Advertisement Upgrade to remove ads

Overview

Abnormal dilation of the renal pelvis and calyces of one or both kidneys
Possibly obstructive, physiological, or secondary to reflux
Possibly acute or chronic

Overview-Pathophysiology

With obstruction in the urethra or bladder, hydronephrosis is usually bilateral.
With obstruction in a ureter, hydronephrosis is usually unilateral.
Obstructions distal to the bladder cause the bladder to dilate, acting as a buffer zone, delaying hydronephrosis.
Total obstruction of urine flow with dilation of the collecting system ultimately causes complete cortical atrophy and glomerular filtration ceases.
Obstruction leads to a rise in ureteral pressure, which causes changes to glomerular filtration, tubular function, and renal blood flow.
Glomerular filtration rate decreases, and the renal tubules are unable to transport sodium and potassium effectively, affecting the ability to concentrate and dilute urine.

Overview-Causes

Obstruction from:
calculi

blood clot

benign prostatic hyperplasia (BPH)

cancer

ureterocele

neurogenic bladder

urethral stricture

aortic aneurysm

uterine prolapse

endometriosis.
calculi
blood clot
benign prostatic hyperplasia (BPH)
cancer
ureterocele
neurogenic bladder
urethral stricture
aortic aneurysm
uterine prolapse
endometriosis.
Reflux
Physiologic hydronephrosis of pregnancy
Excessive diuresis, such as from diabetes insipidus
Infection

Overview-Incidence

Acute unilateral hydronephrosis is more common than bilateral hydronephrosis.
Hydronephrosis occurs more often in women between the ages of 20 to 60 years; men are more often affected after age 60.

Overview-Complications

Urinary stasis
Progressive cortical atrophy
Spontaneous rupture of the renal calyx
Postobstructive diuresis
Sepsis

Assessment-History

Possibly no initial symptoms, but increasing pressure behind the obstruction eventually resulting in renal dysfunction
Varies depending on the cause of the obstruction
No symptoms or complaint of only mild pain and slightly decreased urine flow
Severe, colicky renal pain or dull flank pain that radiates to the groin
Dysuria
Alternating oliguria and polyuria, anuria
Nausea
Vomiting
Abdominal fullness
Pain on urination
Dribbling
Urinary hesitancy
Change in voiding pattern
Suprapubic pain

Assessment-Physical Findings

Hematuria
Pyuria
Urinary tract infection
Palpable kidney (when severe)
Lower extremity edema (with bilateral hydronephrosis)
Distended bladder
Palpable abdominal mass
Flank tenderness
Costovertebral angle tenderness
Edema
Crackles
Hypertension

Diagnostic Test Results-Laboratory

Urinalysis may show hematuria, proteinuria, crystalluria, and pyuria.
Renal function study results are abnormal, revealing elevated creatinine, urea, and potassium levels.
Urine studies confirm the inability to concentrate urine.
Glomerular filtration rate is decreased.
Blood urea nitrogen and serum creatinine may be elevated with bilateral hydronephrosis.
Complete blood count may reveal anemia associated with renal failure or leukocytosis if infection is present.

Diagnostic Test Results-Imaging

Excretory urography, retrograde pyelography, and renal ultrasonography confirm the diagnosis and identify the obstruction.
Voiding cystourethrogram reveals vesicoureteral reflux.
I.V. urography shows the site of the obstruction.
Nephrography shows delayed appearance time.
Radionuclide scan shows the site of the obstruction.
Computed tomography scanning may reveal the cause.
Renal ultrasound identifies the condition and helps to rule out urinary tract obstruction.

Treatment-General

For inoperable obstructions, decompression and drainage of the kidney, using a nephrostomy tube placed temporarily or permanently in the renal pelvis
Urinary catheterization

Treatment-Diet

If renal function affected, low-protein, low-sodium, and low-potassium

Treatment-Medications

Antibiotic therapy for infection or vesicoureteral reflux
Analgesics, such as nonsteroidal anti-inflammatory drugs or acetaminophen with codeine, for renal colic; if necessary, I.V. morphine for renal colic
Oral alkalinization therapy for uric acid calculi

Treatment-Surgery

Dilatation for urethral stricture and placement of urethral stents
Extracorporeal sound wave lithotripsy or lithotripsy for stone obstruction
Ureterolysis for retroperitoneal fibrosis
Prostatectomy for BPH
Placement of percutaneous nephrostomy tube
Ureteral reimplantation for vesicoureteral reflux

Nursing Considerations-Nursing Diagnoses

Acute pain
Anxiety
Deficient fluid volume
Imbalanced nutrition: Less than body requirements
Impaired urinary elimination
Risk for infection
Risk for injury

Nursing Considerations-Expected Outcomes

report increased comfort
express feelings of decreased anxiety
maintain fluid balance
verbalize appropriate food choices according to the prescribed diet
maintain adequate urine output
remain free from signs or symptoms of infection
avoid or have minimized complications.

Nursing Considerations-Nursing Interventions

Give prescribed drugs. Administer morphine I.V. for severe pain associated with renal colic.
Give prescribed I.V. fluids; ensure patent I.V. access.
Assist the patient with measures to promote urine elimination. Assess for bladder distention and costovertebral angle tenderness.
Encourage the patient to express fears and anxieties. Help the patient use coping and relaxation measures.
Prepare the patient and family for possible surgery, including what to expect before and after, such as equipment and monitoring.
Provide site care for a suprapubic catheter or nephrostomy tube site as appropriate.

Nursing Considerations-Monitoring

Renal function
Intake and output
Vital signs
Fluid and electrolyte status
Nephrostomy tube function and drainage, if appropriate
Catheter drainage
Pain level and relief
Wound site (postoperatively)
Signs and symptoms of infection

Nursing Considerations-Associated Nursing Procedures

IV bag preparation
IV bolus injection
IV catheter insertion
Nephrostomy and cystostomy tube dressing changes
Nephrostomy tube irrigation
Pain management
Postoperative care
Preoperative care
Preparing a patient for urologic surgery, OR

Patient Teaching-General

disorder, possible causes, diagnosis, and treatment, including surgery or insertion of catheter or nephrostomy tube as appropriate
usual recovery of renal function after obstruction is relieved
if surgery is scheduled:
procedure and postoperative care

surgical site care

activity restrictions after surgery if appropriate
procedure and postoperative care
surgical site care
activity restrictions after surgery if appropriate
suprapubic catheter or nephrostomy tube care, as appropriate
prescribed medication therapy, including drugs, dosages, rationales for use, frequency and duration of administration, and possible adverse effects
dietary changes if indicated, including the need for increased fluid intake
hydronephrosis symptom recognition and reporting
importance of continued follow up, including diagnostic testing to evaluate the effectiveness of treatment.

Patient Teaching-Discharge Planning

Arrange for home care follow up as appropriate.

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set