Hydronephrosis: A Systematic Review

Abstract

Background: Hydronephrosis describes swelling of the kidneys due to buildup of urine. Hydronephrosis may be physiological or pathological; acute or chronic; complete or partial; unilateral or bilateral; functional or structural. The kidney plays a vital role in the body and hydronephrosis can impair its function.

Aim: To present the current features in the management of hydronephrosis.

Methods:  Publications in English on hydronephrosis from January 1950 to June 2019 were obtained through Google and Medline database and relevant reference lists in publications. Data extracted includes the leading authors' names, year of publication, source country, aetiology, epidemiology, pathophysiology, clinical features, treatment, follow up and complications.

Results: Hydronephrosis can be due to structural or functional obstruction from the external urethral meatus to the kidneys. If the onset is gradual the patient may be symptomless and loin pain is a common presentation in acute cases. Hydronephrosis can lead to a number of changes that can lead to renal failure, urinary tract infection, stones, uncontrolled hypertension, urosepsis, anaemia, failure to thrive, dehydration and even death. The time between development of hydronephrosis and these complications could be as short as 6 weeks in some patients. A number of diagnostic laboratory and radiological investigations exist to aid in the diagnoses of hydronephrosis. Decompression of hydronephrosis and timely treatment of the aetiology can lead to recovery of the kidneys and avoid complications.

Conclusion: Early identification and treatment of hydronephrosis would preserve renal function. A high index of suspicion is necessary in some cases.

Keywords: Hydronephrosis, renal failure, obstructive uropathy.