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Hydronephrosis

Disease Details

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Description: Hydronephrosis is the swelling of a kidney due to a build-up of urine, typically caused by an obstruction in the urinary tract or vesicoureteral reflux.
Type: Hydronephrosis is not typically classified as a type of genetic disorder; rather, it is a condition characterized by the swelling of a kidney due to the build-up of urine. The condition can arise from various factors including congenital abnormalities, kidney stones, or tumors that obstruct urine flow. Hydronephrosis itself is not directly inherited, but certain underlying causes, such as congenital abnormalities like ureteropelvic junction obstruction, may have a genetic component and can be inherited in an autosomal dominant or autosomal recessive manner.
Signs And Symptoms: The signs and symptoms of hydronephrosis depend upon whether the obstruction is acute or chronic, partial or complete, unilateral or bilateral. Hydronephrosis that occurs acutely with sudden onset (as caused by a kidney stone) can cause intense pain in the flank area (between the hips and ribs) known as a renal colic. Historically, this type of pain has been described as "Dietl's crisis".Conversely, hydronephrosis that develops gradually over time will generally cause either a dull discomfort or no pain. Nausea and vomiting may also occur. An obstruction that occurs at the urethra or bladder outlet can cause pain and pressure resulting from distension of the bladder. Blocking the flow of urine will commonly be prone to urinary tract infections which can lead to further development of stones, fever, and blood or pus in the urine. If complete obstruction occurs, a postrenal kidney failure (obstructive nephropathy) may follow.Blood tests may show impaired kidney function (elevated urea or creatinine) or electrolyte imbalances such as hyponatremia or hyperchloremic metabolic acidosis. Urinalysis may indicate an elevated pH due to the secondary destruction of nephrons within the affected kidney, which impairs acid excretion. Physical examination in a thin patient may detect a palpable abdominal or flank mass caused by the enlarged kidney.
Prognosis: The prognosis of hydronephrosis is extremely variable and depends on the condition leading to hydronephrosis, whether one (unilateral) or both (bilateral) kidneys are affected, the pre-existing kidney function, the duration of hydronephrosis (acute or chronic), and whether hydronephrosis occurred in developing or mature kidneys.Permanent kidney damage can occur from prolonged hydronephrosis secondary to compression of kidney tissue and ischemia.For example, unilateral hydronephrosis caused by an obstructing stone will likely resolve when the stone passes, and the likelihood of recovery is excellent. Alternately, severe bilateral prenatal hydronephrosis (such as occurs with posterior urethral valves) will likely carry a poor long-term prognosis, because obstruction while the kidneys are developing causes permanent kidney damage even if the obstruction is relieved postnatal.Hydronephrosis can be a cause of pyonephrosis, which is a urological emergency.

== References ==
Onset: Onset: Hydronephrosis can have a sudden (acute) onset or develop gradually (chronic). The timing depends on the underlying cause, such as a kidney stone (acute) or a slowly developing obstruction (chronic).

