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Research Paper

Shelby Rhoda

An Ultrasound Case of Hydronephrosis

DMS 495

Spring 2016

CERTIFICATE OF AUTHORSHIP: I certify that I am the author of this research paper. I have

cited all of the sources from which I used data, ideas, or words (quoted or paraphrased). I also

certify that this paper was prepared by me specifically for this course.

Signature: Shelby Rhoda Date: 03/22/2016

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An Ultrasound Case of Hydronephrosis

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Abstract

Although hydronephrosis presents in various ways sonographically, ultrasound has proven to be

reliable in detecting it. This is a study on a case of hydronephrosis in a patient who was referred

to ultrasound due to known renal failure and elevated blood urea nitrogen (BUN) and creatinine.

The ultrasound revealed bilateral hydronephrosis and a markedly distended bladder. The

sonographer utilized gray-scale imaging as well as color Doppler imaging to evaluate the

kidneys as well at the bladder. Hydronephrosis can be a response to physiologic changes such as

renal failure or it can be a result of obstruction. In this particular case, the patients

hydronephrosis was a result of renal failure and bladder distension.

Keywords

Sonography, hydronephrosis, renal failure

Hydronephrosis is defined as dilatation of the renal pelvis and calyces of the kidneys.1

Ultrasound can be used to detect the grade of hydronephrosis as well as the cause such as

obstruction of the ureters. Hydronephrosis is a common complication of renal failure and can

often cause labs relevant to the kidneys, such as BUN and creatinine, to be abnormal.

Hydronephrosis shows a progressive separation of the sinus and eventually leading to the renal

calyces appearing dilated and blunted. Renal parenchyma can undergo thinning due to ischemic

compromise with chronic severe hydronephrosis. This is a case on bilateral hydronephrosis in a

patient in stage three renal failure who presented with elevated BUN and creatinine levels and a

urinary tract infection. Literature was used in this study to assess the relationship between
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bladder distension and hydronephrosis along with the relationship between chronic renal failure

and the progression of hydronephrosis.

Case Report

This patient is a 79 year old African American female with a medical history of hypertension,

diabetes mellitus, hyperlipidemia, and COPD. She was admitted to the hospital for chest pain

and was found to have a urinary tract infection (UTI). A renal ultrasound was ordered to evaluate

the kidneys and bladder due to elevated BUN and creatinine. It was also documented that the

patient is in stage three of renal failure. The ultrasound was performed using a GE Logic

ultrasound machine and a curvilinear probe was used at a frequency of 4.0 Megahertz. The renal

ultrasound revealed the right kidney measuring slightly smaller than the left kidney and this can

be attributed to the fact that the severity of the hydronephrosis in the left kidney was greater than

the right. The patient also had a Foley catheter inserted into the bladder and the bladder appeared

distended as seen in Figure 1. Color Doppler was utilized during this study to show that there

was no vascularity within the anechoic spaces seen in the renal pelvis proving that it was fluid

within the real pelvis as seen in Figure 2 and Figure 5. The kidneys in this patient showed the

bear-claw sign bilaterally which is a sonographic sign of moderate hydronephrosis which can

be seen in Figure 3 and Figure 4.1

Discussion

The cause of hydronephrosis can be from obstruction along the urinary tract or from pathologic

change in the body. This patients etiology of disease is said to be from pathologic cause due to

chronic renal failure and the current UTI because no obstruction was seen on ultrasound or

computed tomography (CT). A study that was done showed an incidence of 13.9 percent of
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patients with a distended bladder presented with mild or moderate hydronephrosis. However, in

the same study it was proven that there was no significant correlation between the degree of

hydronephrosis and the amount of bladder distention.2 The course of hydronephrosis consists of

four grades that allow physicians to determine the severity of the pathology. Grade one presents

sonographically as a small amount of fluid in the renal pelvis only. Grade two appears as fluid in

the renal pelvis and a few calices are visible. Grade three presents as all of the calices and the

renal pelvis are dilated. Grade four hydronephrosis presents sonographically as further dilatation

of the renal pelvis and thinning of the renal parenchyma.1 Treatment for hydronephrosis involves

draining the bladder via catheterization and treating the underlying cause. This patient was sent

home with the catheter inserted, was placed on antibiotics for the infection, and was

recommended to follow-up with the urologist. The prognosis of hydronephrosis depends on the

etiology of the disease. If the hydronephrosis is caused by obstruction, the obstructing object can

be removed and the urinary system will then be properly drained. With this patients disease

process of renal failure, the kidneys will not drain themselves on their own due to the

pathological changes to the function of the kidneys indicated by the elevated BUN and creatinine

levels. When renal function is impaired and an increase of protein metabolism will cause the

BUN to be elevated.3 Creatinine is a lab value used to assess renal function and the ability of the

kidney to get rid of waste. Creatinine elevates as a result of renal disease.4 This patients

prognosis is poor due to her end stage kidney failure and the bladder unable to empty itself. The

patient was recommended to be sent home on hospice care.

Conclusion

In conclusion, a 79 year old African American female presented to the hospital with chest pain

and was evaluated for having a UTI. An ultrasound was ordered to image the bladder and the
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kidneys for any indications due to her elevated BUN and creatinine. Due to ultrasound being a

noninvasive procedure, it is often the first method of choice used to evaluate patients suspected

of having an upper urinary tract obstruction.5 The ultrasound revealed bilateral hydronephrosis

and bladder distention that is likely due to the patients end stage renal failure. It is important for

sonographers to always try to follow the ureter from the pelvis of the kidney as far as they can to

the bladder to assess for any obstructing objects when hydronephrosis is visualized. Obstructing

hydronephrosis is a serious pathology that can be reversed after the detection with the help of

sonography.
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REFERENCES

1. Carol Rumack, Stephanie Wilson, J. Charboneau, Deborah Levine. Diagnostic

Ultrasound. Fourth edition. Philadelphia, PA: Mosby, Inc.; 2011.

2. Mann, Melanie J. Hydronephrosis Secondary to Bladder Distension: Myth or Reality?

JDMS; 2005. http://jdm.sagepub.com/content/6/2/87.full.pdf+html

3. Starratt, Edward S. Laboratory Values Associated with Renal Function and Disease

Processes. JDMS; 2006. http://jdm.sagepub.com/content/2/4/206.full.pdf+html

4. Curry, Reva. Tempkin, Betty. Sonography: Introduction to Normal Structure and

Function. Third edition. St. Louis, MO: Saunders; 2011.

5. Meacham, Randall B, Walsh, Richard A, Drose, Julia A. Limitations of Ultrasonography

in the Diagnosis of Upper Tract Urinary Infection. JDMS; 2007.

http://jdm.sagepub.com/content/11/6/320.full.pdf+html