DAVAO DOCTORS COLLEGE, INC.

Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

HYDRONEPHROSIS
GROUP 1
ABDULHALIM, SHAHADA SACOR I.
AFINIDAD, JIEZL
ALBIA, DELCRIS
ALAJAR, MARY ANGELINE
ALGABRE, AILA
ALI, BAI
ALIMAN, MELLY
ARANA, RAIN
ARIZOBAL, LALAINE
BELACHO, MARIA CRISTINA
CABAÑERO, ROSE

DESCRIPTION

Hydronephrosis is a condition wherein there is a dilation of the kidney collecting

system (plumbing). The word “hydro” means “water” and the “nephro” means “kidney”.
This may involve either one or both of the kidneys. Normally, the urine will flow out of
the kidney with a low pressure. But if this pattern of flow is disrupted through dilation of
the kidney, it will increase pressure on the delicate internal structures of the central
urine collecting system, in result , damage will occur through the loss of function. This is
cause by the blockage that happens along the urinary system. This blockage will cause
the urine to become trapped causing the kidney to dilate.
Hydronephrosis is graded on a 0-4 scale. The grade depends on the amount of
dilation, number of calyces seen (small collecting cups within the kidney) and if the
kidney tissue is getting thin and how severe it is. This is seen by an ultrasound image.
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

Grade 1: Mild or dilation of the renal pelvis
(where urine collects and drains to the bladder) only.
Grade 2: Moderate dilatation of renal
pelvis. A few calyces.
Grade 3: Dilatation of the renal pelvis. All the calyces are dilated. Normal kidney tissue.
Grade 4: Dilatation of the renal pelvis. Can see all the calyces. Kidney tissue is thin.
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

ETIOLOGIC FACTORS

1.Predisposing Factors
Congenital anomalies of the kidney and urinary tract that can lead to hydronephrosis
include:
 Vesicourethral reflux
 Ureteropelvic junction obstruction
 Posterior urethral valves
 Prune belly syndrome
 Primary bladder neck obstruction

2.Precipitating Factors
• Renal calculi, kidney stones, ureteral stones, and bladder stones
• Prostate enlargement and prostate cancer
• Pelvic and retroperitoneal masses and tumors compressing renal structures (eg,
ovarian cysts, tuboovarian abscess, pelvic prolapse, retroperitoneal fibrosis,
endometriosis and abdominal malignancies)
• Pregnancy
• Trauma
• Pelvic radiation
• Strictures
• Neurogenic bladder
• Urinary tract infection
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

ASSESSMENT

 Presence of proteinuria (>3.5g/24hours)

 Hypoalbuminemia (>3.0g/dL)
 Peripheral edema
 Hyperlipidemia and thromobotic disease are seen.
 Urine contains fee cells or casts

Complications and can be seen:

 Hypothyroidism
 Anemia
 Coronary artery disease
 High blood pressure
 Acute kidney injury/ Sudden temporary loss of kidney function
 Loss of appetite
 Lethargy
 Edema can be present around eyes, and genitalia

SIGNS AND SYMPTOMS

• Pain in the side and back that may travel to the lower abdomen or groin
• Urinary problems, such as pain with urination or feeling an urgent or frequent
need to urinate
• Nausea and vomiting
• Fever
• Failure to thrive, in infants
• Blood in the urine
• Weakness or malaise
• Fever due to a urinary tract infection
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Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

• No major change in urine output although it may be decreased
DIAGNOSTIC FINDINGS
1. A blood test to evaluate kidney function and to check for infection.
2. A urine test to check for signs of infection or urinary stones that could cause a
blockage or to check for any infection and traces of blood.
3. An ultrasound imaging exam, during which your doctor can view the 8kidneys,
bladder and other urinary structures to identify potential problems and to identify any
blockages.
4. A specialized X-ray of the urinary tract that uses a special dye to outline the kidneys,
ureters, bladder and urethra, capturing images before and during urination
5. If necessary, your doctor may recommend additional imaging exams, such as a CT
scan or MRI. Another possibility is a test called a MAG3 scan that evaluates function
and drainage in the kidney.

MEDICAL MANAGEMENT
Treatment for hydronephrosis depends on the underlying cause. Although surgery is
sometimes needed, hydronephrosis often resolves on its own.

 Mild to moderate hydronephrosis. Your doctor may opt for a wait-and-see

approach to see if you get better on your own. Even so, your doctor may
recommend preventive antibiotic therapy to lower the risk of urinary tract
infections.
 Severe hydronephrosis. When hydronephrosis makes it hard for the kidney to
function — as can happen in more-severe hydronephrosis or in hydronephrosis
that involves reflux — surgery may be recommended to fix a blockage or correct
reflux.

