Hydronephrosis (Swollen Kidney): Understanding and Managing Kidney Swelling

What is Hydronephrosis (Swollen Kidney)?

Hydronephrosis is when your kidney gets swollen due to urine backup. Doctors also call this “upper urinary tract dilation” because it stretches the upper part of your urinary system. This happens when urine can’t flow properly from your kidney to your bladder. It can affect one kidney (unilateral) or both kidneys (bilateral). It’s often caused by a blockage in your ureter, the tube that carries urine from your kidney to your bladder.

Hydronephrosis can happen to anyone, including babies before birth. It’s actually one of the most common urinary problems in children. The severity can range from mild to severe. Sometimes it’s temporary; other times, treatment is necessary.

Things to watch out for:

  • Back or side pain
  • Peeing trouble
  • Feeling like you need to pee too often
  • Blood in your pee

Your doctor can diagnose hydronephrosis with scans like ultrasounds or CT scans. They’ll look at how swollen your kidney is and try to find out what’s causing it.

Treatment depends on what’s causing the blockage, with options ranging from medicines to surgery in severe cases of hydronephrosis. Contact our team for an appointment today.

How Your Urinary Tract Works

Your urinary tract is a system that helps your body get rid of waste, made up of several parts working together:

Kidneys:

These bean-shaped organs are the stars of the show. They filter your blood, removing excess water and waste, producing urine.

Ureters:

You have two thin tubes called ureters, one for each kidney, which carry urine from the kidneys to your bladder.

Bladder:

Your bladder acts as a storage tank for urine. It can hold a significant amount before you feel the need to urinate.

Urethra:

When it’s time to urinate, urine leaves your body through the urethra, the final stop in the urinary tract.

The upper part of your urinary tract consists of your kidneys and ureters, while your bladder and urethra make up the lower part. Inside your kidneys, tiny structures called nephrons filter the blood. The filtered fluid then moves to the renal pelvis, a funnel-like structure that leads to the ureter.

When functioning correctly, your urinary tract is a well-oiled machine. However, if something blocks the flow, it can cause problems like swelling in your kidneys.

Common Kidney Issues Include:

Urinary Tract Infections (UTIs): Infections that can occur in any part of the urinary system, often leading to discomfort and the urge to urinate frequently.

Chronic Kidney Disease (CKD): The gradual loss of kidney function over time, which can lead to the buildup of waste products in the body.

Glomerulonephritis: An inflammation of the nephrons in the kidneys, which can affect the kidneys’ ability to filter waste and fluids effectively.

Understanding the kidney system’s functions and being aware of common kidney issues are crucial steps in maintaining kidney health and overall well-being. If you experience symptoms or have concerns about your kidney health, it’s important to consult a healthcare professional for proper diagnosis and treatment.

Hydronephrosis Symptoms

Hydronephrosis can cause many uncomfortable symptoms. You might feel pain, urinary changes and general discomfort. These symptoms often point to underlying kidney problems that need attention.

General Symptoms:

  • Pain in the lower back, side, or abdomen
  • Frequent or difficult urination
  • Blood in urine
  • Nausea and vomiting
  • Fever
  • Feeling of incomplete bladder emptying
  • Weakness or fatigue
  • Peeing than usual

Infants and Children:

  • Abdominal or back pain
  • Blood in urine
  • Persistent urge to urinate
  • Fever
  • Vomiting

UTI Symptoms

Urinary tract infections (UTIs) can occur with hydronephrosis. You might notice that your urine looks cloudy or has blood in it. Urinating may also hurt or burn, and you might feel the need to urinate more often than usual. Another is you might experience lower abdominal pain and back pain.

You might also feel weak and tired, urinate less than usual, or have trouble emptying your bladder completely. If you develop a fever and chills, see a doctor immediately. These symptoms indicate that the infection has spread.

For children with hydronephrosis, tummy or back pain is common. They might also have a fever or feel sick. If you notice any of these signs in your child, get them checked by a doctor.

Hydronephrosis Causes

Hydronephrosis occurs when urine can’t flow properly from your kidneys to your bladder, which can cause kidney swelling and damage. Several things can cause this condition at different stages of life. Here are some possible causes:

Adult Hydronephrosis

As an adult, you may develop hydronephrosis due to:

  • Kidney stones:Can block urine flow in your urinary tract.
  • Enlarged prostate: In men, an enlarged prostate squeezes the urethra and make it hard to pee.
  • Cancer:Tumours in your bladder, cervix, colon, or prostate can press on your ureters.
  • Blood clots or tissue scarring:Can occur from injury or surgery and block urine flow.
  • Urinary tract infections (UTIs):Can cause inflammation and swelling in your urinary system.
  • Neurogenic bladder:Nerve damage can affect your bladder control and cause urine retention.
  • Narrowing of your urinary tract:tract: This narrowing can be due to injury, infection, birth disorders or surgery.
  • Ureterocele:A condition where the lower part of your ureter may protrude into your bladder.

