What If I Get Hydronephrosis? What Should I Pay Attention To?

First, the presence of hydronephrosis should be determined, and then the cause, site, extent, presence or absence of infection and renal impairment should be determined. The possibility of hydronephrosis should be noted in the differential diagnosis of abdominal mass. The mass of hydronephrosis has varying degrees of tension. If the mass is low in tension, sometimes hard and sometimes soft, and there is a sense of fluctuation, the hydronephrosis is very likely. In some secondary hydronephrosis, the symptoms of the primary disease are more significant, such as tuberculosis, tumor and so on, it is easy to ignore the existence of hydronephrosis. Urinary obstruction and hydronephrosis caused by adjacent lesions of the urinary system are often not diagnosed in time, even when renal failure or anuria is detected. Laboratory tests should include blood tests for azogenemia, acidosis and electrolyte disturbances. In urine, in addition to routine examination and culture, tuberculosis bacilli and exfoliated cells should be examined if necessary.

Urography is of great value in diagnosis. One of the typical features of excretory urography is prolonged development of renal parenchyma. Due to the decreased glomerular filtration rate, slow urine outflow and increased water reabsorption in renal tubules result in the accumulation of contrast media in the renal cortex, mainly in the proximal convoluted tubules, resulting in better imaging of the kidney. Thus, acute obstruction is characterized by a concentrated renal shadow. High-dose delayed excretory urography is more helpful in the diagnosis of hydronephrosis. The contrast dose can be increased by 2 ~ 3 times, and the delay time can be as long as 24 ~ 36 hours. When the excretory urography is not clear enough, retrograde pyelography can be performed by ureteral intubation via cystoscope. After the catheter is inserted into the renal pelvis, a large amount of urine can be extracted if hydronephrosis is present, and lateral renal function can be measured. If retrograde intubation is difficult, renal puncture imaging may be performed instead. During retrograde and puncture imaging, bacteria should be prevented from being introduced into the hydrous kidney.

Ultrasound, CT, and MRI can clearly distinguish whether the enlarged kidney is hydronephrosis or solid mass and can also find the lesions that are pressing the urinary system. Since ultrasound is widespread and non-invasive, it can be performed before urography. Radionuclide scanning and nephrography can also be used to diagnose hydronephrosis. In the case of dynamic obstruction, the peristalsis and emptying of the renal pelvis and ureter can be observed by urography. This neurogenic bladder is characterized by cystography as a "pagoda" with trabeculae and pseudodiverticulum.