Left untreated, severe hydronephrosis can lead to permanent kidney damage. Rarely, it
can cause kidney failure. But hydronephrosis typically affects only one kidney and the
other kidney can do the work for both.
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

If hydronephrosis is caused by stones in the kidneys or ureters, treatment options may
include:

• Shock wave lithotripsy

 This is the most common method for treating kidney stones. High-energy
shock waves are emitted by a machine outside to break up the stones into
dust or smaller fragments so they can pass out of the body.

• Ureteroscopy

 A thin tube with special instruments may be placed in the urethra to allow
a doctor to break up and remove the stones. This method is used most
often for stones in the bladder or lower half of the ureters. Ureteroscopy
may be used in combination with other techniques, such as a pulsed dye
laser or electrohydraulic lithotripsy, to break up stones. This is the method
of choice for pregnant women, patients with blood clotting disorders and
those who are morbidly obese.

• Surgery

 When kidney stones are very large or difficult to remove, they may have to
be removed surgically. Also, you might need surgery in the case of tumors
or other types of blockages.

NURSING MANAGEMENT
1.Impaired Sense of Comfort: Pain related to acute obstruction
 The patient looked relaxed
 The patient expressed pain
 Assess the level of pain
 Give an explanation of the cause of pain
 Teach relaxation and distraction
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

 Collaboration of analgesic

2. Impaired balance of fluid volume associated with fluid restriction

 Weigh every three days.
 Observation TTV
 Give trendelenberg position
 Monitor intake and output
 Diuresis-administration collaboration
 Check full blood lab / routine

3.Risk for infection:

 Wash your hands before and after the action
 Cover the wound with aseptic technique
 Monitor when there is inflammation
 Monitor TTV
 Collaboration of antibiotics
Reporting decrease symptoms of activity intolerance interventions:
 Assess the individual response to activity, pain, dyspnea, vertigo
 Increase activity gradually client

4.Weight loss in the range of normal intervention:

 Explain the importance of adequate nutrition.
 Give small portions but frequently
 Encourage clients to eat with family members
5. Activity intolerance interventions:
 Assess the individual response to activity, pain, dyspnea, vertigo
 Increase activity gradually client
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

RESEARCH/CLINICAL CASE STUDY

Hydronephrosis associated with ureteral metastasis of prostate

cancer: A rare case report

Authors: Dong Zhang, Hongliang Li, Weimin Gan

Published date: February 10, 2016

The ureter is a rare location of metastasis, irrespective of the primary cancer lesion . The
most common malignant tumors metastasizing to the ureter are breast cancer and stomach
cancer, whereas colon, cervix and rectum cancers also metastasize to the ureter with an
appreciable frequency. However, ureteral metastasis from prostate cancer is extremely rare.
The present case study reported such an incidence of a patient presenting hydronephrosis
secondary to ureteral metastasis of prostate cancer

A 63 year old man presented with asymptomatic right hydronephrosis,a dilated middle-
upper ureter secondary to thickening of the distal ureter and benign prostate hyperplasia was
detected through Computed Tomography Urography. Urine analysis shows negative for
hematuria, serum prostate specific antigen concentration was 111.400 ng/ml.Digital rectal exam
revealed enlarged and stony hard prostate gland.

Ureteroscopy was conducted to determine if the lesion of the distal ureter was transitional
cell carcinoma (TCC). Biopsy results were not obtained because the bladder wall and right
ureteral orifice were thick and stiff. Nephroureteroctomy was performed to remove the affected
area. In order to reduce the PSA levels of the patient, the following medications were
administered: combined androgen blockade therapy with bicalutamide (50 mg), and goserelin
(3.6 mg). Improved PSA levels were recorded after 3 to 6 months.

The case of ureteral metastasis of prostate cancer rarely occurs. The most common
reported symptom is flank pain due to ureteral obstruction. Ureteral metastasis from prostate
cancer is a result of direct invasion of prostate cancer, or compression by lymphadenopathy.
The case of the patient is related to direct invasion. Prostate cancer should be considered in
 DAVAO DOCTORS COLLEGE, INC.
Gen. Malvar St., Davao City 8000

Bachelor of Science in Nursing

differential diagnosis of elderly men with lesions in the ureter, for this can result to metastasis
and hydronephrosis.

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 DAVAO DOCTORS COLLEGE, INC.
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Bachelor of Science in Nursing

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