Hydronephrosis is a structural problem of the urinary system, where one (unilateral hydronephrosis) or both (bilateral hydronephrosis) kidneys become dilated and distended from the pressure, fluid buildup, and incomplete emptying of the urinary collecting system.
Hydronephrosis is not a disease itself but a secondary condition from other underlying diseases. It can be acute or chronic, partial or complete, and can occur anywhere in the urinary collecting system.
Any obstruction in the urinary tract will cause a pressure build-up causing the kidneys to be engorged with urine and press nearby organs. The pressure that builds up for too long, causes the kidneys to lose their function permanently if left untreated.
Signs and Symptoms of Hydronephrosis
Urinary urgency, frequency, or incontinence and painful urination (dysuria)
Sudden or intense flank pain that may radiate to the lower abdomen or groin
Hematuria or blood in the urine
Weak urine stream or feeling of incomplete emptying
An abdominal mass is usually seen in children
Tenderness at the costovertebral angle
Weakness or malaise
Fever from urinary tract infection
Decreased urine output
Causes of Hydronephrosis
Hydronephrosis is usually caused by intrinsic and extrinsic compression from another underlying illness. Problems with the kidneys, ureters, bladder, urethra, and structure along the urinary tract may cause hydronephrosis. These includes:
Urinary tract infection – Diseases that cause inflammation of the urinary tract can cause an interruption in the urine flow leading to hydronephrosis.
Kidney stone – A sudden development of obstruction anywhere in the urinary collecting system can cause an acute unilateral obstructive uropathy.
Cancer – Kidney, bladder, prostate, or ovarian cancer can cause hydronephrosis due to ureteral obstruction, tumor infiltration, or compression.
Benign prostatic hyperplasia (BPH) – Enlargement of the prostate gland can cause pressure on the urethra.
Urinary retention – Some individuals may have difficulty with emptying the bladder causing the retention and backing up of urine.
Blood clots – Renal vein thrombosis can occur due to trauma, tumors, dehydration, nephrotic syndrome, or chronic kidney disease which makes the body form blood clots easily.
Stricture of the urinary tract – Scarring of urinary tract tissue from injury or surgery may compromise the glomerular and tubular function causing narrowing and urinary blockage.
Nerve or muscle problems – Patients with diabetes mellitus can have this problem affecting the ureters and kidneys.
Vesicoureteral reflux – Urine flows back to the kidneys from the bladder, making it difficult for the kidney to empty, causing swelling.
Uterocele – Protrusion of the lower part of the ureter into the bladder
Maternal hydronephrosis – During pregnancy, mechanical compression of the ureters from the growing fetus and the effects of progesterone may have caused this.
Uterine prolapse – This is a condition where the uterus slips out of its anatomical position.
Cystocele – The bladder droops into the vagina when the wall in between weakens.
Risk Factors of Hydronephrosis
Women at 20-60 years old due to pregnancy and gynecologic malignancy
Men at 60 years old and up due to prostate disease and complication
Presence of kidney stones
Pregnancy
Diagnosis of Hydronephrosis
For the initial investigation, getting an overall assessment of the health status, medical and family history, urinary signs and symptoms, and pelvic and rectal examination will be done. The physician may also do the following test:
Basic metabolic panel – This test establishes the baseline renal function to determine the cause of hydronephrosis.
Urinalysis – Patients with renal colic, fever, nausea, abdominal pain, or decreased oral intake should be checked for urinary tract infections, hematuria, and kidney stones.
KUB Ultrasound – Used to evaluate patients with a history of frequent kidney stones and pregnant patients. This test can determine the extent of swelling and locate the area of the blockage.
Cystoscopy – This involves the use of a long tube with a camera to allow the physician a view of the bladder and urethra.
Intravenous pyelogram (IVP) – This is a specialized test that uses dye to outline anatomical parts of the urinary system while capturing images using a specialized x-ray.
Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan – This is a highly sensitive and specific test to evaluate causes of severe flank pain, external compression, and nephrolithiasis as the cause of symptoms.
Treatment for Hydronephrosis
Treatment of hydronephrosis usually depends on the cause and severity of kidney swelling and obstruction. The goal is to decrease the swelling and pressure from the urine backup and restore the flow of the urinary tract. This includes:
Medications. Patients with long-term hydronephrosis should be given antibiotics to reduce the risk of urinary tract infections. Analgesics may be used to relieve pain.
