Which clinical history findings suggest hydronephrosis and hydroureter in adults?

Updated: Dec 16, 2020
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Symptoms vary depending on whether the hydronephrosis is acute or chronic.

With acute obstruction, pain is frequently present, due to distention of the bladder, collecting system, or renal capsule. Pain is typically minimal or absent with partial or slowly developing obstruction (as with congenital ureteropelvic junction [UPJ] obstruction or a pelvic tumor). It is not uncommon, for example, to see an adult who is noted to have hydronephrosis due to previously unsuspected UPJ obstruction.

In comparison, relatively severe pain (renal or ureteral colic) may be seen with acute complete obstruction (as with a ureteral calculus) or when acute dilatation occurs after a fluid load that increases the urine output to a level greater than the flow rate through the area of obstruction. An example of the latter problem occurs after beer drinking in a college student with previously asymptomatic and unsuspected UPJ obstruction.

The site of obstruction determines the location of pain. Upper ureteral or renal pelvic lesions lead to flank pain or tenderness, whereas lower ureteral obstruction causes pain that may radiate to the ipsilateral testicle or labia.

With regard to renal insufficiency, patients with complete or severe partial bilateral obstruction also may develop acute or chronic renal failure. In the latter setting, the patient is often asymptomatic and the urinalysis results may be relatively normal or reveal only a few white or red blood cells. [2]

Anuria may be a presenting symptom of the patient. Although the urine volume could be reduced in any form of renal disease, anuria is most often seen in 2 conditions: complete bilateral urinary tract obstruction and shock. Other less common causes of anuria are hemolytic-uremic syndrome, renal cortical necrosis, bilateral renal arterial obstruction, and crescentic or rapidly progressive glomerulonephritis, particularly anti–glomerular basement membrane (GBM) antibody disease. Bilateral symmetrical hydronephrosis usually suggests a cause related to the bladder, such as retention, prostatic blockage, or severe bladder prolapse.

Considerations include the following:

  • A history of hematuria may herald a stone or malignancy anywhere in the urinary tract
  • A history of fever or diabetes adds urgency to the evaluation and treatment
  • Hydronephrosis in a patient with a solitary kidney is an emergent situation
  • Hydronephrosis may develop silently, without symptoms, as the result of advanced pelvic malignancy or severe urinary retention from bladder outlet obstruction.

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