephrosis is an infection, treatment with antibiotics is needed. In essence, find out as soon as possible what is the cause of hydronephrosis so that appropriate management can be carried out.
In some cases, excess urine may need to be removed using a catheter, stent, or nephrostomy which drains the urine from the kidney.
In more severe cases, it can damage the kidneys and cause kidney failure. If kidney failure occurs, treatment will be required with dialysis or a kidney transplant.
Prevention
Until now there is no known prevention to avoid hydronephrosis.
However, you can start preventive measures by paying attention to fluid intake to avoid stone formation.
Complications
If left untreated, severe hydronephrosis can cause permanent kidney damage. In rare conditions, this health disorder can cause kidney failure.
When to See a Doctor?
Immediately consult a doctor if you find the symptoms of hydronephrosis above.