Catheter insertion. Draining the urine by inserting a tube relieves the pressure and obstruction in the lower urinary tract. After the pressure has been relieved, the cause may need to be treated.
Extracorporeal shock wave lithotripsy. High-energy shock waves emitted by a machine are used to break kidney stones in the renal pelvis into smaller fragments so they can pass out of the body and prevent further obstruction.
Ureteroscopy. This is the most commonly used method for stones in the lower half of the ureters and bladder. A thin instrument is placed in the urethra to break up and remove the stones. This can be used in combination with pulsed dye laser or electrohydraulic lithotripsy and is a method of choice for pregnant, obese, and patients with clotting disorders.
Stent placement. Cystoscopy-guided ureteral stent placement is used for intrinsic and extrinsic causes of hydronephrosis. Fluoroscopy-guided percutaneous nephrostomy tube placement is a less invasive procedure for patients with contraindications with the latter procedure.
Surgery. This treatment can be done endoscopically for patients with extrinsic compression from retroperitoneal tumors, aortic aneurysms, benign prostatic hyperplasia, etc. Scar tissue might be removed completely and reconnect the healthy ends to restore normal urine flow.
Chemotherapy or radiation therapy. These treatments may be used in combination to treat cancerous tissue causing hydronephrosis.
Prevention of Hydronephrosis
The following are measures to prevent hydronephrosis, especially in highly vulnerable patient groups:
Dietary changes to prevent recurrent stone formation
Having regular check-ups and follow-ups for patients with comorbidities
Nursing Diagnosis for Hydronephrosis
Hydronephrosis Nursing Care Plan 1
Excess Fluid Volume
Nursing Diagnosis: Excess Fluid Volume related to decreased kidney function secondary to Hydronephrosis as evidenced by reduced urine production, weight gain, adventitious breath sound, and bipedal edema.
Desired Outcomes:
- The patient will have adequate fluid volume, as shown by balanced intake and output.
- The patient will not exhibit any edema or unexpected weight gain symptoms.
- The patient will have clear breath sounds and a normal respiratory rate.
Hydronephrosis Nursing Interventions and Rationales
Weigh the client daily using the same weighing scale.Body weight daily is an excellent measure of hydration condition. A weight increase of more than 0.5 kg per day may indicate fluid retention.
Monitor and document the client’s intake and output at least every 4 hours. To determine an accurate fluid balance.
Monitor the client’s vital signs. Elevated heart rate, blood pressure, and respiratory rate can suggest fluid volume increases.
Auscultate lung sounds. Crackles are respiratory sounds that can indicate worsening pulmonary congestion.
Assess the client for edema. Pitting edema on the body, such as in the arms, hands, legs, and feet, indicates tissue fluid. A rapid weight increase may also suggest fluid retention. Ascites, or fluid buildup in the abdominal wall, can develop in patients with liver cirrhosis.
Enforce fluid restriction as directed. If a hydration restriction is recommended, the nurse should advise the client and their family on the importance of better adherence. Fluid restrictions keep the patient from drinking too much fluid. The volume of fluid allowed depends on the client’s weight, urine output, and response to treatment.
Hydronephrosis Nursing Care Plan 2
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to the inability to digest food secondary to Hydronephrosis as evidenced by digestive tract edema that interferes with absorption and protein deficiency.
Desired Outcomes:
- The patient will identify the factors that lead to being underweight or overweight.
- The patient will determine the proper nutritional needs/requirements.
- The patient will receive appropriate nutrition.
Nursing Interventions for Imbalanced Nutrition: Less Than Body Requirements
Perform a comprehensive nutrition screening. This will enable the nurse to determine the patient’s current nutritional condition and identify needs.
Evaluate the client’s laboratory results. Some test results may be abnormal when a client has an inadequate diet.
Determine the ideal body weight for the client’s age and height. Consult a nutritionist or dietician for a thorough nutrition assessment and nutritional support options. To promote adequate nutritional intake, a nutritionist or dietician can determine the patient’s daily requirements for certain nutrients.
Inform the client about the nutritional requirements of the body. This will allow the client to receive information on how to care for oneself after discharge independently.
