Doctors Lounge - Nephrology Answers
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Forum Name: Miscellaneous Nephrology Topics
Question: Hydronephrosis & hydroureter
|kidneypain - Mon Jul 23, 2007 3:12 pm||
In 2002, while pregnant, they found hydronephrosis and hydroureter on the right side. It continued to worsen, so they stented me. At the beginning, the stent provided much needed relief, but after a few weeks, the hydronephrosis came back. It continued to worsen, and a month before my baby was due, my left kidney began swelling as well. They delivered the baby then because of the kidney's swelling. The docs took the stent out after I had healed from the delivery since it was no longer working and caused great discomfort. The doc wanted to wait and see if now since the baby was out if the hydronephrosis would go away - it's now been 5 years and I still have it. I have periodic horrible pain on the right side that travels to the groin (which I assume is the path of my ureter). It lasts until I take pain meds for a few days, then it will get to a bearable level for a while then it comes back. Occasionally it is associated with a UTI, but most of the time - urine is clean.
My gp and my gynecologist both tell me I need to find out what the cause is - but the urologist I went to felt like we'll just wait and see - or do exploratory surgery and put another stent in. My last IVP about 1 year ago showed the hydronephrosis and ureter on the right - but the kidney was not damaged. I had an ultrasound at my gynecologist office 2 weeks ago due to pain and he said the pain is my kidneys - he could feel it which is why he did the ultrasound.
The urologist said that the IVP's and MRI's do not show a clear blockage which is why there's the whole wait and see attitude. But 5 years later I am tired of this pain! I am afraid of surgery because I also have developed a bleeding disorder and have a tendency to hemorrhage after surgery. I am afraid of a stent because it didn't last and it was extremely uncomfortable. When he pulled it out it was covered in crystals and you can just imagine how that felt being pulled through my urethra!
Since the urologist doesn't seem all that concerned, should I see a nephrologist? I don't want to end up with kidney damage eventually which is what I read can happen. Is it important that I truly find the cause - or should I just deal with it?
Sorry so lengthy, wanted to make sure you had the whole picture.
|Dr. Chan Lowe - Wed Jul 25, 2007 5:20 pm||
There may be some variation amongst physicians so keep in mind that my answer is my opinion. I believe that hydronephrosis should be worked up to find the cause.
I would be suspicious of some obstruction or external compression, especially since it started during pregnancy.
Another possible cause is vesicoureteral reflux. Normally the ureters have valves that prevent urine from flowing backwards up into the ureter and kidney after entering the bladder. In some people this valve does not work properly allowing urine to reflux back up into the kidney. If this reflux is severe enough it can cause hydroureter and hydronephrosis. This can be tested with a study known as a VCUG (voiding cystourethrogram).
Seeing a nephrologist is probably not a bad idea. Follow up with your urologist is also important.
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