People with Uteruses

If you have a uterus, you may face unique causes of hydronephrosis:

  • Pregnancy: Your growing uterus can compress the ureters, especially in the 3rd trimester.
  • Pelvic organ prolapse:When pelvic organs bulge into the vagina, they can block urine flow.
  • Endometriosis: Tissue similar to the uterus lining grows outside the uterus, causing pain and blockage.
  • Fibroids: Large uterine fibroids can press on the ureters and cause hydronephrosis.

Antenatal Hydronephrosis

In unborn babies, hydronephrosis can occur due to increased urine production or blockages. This condition is often detected during routine pregnancy scans. Here are some common causes:

  • Ureteropelvic junction obstruction: The connection between the kidney and ureter is too narrow, causing a blockage.
  • Posterior urethral valves:Extra flaps of tissue in the urethra block urine flow in male foetuses.
  • Vesicoureteral reflux:Urine flows back from the bladder to the kidneys.
  • A blockage in the flow of urine at some point in their urinary tract.

These conditions may resolve on their own, but some may require treatment after birth. Your doctor will look after your condition from pregnancy until after delivery.

Get a checkup from our team of kidney specialists/doctors at Nuffield Kidney & Dialysis today! We’re here to help nip any health issues in the bud before they escalate beyond help.

Hydronephrosis Treatments

Kidney Dialysis

May be needed if hydronephrosis has progressed to the point where kidney damage is significant and renal failure has occurred. While not a treatment for hydronephrosis itself, kidney dialysis is used when the kidneys have lost their filtering ability due to prolonged blockage of the urinary tract and the resulting pressure. This helps to remove waste products and excess fluid in the blood, doing the work the damaged kidneys can’t.

Kidney Transplant

Major surgery for severe hydronephrosis when the kidneys are beyond repair. This is when a damaged kidney is replaced with a healthy one from a donor. A successful kidney transplant will get your kidneys working normally again, and you can live a normal life without dialysis. It’s considered when other treatments have failed and the kidneys can’t function on their own. It has risks of rejection of the donor kidney and complications from surgery, but it’s a chance for extended life and better health if successful.

Shock Wave Lithotripsy

A non-invasive procedure used to treat kidney stones that cause hydronephrosis. By using high-energy sound waves, this method breaks down kidney stones into smaller pieces that can be passed through the urinary tract. It’s done on an outpatient basis and is best for stones less than 2 cm in diameter, so it relieves the blockage in the urinary system and symptoms of hydronephrosis.

Urethral Catheter

A urethral catheter is used to relieve acute urinary retention by draining urine directly through the urethra. This is a simple procedure that involves inserting a flexible tube into the bladder and gives immediate relief from bladder distension. It’s especially useful in emergency situations where quick action is needed to prevent further complications of hydronephrosis like infection or increased kidney pressure.

Suprapubic Catheter

The suprapubic catheter is an alternative to the traditional urethral catheter by draining urine directly from the bladder through a small incision in the abdomen. This is used when urethral catheterisation is not possible due to obstructions or injuries. By bypassing the urethra, it reduces the risk of infection and is a longer-term solution for patients with chronic urinary retention causing hydronephrosis.

Pyeloplasty

Pyeloplasty is a surgical procedure to remove blockages at the ureteropelvic junction where the kidney connects to the ureter. This procedure not only relieves the obstruction but also restores normal urine flow, addressing the underlying cause of hydronephrosis. It’s recommended for patients with congenital blockages or where stenting has failed. Stenting refers to inserting a tube to keep a blocked passageway open.

Ureteroscopy

Ureteroscopy involves using a small scope to directly visualise and remove stones or obstructions in the ureter. This minimally invasive procedure allows for immediate removal of blockages under direct vision, has a high success rate in relieving hydronephrosis without the need for major surgical incisions.

Ureteral Stent Placement

A ureteral stent is a tube inserted into the ureter to keep it open, allowing urine to flow from the kidneys to the bladder despite obstructions like stones or tumors. This stent is important to prevent urine build-up in the kidney and relieve symptoms of hydronephrosis while other long-term solutions are being considered.

