DISEASE PROCESS of HYDRONEPHROSIS

Hydronephrosis commonly results from an obstruction located at the junction of the ureter and
renal pelvis (ureteropelvic junction). Causes of this type of obstruction include the following:

• Structural abnormalities—for example, a birth defect in which the insertion of the

ureter into the renal pelvis is too high or there is inadequate development of the
ureteral muscles (congenital ureteropelvic junction obstruction)
• Kinking at the ureteropelvic junction resulting from a kidney shifting downward (ptosis
of the kidney)
• Stones (calculi) or a blood clot in the renal pelvis
• Compression of the ureter by bands of fibrous tissue, an abnormally located artery or
vein, or a tumor

Hydronephrosis can also result from an obstruction below the ureteropelvic junction or from
backflow (reflux) of urine from the bladder. Causes of this type of obstruction include the
following:

• Stones in the ureter

• Blood clot in the ureter
• Tumors in or near the ureter
• Narrowing of the ureter resulting from a birth defect, an injury, an infection, radiation
therapy, or surgery
• Disorders of the muscles or nerves in the ureter or bladder
• Formation of fibrous tissue in or around the ureter resulting from surgery, radiation
therapy, or drugs (especially methysergide Some Trade Names
SANSERT)
• Bulging of the lower end of the ureter into the bladder (ureterocele)
• Cancers of the bladder, cervix, uterus, prostate, or other pelvic organs
• Obstruction that prevents urine flow from the bladder to the urethra, resulting from
prostate enlargement (most often caused by a condition called benign prostatic
hyperplasia)
• Abnormal contractions of the bladder resulting from a birth defect or a spinal cord or
nerve injury

Hydronephrosis of both kidneys can occur during pregnancy as the enlarging uterus
compresses the ureters. Hormonal changes during pregnancy may aggravate the problem by
reducing the muscular contractions that normally move urine down the ureters. This condition,
commonly called hydronephrosis of pregnancy, usually ends when the pregnancy ends,
although the renal pelvis and ureters may remain somewhat distended afterward.