Bilateral Hydronephrosis: Causes, Diagnosis & Treatment

Written by Medicover Team and Medically Reviewed by Dr Mayur Dalvi , Urologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Bilateral hydronephrosis is a medical condition characterized by swelling of both kidneys due to urine accumulation. This condition arises when an obstruction impedes the normal flow of urine, causing it to back up into the kidneys. Understanding the causes, symptoms, diagnosis, and treatment options for bilateral hydronephrosis is crucial for effective management and prevention of complications.

What is Bilateral Hydronephrosis?

Hydronephrosis refers to the swelling of one or both kidneys due to urine buildup. When this swelling occurs in both kidneys, it is termed bilateral hydronephrosis. This condition can vary in severity and may result in significant complications if not addressed promptly.

What Are the Causes of Bilateral Hydronephrosis?

Bilateral hydronephrosis commonly results from obstructive uropathies, which are blockages in the urinary tract. These blockages can occur at various points along the urinary system and may be caused by:

Obstructive Causes

Ureteropelvic Junction Obstruction (UPJ): A blockage where the ureter meets the kidney.
Ureterovesical Junction Obstruction (UVJ): A blockage where the ureter meets the bladder.
Posterior Urethral Valves (PUV): Congenital malformations in the urethra cause obstruction and are common in male infants.
Stones or Calculi: Kidney stones can obstruct urinary flow.

Non-Obstructive Causes

Non-obstructive factors contributing to bilateral hydronephrosis include:

Vesicoureteral Reflux (VUR): A condition where urine flows backwards from the bladder into the ureters and kidneys.
Neurogenic Bladder: Dysfunction of the bladder due to nerve damage that affects urine flow.

Other Contributing Factors

Certain conditions such as pregnancy, tumours, or enlarged prostate in men can also lead to bilateral hydronephrosis by exerting pressure on the urinary tract.

What Are the Symptoms of Bilateral Hydronephrosis?

Bilateral hydronephrosis symptoms can vary based on the underlying cause and severity. Common symptoms include:

Pain: Abdominal or flank pain.
Urinary Changes: Frequent urination, urgency, or difficulty urinating.
Hematuria: Presence of blood in urine.
Infections: Recurrent urinary tract infections (UTIs).
Nausea and Vomiting: Often related to severe obstruction.

In some cases, especially when the condition is mild, bilateral hydronephrosis may be asymptomatic and discovered incidentally during imaging tests for other conditions.

When to See a Doctor for Bilateral Hydronephrosis?

If you experience urinary symptoms or flank pain, consult a urologist or nephrologist promptly. Bilateral hydronephrosis can lead to kidney damage if left untreated, making early diagnosis and intervention essential.

You should see a doctor if you have:

Decreased urine output, difficulty urinating, or swelling in your legs and ankles
Persistent pain in your lower back or sides, especially with fever or nausea
Changes in urination frequency, blood in urine, or recurrent urinary tract infections

Get medical help immediately if:

You cannot urinate at all or produce very little urine over several hours
You develop severe back pain with high fever, vomiting, or signs of infection

These could be signs of a serious complication like acute kidney failure, which needs urgent care.

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How is Bilateral Hydronephrosis Diagnosed?

Diagnosis typically involves imaging studies to assess the kidneys and urinary tract:

Imaging Techniques

Ultrasound: A non-invasive imaging technique to detect swelling and assess kidney function.
CT Scan: Provides detailed images of the urinary tract and can help identify the cause of obstruction.
MRI: Used when more detailed photos are needed, especially in complex cases.

Functional Tests

In addition to imaging, functional tests may be conducted:

Renal Scan: Evaluates kidney function and drainage.
Voiding Cystourethrogram (VCUG): An X-ray test to examine the bladder and urethra while urinating.

What Are the Treatment Options for Bilateral Hydronephrosis?

The management of bilateral hydronephrosis depends on the underlying cause, severity, and presence of symptoms. Treatment options include:

Medical Management

Antibiotics: For managing infections associated with hydronephrosis.
Pain Management: Analgesics are used to relieve pain and discomfort.

Surgical Interventions

Surgical interventions may be necessary to remove obstructions or correct anatomical anomalies:

Ureteral Stenting: Placement of a stent to allow urine to flow past an obstruction.
Percutaneous Nephrostomy: A procedure to drain urine directly from the kidneys.
Pyeloplasty: Surgical correction of UPJ obstruction.
Endoscopic Valve Ablation: Treatment for PUV in male infants.

Monitoring and Follow-up

Regular monitoring and follow-up are essential to prevent recurrence and manage any long-term complications. This may involve routine imaging and functional assessments to ensure kidney health and proper urinary function.

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What Are the Complications of Bilateral Hydronephrosis?

If left untreated, bilateral hydronephrosis can lead to significant complications:

Chronic Kidney Disease (CKD): Prolonged pressure and damage to the kidneys can result in CKD.
Acute Kidney Injury (AKI): Sudden and severe obstruction can cause AKI.
Hypertension: Damage to the kidneys can lead to high blood pressure.
Infections: Increased risk of recurrent UTIs and pyelonephritis (kidney infection).