Direct Kidney Drainage (Nephrostomy)

In severe cases of hydronephrosis where immediate relief from kidney pressure is needed, a nephrostomy tube may be inserted directly into the kidney to drain urine externally. This is used when other urinary tract interventions are not possible or have failed, it’s a temporary but effective way to relieve kidney swelling.

Antibiotics for Infections

For hydronephrosis complicated by urinary tract infections, antibiotics are prescribed to reduce inflammation and swelling caused by bacteria. Effective management of infections is crucial to prevent further damage to the kidney and relieve the symptoms of hydronephrosis.

Chemotherapy or Radiotherapy for Cancer-Related Obstructions

When hydronephrosis is caused by tumours pressing on the urinary tract, chemotherapy or radiotherapy may be needed to reduce the size of the tumours and relieve the obstruction. These treatments are important to restore normal urinary function and prevent further kidney damage.

Medication for Overactive Bladder

Anticholinergics are prescribed to calm an overactive bladder, a condition that can worsen hydronephrosis by causing frequent, urgent urination that disrupts normal urine flow. These medications relax the bladder muscles, reducing symptoms of urgency and frequency and improving bladder capacity.

Treatment for Prostate Enlargement

In cases where hydronephrosis is caused by benign prostatic hyperplasia (BPH), medications or surgical procedures are used to reduce prostate size and relieve pressure on the urinary tract. These treatments restore normal urine flow and prevent backflow of urine into the kidneys, which is critical in preventing complications of hydronephrosis.

Non-Invasive Interventions

Postnatal scans like ultrasounds or a micturating (MCUG): For newborns who may have hydronephrosis, non-invasive diagnostic tools are essential. Ultrasounds provide a detailed look at the kidneys and bladder to identify structural anomalies or obstructions without any discomfort to the infant.

The MCUG involves inserting a catheter to fill the bladder with a contrast dye visible on X-rays, which helps detect vesicoureteral reflux by monitoring the urine flow during urination. This test can show if urine flows back from the bladder into the ureters or kidneys instead of the normal outward flow.

Hydronephrosis Diagnosis

Your doctor may use several tests to diagnose hydronephrosis:

Initial Assessment:

The process starts with a physical exam and a discussion about your symptoms.

Blood and Urine Tests:

These are the first tests to check your kidney function and look for signs of infection or kidney stones.

Ultrasound:

This is the primary test for hydronephrosis. It quickly shows if your kidneys are swollen and it is painless.

CT Scans and MRIs:

These provide detailed images of your urinary system and can identify any blockages.

Voiding Cystourethrogram (VCUG):

This special X-ray examines how your bladder empties and provides a closer look at your bladder and urethra.

Intravenous Urogram (IVU):

This test uses dye to highlight your urinary tract on X-rays.

Renal Scan:

If needed, this test uses a small amount of radioactive material to check how well your kidneys are functioning.

Your doctor will decide which tests are best based on your symptoms and medical history. Don’t hesitate to ask questions about any test you need to undergo.

Hydronephrosis Treatment Benefits

  • Kidney Damage Prevention: The biggest benefit of treating hydronephrosis is prevention of permanent kidney damage or kidney failure. Early and timely treatment can restore normal kidney function and prevent long term complications.
  • Pain and Discomfort Relief: Hydronephrosis causes severe pain and discomfort due to pressure in the kidneys. Treatment relieves these symptoms and improves patient’s quality of life.
  • Infection Risk Reduction: By addressing the urinary blockages causing hydronephrosis, treatment reduces the risk of urinary tract infections which can become severe if left untreated.
  • Urinary Flow Improvement: Treatments like stenting or removal of blockages restore normal urine flow, prevents urine retention and reduces pressure on the kidneys.
  • Overall Health Maintenance:Effective management of hydronephrosis maintains overall health by keeping the body’s waste removal systems functioning properly. This helps other body functions and prevents other health issues due to toxin buildup.

Hydronephrosis Risks

  • Infection: UTI risk for a short time after treatment, with discomfort and fever.
  • Pain: Temporary pain or discomfort in your lower back or abdomen; can be managed with pain medications.
  • Bleeding: Small risk of bleeding, especially with stent insertion, which may cause blood in your urine.
  • Kidney Function Changes: Temporary changes in kidney function affecting urea and creatinine levels.
  • Stent Issues:
    • Bladder irritation
    • Frequent urination
    • Discomfort during urination
  • Anesthesia Risks: Drowsiness or nausea for a short time after general anesthesia.