Nan: Not applicable (N/A).
Prevalence: The prevalence of hydronephrosis varies depending on the population studied and the underlying causes. It is relatively common and can occur at any age. For newborns, prenatal hydronephrosis occurs in approximately 1 in 100 pregnancies. In adults, the prevalence can range from 0.9% to 3%, depending on factors such as urolithiasis, tumors, and other conditions that can obstruct urine flow.
Epidemiology: Hydronephrosis is a condition characterized by the swelling of one or both kidneys due to the buildup of urine. It can occur at any age but is often detected during prenatal ultrasounds and thus seen in newborns and infants. The exact prevalence varies, with studies suggesting that around 1 in 500 people may be affected overall, although this can be higher in certain populations or age groups. Hydronephrosis can result from various underlying causes, such as kidney stones, congenital anomalies, or obstructive issues like tumors. Early detection and management are crucial to prevent potential kidney damage.
Intractability: Hydronephrosis is not inherently intractable. It refers to the swelling of a kidney due to a build-up of urine, typically caused by an obstruction, infection, or underlying condition. Treatment focuses on addressing the underlying cause and relieving the obstruction. If treated promptly and effectively, the condition can often be resolved without permanent damage to the kidneys.
Disease Severity: Hydronephrosis is the swelling of one or both kidneys due to a build-up of urine. It can range in severity from mild to severe, depending on the degree of kidney swelling and the underlying cause of the obstruction. Severe cases can lead to kidney damage and impaired function.
Healthcare Professionals: Disease Ontology ID - DOID:11111
Pathophysiology: Hydronephrosis is caused by obstruction of urine before the renal pelvis. The obstruction causes dilation of the nephron tubules and flattening of the lining of the tubules within the kidneys which in turn causes swelling of the renal calyces.Hydronephrosis can either be acute or chronic. In acute hydronephrosis full recovery of kidney function is seen. However, with chronic hydronephrosis, permanent loss of kidney function is seen even once obstruction is removed.Obstruction that occurs anywhere along the upper urinary tract will lead to increased pressure within the structures of the kidney due to the inability to pass urine from the kidney to the bladder. Common causes of upper tract obstruction include obstructing stones and ureteropelvic junction (UPJ) obstruction caused by intrinsic narrowing of the ureters or an overlying vessel.
Obstruction occurring in the lower urinary tract can also cause this increased pressure through the reflux of urine into the kidney. Common causes include bladder dysfunction (such as neurogenic bladder) and urethral obstruction (such as posterior urethral valves in male infants) or compression (such as from prostatic hypertrophy in older male adults).
In pregnancy, dextrorotation (rotation to the right) of the uterus can cause compression on the right ureter, thus making hydronephrosis more common in right kidney than left kidney. Besides, hormones such as oestrogen, progestrerone, and prostaglandin can cause ureter dilatation, thus causing hydronephrosis despite the absence of visible obstruction along the urinary tract.
Carrier Status: Hydronephrosis is a condition characterized by the swelling of one or both kidneys due to a build-up of urine. It is not typically associated with a carrier status or genetic inheritance, as it is more often caused by an obstruction or other underlying condition affecting the urinary tract.
Mechanism: Hydronephrosis is a condition characterized by dilation and swelling of the kidney due to the accumulation of urine. Here's a brief overview of its mechanisms and molecular mechanisms:

### Mechanism:
1. **Obstruction**: The primary mechanism behind hydronephrosis is the obstruction of urine flow. This can occur at any point along the urinary tract, including the ureters, bladder, or urethra.
2. **Increased Pressure**: The obstruction causes urine to accumulate in the renal pelvis, leading to increased pressure within the kidney.
3. **Kidney Swelling**: The increased pressure results in the dilation of renal pelvis and calyces, leading to kidney swelling. Over time, persistent pressure can damage kidney tissues and impair renal function.
4. **Possible Causes**: Common causes of obstruction include kidney stones, congenital abnormalities, tumors, scarring from previous infections, and external compression by neighboring structures.

### Molecular Mechanisms:
1. **Inflammatory Response**: Chronic obstruction can trigger an inflammatory response, leading to the release of cytokines and chemokines. These molecules can attract immune cells, contributing to tissue damage and fibrosis.
2. **Oxidative Stress**: The buildup of urine increases cellular stress and can lead to oxidative stress. Reactive oxygen species (ROS) can damage renal cells and tissues, exacerbating kidney dysfunction.
3. **Fibrosis Pathways**: Key signaling pathways like the TGF-β (Transforming Growth Factor-beta) pathway can be activated in response to obstruction. TGF-β is known to promote fibrosis by stimulating the production of extracellular matrix components and inhibiting their degradation.
4. **Cell Death**: Prolonged obstruction and pressure can lead to apoptosis (programmed cell death) or necrosis (unplanned cell death) of renal cells. This loss of functional cells diminishes the kidney’s ability to filter blood and produce urine.
5. **Hypoxia**: Obstruction can lead to reduced blood flow and oxygenation to the affected kidney, resulting in hypoxia. Hypoxia-inducible factors (HIFs) may be activated, which can lead to further physiological changes and contribute to tissue damage and fibrosis.

Understanding these mechanisms is crucial for developing targeted therapies to mitigate kidney damage and preserve renal function in individuals with hydronephrosis.
Treatment: Treatment of hydronephrosis focuses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies.Acute obstruction of the upper urinary tract is usually treated by the insertion of a nephrostomy tube. Chronic upper urinary tract obstruction is treated by the insertion of a ureteric stent or a pyeloplasty.Lower urinary tract obstruction (such as that caused by bladder outflow obstruction secondary to prostatic hypertrophy) is usually treated by insertion of a urinary catheter or a suprapubic catheter. Surgery is not required in all prenatally detected cases.
Compassionate Use Treatment: Hydronephrosis, the swelling of a kidney due to a build-up of urine, is typically managed by addressing the underlying cause of the obstruction. Currently, there are no specific compassionate use treatments or approved experimental treatments exclusive to hydronephrosis. Management often includes:

1. **Surgical Intervention:** Procedures to remove obstructions or alleviate pressure on the kidneys, such as ureteral stenting or nephrostomy.
2. **Medical Management:** Use of antibiotics to manage or prevent infections and pain relievers for symptom control.
3. **Off-label or Experimental Treatments:** These are not typically established for hydronephrosis itself, but novel approaches are investigated based on the underlying causes such as congenital malformations, kidney stones, or tumors. Research in areas like minimally invasive surgical techniques or regenerative medicine could indirectly impact treatment of hydronephrosis as part of a broader therapeutic strategy.

