eMedicine Specialties > Urology > Hydronephrosis and Ureter Disorders

Hydronephrosis and Hydroureter: Follow-up

Author: Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Coauthor(s): Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Contributor Information and Disclosures

Updated: Feb 25, 2008

Follow-up

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.

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.

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.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Once the diagnosis of hydroureteronephrosis is made, immediately refer the patient to a urologist. Delay in referral could result in irreversible loss of renal function.
  • If bladder outlet obstruction is the cause of the hydroureteronephrosis and a large volume is drained, the catheter should be left in place, with a leg bag. Severe bladder distention can be associated with impaired detrusor function for the first few days after relief of obstruction. The catheter allows drainage during this recovery period.
  • Before performing any invasive procedure to relieve an obstructed system, assess the degree of function in the contralateral kidney.

Special Concerns

  • Hydronephrosis and hydroureter during pregnancy are physiologic and are most pronounced during the third trimester. This is believed to be due to mechanical obstruction by the gravid uterus and the effects of increased progesterone levels.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Martin I Resnick, MD †, to the development and writing of this article.



More on Hydronephrosis and Hydroureter

Overview: Hydronephrosis and Hydroureter
Differential Diagnoses & Workup: Hydronephrosis and Hydroureter
Treatment & Medication: Hydronephrosis and Hydroureter
Follow-up: Hydronephrosis and Hydroureter
References

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Further Reading

Keywords

hydronephrosis, hydroureter, urinary tract obstruction, renal pelvis dilation, calyces dilation, hydroureteronephrosis, hydronephrotic system, pyonephrosis, urine flow interruption, interrupted urine flow, pyelolymphatic backflow, renal colic, advanced pelvic malignancy, prostatic hypertrophy, prostate cancer, cervical cancer, pregnancy, ureter calculi, ureteral calculi, ureteropelvic junction obstruction, UPJ obstruction, urine reflux, postobstructive diuresis

Contributor Information and Disclosures

Author

Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Disclosure: Nothing to disclose.

Coauthor(s)

Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Prakash Maniam, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction
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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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