Hydronephrosis Complications

  • Permanent Kidney Damage: Untreated hydronephrosis can cause reduced kidney function or kidney failure.
  • Ongoing Pain: Back or side pain that interferes with daily activities and sleep.
  • Chronic Infections: Recurring UTIs or severe kidney infections from urine backup.
  • Nerve Issues:
    • Numbness in your legs
    • Weakness in the lower body
    • Bladder control problems
  • Inflammation: Fever, chills, nausea, vomiting.
  • High Blood Pressure: Can develop from damaged kidneys that can’t regulate blood pressure.

Cost of Hydronephrosis Treatment in Singapore

Hydronephrosis treatment in Singapore can range from to depending on the severity of your condition and type of treatment needed. Please note these are estimated costs and yours may vary.

  • Conservative Treatment (pain relief and antibiotics): SGD 100 to SGD 500 depending on the antibiotics used and duration of treatment.
  • Shock Wave Lithotripsy (ESWL): SGD 3,000 to SGD 8,000 depending on the number of kidney stones, size of stones and hospital.
  • Urethral Catheter and Suprapubic Catheter: Less expensive than surgery but varies depending on the hospital and whether it’s an emergency case.
  • Stent to Drain Urine (Ureteral Stent Placement):SGD 3,000 to SGD 7,000 depending on how long the stent is needed and the complexity of the case.
  • Pyeloplasty: For severe cases especially in children, pyeloplasty can cost between SGD 15,000 to SGD 30,000 depending on the complexity of the surgery and hospital.
  • Ureteroscopy: SGD 3,000 to SGD 9,000 to remove stones or obstruction from the ureter.
  • Direct Kidney Drainage (Nephrostomy): Cost varies depending on urgency and setting.
  • Chemotherapy or Radiotherapy for Cancer-Related Obstructions: These can be very costly and varies greatly depending on the duration and type of treatment.
  • Follow-up Appointments and Ultrasounds: SGD 200 to SGD 500 per session.

Are There Subsidies for Hydronephrosis Treatment in Singapore?

The cost for medical procedures can seem daunting, but it shouldn’t deter you from seeking treatment when necessary.

At Nuffield Kidney & Dialysis, we have various payment options to help you manage the cost of hydronephrosis treatment. We also process claims with major insurance providers, so you have multiple options to pay for your treatment.

Government subsidies are also available to help with medical costs in Singapore. Patients can use MediSave for some treatment costs, MediShield Life for major hospital bills, and MediShield Life for costly outpatient treatments.

Why Choose Nuffield Kidney & Dialysis for Hydronephrosis Treatment?

At Nuffield Kidney & Dialysis, rest assured that you’re in good hands. Our team is led by Dr. Behram Khan, who has over 25 years of kidney experience, so every patient gets the best possible care. From simple to complex kidney cases, from hydronephrosis diagnosis to long term management, we’ve treated all manners of kidney-related problems.

Located in the heart of Singapore at Wheelock Place, we make it easy for you to get the care you need on time. Early treatment is key to preventing complications, so if you have hydronephrosis concerns, don’t wait a second longer. Contact us now to book an appointment.

FAQs

Can Hydronephrosis Be Cured?

Yes. Hydronephrosis can be cured. The key is to treat it early, as severe or long-term hydronephrosis can cause permanent kidney damage. Book an appointment with Nuffield Kidney & Dialysis today!

Is Hydronephrosis Serious?

Yes. Hydronephrosis is serious. If left untreated, it can damage your kidney permanently. In rare cases, it can even lead to kidney failure. Get treatment immediately if you are experiencing symptoms.

Should I Worry About Hydronephrosis?

No, you don’t need to worry as long as you find the right help. Most cases can be treated and full recovery is possible at the early stages.

Does Drinking More Water Help Hydronephrosis?

Definitely. Increased fluid intake dilutes your urine and flushes out bacteria from your system. Try to drink at least 8 glasses of water a day. You can try to have a glass every hour while you’re awake to stay hydrated.

What is the Best Drink to Restore Kidney Function?

If you have hydronephrosis and want to drink something other than water to support kidney health here are a few options:

  • Cranberry Juice: Known to prevent UTIs, cranberry juice can be good but best consumed in moderation as it can affect kidney stones and some brands have high sugar content.
  • Coconut Water:A hydrating option with electrolytes like potassium and sodium which are important for fluid balance. If you’re on a potassium restricted diet, you need to choose brands that don’t have added potassium.
  • Herbal Teas: Specific herbal teas like green tea, chamomile and mint tea are generally safe for kidney health. These teas are low in oxalates and potassium and hydrate without burdening the kidneys. However, some teas especially those with high oxalates or caffeine should be consumed with caution.

How Common Is Hydronephrosis?