Maintain proper oral hygiene and dentures. Proper Oral hygiene improves appetite and food flavor. Dentures must be clean, comfortable, and present in the patient’s mouth to encourage eating.
Propose five small nutrient-dense meals each day rather than three larger meals to prevent feelings of fullness. Eating small, frequent meals reduces the sensation of fullness and the tendency to vomit.
Hydronephrosis Nursing Care Plan 3
Fatigue
Nursing Diagnosis: Fatigue related to discomfort secondary to hydronephrosis as evidenced by tired legs, muscle weakness, and severe edema.
Desired Outcomes:
- The patient will express a reduction in fatigue.
- The patient will be able to perform daily tasks on their own.
- The patient will have sufficient energy levels to accomplish activities.
- The patient’s vital signs and laboratory results will remain stable as they connect to any possible underlying chronic diseases.
Nursing Interventions for Fatigue
Determine the severity of fatigue, weakness, edema, and restricted movement or activities in bed. Provides more information on fatigue and the tendency to remain prone without moving or changing position.
Plan activities carefully and monitor the client for behavioral changes thereafter. Increases endurance while avoiding tiredness; chronic condition, a steroid medication, and inactivity cause mood swings and irritation in the client.
During the most acute stage, maintain bed rest. When edema is severe, it prevents energy consumption.
Encourage the patient to keep a daily fatigue or activity record for at least one week. Understanding links between various activities and fatigue levels can help the patient identify wasteful energy outflow. The log could show the times of day when the person feels the least tired. This information can assist the patient in deciding how to schedule their activities to take advantage of periods of high energy.
Encourage adequate nutritional intake. To provide energy resources, the patient will require a balanced intake of fats, carbs, proteins, vitamins, and minerals.
Deficient Knowledge Nursing Care Plan 4
Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to inadequate exposure to disease information secondary to hydronephrosis as evidenced by verbally providing incorrect information about the condition/treatment.
Desired Outcomes:
- The client will verbally express his or her awareness of the illness’s causes and treatment.
- The patient will verbalize accurate information regarding his or her disease and therapy.
- The patient will recognize when to get assistance to learn new information.
Nursing Interventions for Deficient Knowledge
Assess disease awareness, recurrence signs and symptoms, food and exercise aspect of care, administering medication and side effects, urine and vital sign monitoring. Gives information about educational requirements for follow-up care.
Give information regarding the disease, its causes, and the necessity for frequent hospitalizations if the disease is chronic or relapsing with remissions and exacerbations. Promotes comprehension of the disease process and the need to adhere to therapy to avoid exacerbation.
Determine the amount of concern, the need for care support, and the possibility of a relapse. Anxiety impairs one’s ability to learn.
Educate on medication administration, particularly its reversible side effects and consequences when suddenly discontinued; to avoid complications, do not discontinue any medication gradually. Encourages adherence to correct medication administration and what to expect from pharmacological therapy.
Encourage clients to ask questions. The patient can participate in the learning process by asking questions. It indicates that the patient is paying attention to the topic and is eager to learn.
Risk for Infection Nursing Care Plan 5
Risk for Infection
Nursing Diagnosis: Risk for Infection related to inadequate primary defense secondary to hydronephrosis.
Desired Outcomes:
- The patient will be free of infection, as evidenced by normal vital signs and the absence of infection-related symptoms.
- The patient verbalizes comprehension of infection-prevention behavioral and hygiene measures.
- The patient verbalizes the recognition of infection symptoms that must be notified to a healthcare provider for immediate treatment.
Nursing Interventions for Risk for Infection
Check for fever, respiratory symptoms (dyspnea, productive cough with yellow sputum), urinary changes (cloudy, foul-smelling urine), and skin changes (tenderness, redness, swelling). Signifies an infectious process resulting from medication used to improve body defenses and reduce the risk of recurrence.
Enforce and promote medical aseptic techniques. When delivering care, use proper methods and handwashing. Encourages infection prevention methods.
Avoid contact with those who have active infections. Offers a better understanding of infection susceptibility.
Encourage the consumption of high-calorie, protein-rich foods.
When nutrition is adequate, the immune system is more responsive and effective.
When nutrition is adequate, the immune system is more responsive and effective.Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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