If you are considering alternative treatments, it is crucial to consult with a healthcare provider to understand potential risks, benefits, and the latest research findings.
Lifestyle Recommendations: ### Lifestyle Recommendations for Hydronephrosis

1. **Stay Hydrated**: Drink an appropriate amount of water daily, but avoid excessive fluid intake which can exacerbate the condition. Consult with a healthcare provider for personalized advice.

2. **Dietary Changes**: Reduce salt intake and eat a diet rich in fruits, vegetables, and whole grains. Avoid foods that can cause kidney stones, such as oxalate-rich foods or excessive protein.

3. **Regular Monitoring**: Keep regular appointments with your healthcare provider to monitor kidney function and manage underlying causes.

4. **Avoid Alcohol and Caffeine**: These can irritate the kidneys and exacerbate symptoms.

5. **Exercise**: Engage in regular physical activity to maintain overall health, but avoid high-impact sports that could strain the kidneys.

6. **Medication Compliance**: Take medications as prescribed, especially if you have conditions like kidney stones, infections, or other related issues.

7. **Manage Underlying Conditions**: If hydronephrosis is due to other medical conditions (e.g., BPH, kidney stones), ensure that these are managed effectively.

8. **Avoid Painkillers**: Limit use of NSAIDs (like ibuprofen) that can affect kidney function unless advised differently by a healthcare provider.

9. **Posture**: Avoid prolonged sitting to reduce pressure on the kidneys.

10. **Immediate Care for Infections**: Seek prompt treatment for urinary tract infections to prevent complications.

Always consult with healthcare providers for personalized recommendations tailored to the specifics of your condition.
Medication: Hydronephrosis, a condition characterized by the swelling of a kidney due to a build-up of urine, is not directly treated with medication alone. The primary approach involves addressing the underlying cause, which may include obstruction or infection. However, medications may be used to manage symptoms or treat associated conditions:

1. **Antibiotics**: If an infection is present, antibiotics may be prescribed to treat the infection and prevent further complications.
2. **Pain Relief**: Analgesics may be used to manage pain associated with the condition.

Definitive treatment often involves procedures to remove obstructions, such as removing kidney stones, draining urine using a catheter or stent, or surgery for structural abnormalities.
Repurposable Drugs: There are no widely recognized repurposable drugs specifically for hydronephrosis. Treatment typically focuses on addressing the underlying cause of the condition, such as removing obstructions in the urinary tract or treating associated infections. Medications may include antibiotics for infections, analgesics for pain, or diuretics to promote urine flow, but none of these are repurposed specifically for hydronephrosis.
Metabolites: Hydronephrosis itself is not directly associated with specific metabolites, as it is a condition characterized by the swelling of one or both kidneys due to a build-up of urine. However, underlying causes of hydronephrosis, such as urinary tract infections or kidney stones, could potentially affect metabolites in the body. If you need specific information on how such conditions alter metabolite levels, please provide more details.
Nutraceuticals: Nutraceuticals have limited evidence in the treatment of hydronephrosis, which is a condition where the kidney swells due to urine failing to properly drain. Traditional treatment focuses on addressing the underlying cause, such as removing obstructions or treating infections. Always consult a healthcare professional for personalized recommendations.
Peptides: Hydronephrosis is characterized by the swelling of one or both kidneys due to a build-up of urine. It occurs when there is an obstruction in the urinary tract or when urine cannot drain from the kidney to the bladder.

### Peptides:
Peptides are short chains of amino acids. While not commonly a standard treatment for hydronephrosis, research into peptide-based therapies might focus on reducing inflammation or promoting tissue repair to alleviate the underlying cause of the obstruction.

### Nanotechnology:
Nanotechnology could offer innovative solutions for diagnosing and treating hydronephrosis. For example, nanoparticles could be used to deliver drugs directly to affected areas, enhancing treatment efficacy and reducing side effects. Additionally, nanotechnology could improve imaging techniques, making it easier to diagnose the severity and cause of hydronephrosis.