Hydronephrosis affects about 1 in 100 adults at some point in their lives. It can happen to anyone. In babies, it happens in up to 1% of pregnancies.

How Can I Prevent Hydronephrosis?

  • Hydration: Drink at least 1.5L of water a day. Hydration helps with urine flow and prevents stones from forming which can block the urinary tract.
  • Physical Activity:Exercise regularly (30 minutes of moderate activity for at least 5 days per week). Exercise helps with weight management and prevents blood pressure spikes which can affect kidney health.
  • Healthy Diet:Eat a balanced diet with fruits, vegetables, lean proteins and whole grains. Limit salt to reduce risk of stone formation. Avoid foods high in oxalates (spinach and almonds) if you’re prone to calcium oxalate stones.
  • Manage Chronic Conditions: If you have conditions that can lead to hydronephrosis like diabetes or high blood pressure, manage them well. Follow your doctor’s advice closely.
  • Don’t Hold Urine: Go to the bathroom when you feel the urge rather than holding it in. Emptying your bladder regularly can reduce risk of UTI and potential blockages.
  • Regular Health Screenings: Get annual check-ups that include blood pressure check and kidney function tests. Early detection of conditions like high blood pressure or diabetes can prevent complications that lead to hydronephrosis.

1. What Does it Feel Like to Have a Kidney Stone?

Kidney stones usually don’t cause pain when they’re still in the kidney. But if they move into the ureter, you might feel pain in your back below your ribs. The pain can change as the stone moves.

2. I Think I Have a Kidney Stone. What Should I Do?

If you suspect a kidney stone, drink plenty of water and seek medical advice. Pain relief may be necessary if discomfort is severe.

3. Can Kidney Stones Cause Kidney Disease?

Yes, kidney stones can cause kidney disease. If untreated, they can lead to infections, block urine flow, and damage the kidneys, potentially resulting in chronic kidney disease.

4. Do All Kidney Stones Cause Pain?

No, kidney stones in the kidney often don’t hurt. Pain happens when a stone blocks urine flow.

5. Can Children Get Kidney Stones?

Yes, children can get kidney stones. Though less common than in adults, the number of cases in children is rising. Causes include diet, genetics, and medical conditions that affect the body’s handling of minerals.

6. How Big are Kidney Stones?

  • Small kidney stones: These can be as tiny as a grain of sand or smaller, typically measuring up to 4 mm in diameter.
  • Large kidney stones:These can grow to several centimetres in diameter, ranging from 5 mm up to more than 1 cm in size.

7. Can Kidney Stones Go Away On Their Own?

Yes, kidney stones can often pass on their own, especially if they are small. Drinking plenty of fluids helps move them through the urinary tract and out of the body.

8. How Long Does it Take to Pass Kidney Stones?

The time it takes to pass kidney stones can vary widely, typically ranging from a few days to several weeks. Small stones may pass on their own within a few days, while larger stones might require weeks and potentially medical intervention to help them pass.

9. Can Kidney Stones be Dissolved?

Medications can help with symptoms but don’t dissolve the stone. The main focus of treatment is pain relief and removing the stone.

10. Can Drinking Bubble Tea Give You Kidney Stones?

Regularly consuming large amounts of bubble tea, especially several times a week, can increase the risk of kidney stones due to its high sugar and oxalate levels. Moderation is key.

11. What is the Difference Between Kidney Stones and Gallstones?

  • Location: Kidney stones form in the kidneys; gallstones develop in the gallbladder.
  • Composition: Kidney stones are made from chemicals in urine like calcium oxalate; gallstones consist of cholesterol or bilirubin (a yellow pigment produced during red blood cell breakdown).
  • Symptoms: Kidney stones cause pain during urination; gallstones lead to digestive issues and jaundice (yellowing of skin and eyes due to high bilirubin levels).

Medical References

Alshoabi, Sultan Abdulwadoud, et al. “Etiology of Hydronephrosis in Adults and Children: Ultrasonographic Assessment in 233 Patients.” Pakistan Journal of Medical Sciences, vol. 37, no. 5, July 2021, doi:10.12669/pjms.37.5.3951.

Patel, Kishan, and Deepak Batura. “An Overview of Hydronephrosis in Adults.” British Journal of Hospital Medicine, vol. 81, no. 1, Jan. 2020, pp. 1–8, doi:10.12968/hmed.2019.0274.

Rickard, Mandy, et al. “Prenatal Hydronephrosis: Bridging Pre‐ and Postnatal Management.” Prenatal Diagnosis, vol. 42, no. 9, Feb. 2022, pp. 1081–93, doi:10.1002/pd.6114.