Hydronephrosis and Hydroureter Follow-up

  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Sep 20, 2011
 

Further Inpatient Care

Monitor patients for postobstructive diuresis. This is a marked polyuria observed after relief of an obstructed system.

Patients who are most likely to experience postobstructive diuresis present with chronic obstruction, edema, congestive heart failure, hypertension, weight gain, and azotemia. Clinically significant postobstructive diuresis is usually seen only in the setting of prior bilateral obstruction or, similarly, a unilateral obstruction of a solitary functioning kidney.

This postobstructive diureses can lead to a marked diuresis with the wasting of sodium, potassium, phosphate, and the divalent cations. Management involves avoiding severe volume depletion, hypokalemia, hyponatremia, hypernatremia, and hypomagnesemia.

Volume or free-water replacement is appropriate only when the salt and water losses result in volume depletion or a disturbance of osmolality. In many cases, excessive volume or fluid replacement prolongs the diuresis and natriuresis. An appropriate starting fluid for replacement is 0.45% saline. During this period, vital signs, volume status, urine output, and serum and urine chemistry and osmolality should be monitored.

Postobstructive diuresis is usually self-limited. It usually lasts for several days to a week but may, in rare cases, persist for months.

In fetuses with severe oligohydramnios and documented lung maturation, early delivery has been suggested. Although no data document improved renal outcome with early delivery, early delivery may be indicated to reduce the risk of other adverse outcomes from oligohydramnios, such as umbilical cord compression.

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Further Outpatient Care

Once the diagnosis is made and treatment is performed, follow-up imaging studies are necessary to assess for resolution of the hydronephrosis and hydroureter. Additionally, perform laboratory studies on renal function to assess the recovery of renal function.

For ultrasonography follow-up, fetuses with mild hydronephrosis should have follow-up ultrasonography in the third trimester (32-34 wk gestation). The interval for follow-up examination and management is dictated by the initial findings and the amount of amniotic fluid. Those with resolution have a low risk of clinically significant pathology and do not need further antenatal or postnatal evaluation. Serial follow-up ultrasonography is indicated for fetuses with the following:

  • Moderate or severe hydronephrosis
  • Bilateral involvement
  • Progression and/or persistence of hydronephrosis
  • Normal amniotic fluid volume: Fetuses with unilateral involvement and normal amniotic fluid volume should have repeat prenatal ultrasonography examination at 32-34 weeks of gestation to evaluate and guide postnatal evaluation.
  • Bilateral hydronephrosis and normal amniotic fluid volume: These patients should have repeat ultrasonography examination 2-3 weeks after diagnosis to evaluate for progression and amniotic fluid volume. Follow-up examinations are determined according to the serial ultrasonography results.
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Complications

Postobstructive diuresis refers to polyuria that occurs after relief of obstruction. Patients with edema, congestive heart failure, hypertension, weight gain, and azotemia are most likely to exhibit this condition. It is more common in patients with chronic obstruction. Postobstructive diuresis is usually clinically significant only in patients whose obstruction involves both kidneys or a unilateral obstruction of a solitary functioning kidney.

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Patient Education

For patient education resources, see the Kidneys and Urinary System Center, as well as Intravenous Pyelogram.

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Contributor Information and Disclosures
Author

Dennis G Lusaya, MD  Associate Professor II, Department of Surgery (Urology), University of Santo Tomas; Head of Urology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital; Chief of Urologic Oncology, St Luke's Medical Center Global City, Philippines

Dennis G Lusaya, MD is a member of the following medical societies: American Urological Association, Philippine College of Surgeons, Philippine Medical Association, Philippine Society of Urological Oncology, Philippine Urological Association, and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Edgar V Lerma, MD, FACP, FASN, FAHA  Clinical Associate Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC

Edgar V Lerma, MD, FACP, FASN, FAHA is a member of the following medical societies: American Heart Association, American Medical Association, American Society of Hypertension, American Society of Nephrology, Chicago Medical Society, Illinois State Medical Society, National Kidney Foundation, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard A Santucci, MD, FACS  Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Srinivas Vourganti, MD, Prakash Maniam, MD, and martin I Resnick, MD, to the development and writing of this article.

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