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Obstruction
Definition of Hydronephrosis
Hydronephrosis is caused by an obstruction of the urine flow from the kidney.
Hydronephrosis means literally "water inside the kidney" and refers to the distension and
dilation of the pyelocaliceal system.
Bladder diseases: bladder tumors, bladder stones, bladder neck sclerosis, detrusor
sphincter dyssynergia (DSD).
Ureteral stone
Ureteral cancer
Aortic aneurysm
During pregnancy, the enlarged uterus can compress the ureter (right more than left)
and may cause pyelonephritis during pregnancy.
Extra-uterine pregnancy
Tuboovarial abscess
Tumors: cervical cancer, ovarian cysts, ovarian cancer, uterine leiomyoma ...
Lymph node or distant metastases: prostate cancer, cervical cancer, breast cancer,
colon cancer, stomach cancer, bladder cancer, ....
Retroperitoneal fibrosis
Pelvic lipomatosis : rare disease with pelvic fat accumulation and cranial
displacement of bladder and ureters.
Ureteropelvic-junction obstruction
Megacalicosis
Caliceal diverticula
Renal scintigraphy is necessary to judge the significance of the upper urinary tract
obstruction.
Hydronephrosis grade III: Missing or marginal sinus reflex. Minor signs of organ atrophy
present (flat papillae and blunt fornices).
Hydronephrosis grade IV: massive dilatation of the renal pelvis and calices. Borders between
renal pelvis and calyces are missing. Significant signs of renal atrophy (thin parenchyma).
Grade
Description
Grade
dilation of the renal pelvis without dilatation of the calices
I
Grade dilation of the renal pevis and calices, that become convex; no signs of
II
cortical thinning
Grade
presence of cortical thinning
III
Grade
massive dilation of the real pelvis and calices, severe cortical thinning
IV
References:
two hydronephrosis grading systems: the Society for Foetal Urology grading system vs. the
Onen grading system. Clin Radiol. 2013 Sep;68(9):e484490.
Kidney disease
Enlarged prostate
Tumors
Your provider may also use this test to find the cause of flank pain or pain spasms in the
kidney area.
A CT scan of the kidneys will make a more accurate diagnosis of kidney tumors or kidney
problems caused by trauma.
Your healthcare provider may have other reasons to recommend an IVP.
Are pregnant or think you may be pregnant. Radiation exposure during pregnancy
may lead to birth defects.
Are allergic to or sensitive to any medicines, contrast dye, or iodine. Because contrast
dye is used, there is a risk for allergic reaction to the dye.
Have kidney failure or other kidney problems. In some cases, the contrast dye can
cause kidney failure. You are at higher risk for this if you take certain diabetes
medicines.
Possible complications of this test also include problems urinating and urinary tract
infections.
You may have other risks depending on your specific health condition. Be sure to talk with
your provider about any concerns you have before the procedure.
Certain things can make this test less accurate. These include:
Your healthcare provider will explain the procedure to you. Ask him or her any
questions you have about the procedure.
You may be asked to sign a consent form that gives permission to do the procedure.
Read the form carefully and ask questions if anything is not clear.
You'll be asked to not eat or drink liquids (fast) before the procedure. Your healthcare
provider will tell you how long to fast. It might be several hours or overnight.
Tell your healthcare provider if you are pregnant or think you may be pregnant.
Tell your healthcare provider if you are allergic to contrast dye or iodine.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines,
latex, tape, or anesthetic drugs (local and general).
Tell your healthcare provider about all medicines you are taking. This includes
prescriptions, over-the-counter medicines, and herbal supplements. If you have
diabetes and take metformin, you may need to stop taking this medicine several days
before the exam.
Tell your healthcare provider if you have had a bleeding disorder. Also tell your
provider if you are taking blood-thinning medicine (anticoagulant), aspirin, or other
medicines that affect blood clotting. You may need to stop these medicines before the
test.
You need to take a laxative the night before the test and have a cleansing enema or
suppository a few hours before the test.
You may need to have a blood test to see how well your kidneys will react to the
contrast dye.
Follow any other instructions your healthcare provider gives you to get ready.
6. The radiologist will inject the contrast dye into the IV. You may feel a flushing
sensation, a salty or metallic taste in your mouth, a brief headache, itching, or nausea
or vomiting. These effects usually last for a few moments.
7. The radiologist will take a series of X-rays as the dye travels through the kidneys and
urinary tract. This usually lasts about 30 minutes. You may be asked to change
positions while the X-rays are taken.
8. You will be asked to empty your bladder. You may be given a bedpan or urinal. Or
you may be allowed to use the restroom.
9. After you have emptied your bladder, the radiologist will take a final X-ray to see
how much contrast dye remains in the bladder.
Fever or chills
Your healthcare provider may give you other instructions, depending on your situation.
Next steps
Before you agree to the test or the procedure make sure you know:
Who will do the test or procedure and what that persons qualifications are
What would happen if you did not have the test or procedure
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure