Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis

Mark L Zeidel, MD
W Charles O'Neill, MD
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD


Obstruction to urinary flow may occur at any site in the urinary tract. Urinary tract obstruction (UTO) may be acute or chronic, partial or complete, and unilateral or bilateral. UTO is important to recognize since it is readily reversible if quickly corrected. If uncorrected, UTO may predispose to urinary tract infection (UTI) and urosepsis and eventually cause end-stage renal disease (ESRD).

This topic reviews the diagnosis of UTO and hydronephrosis in adults. Hydronephrosis in infants and children is discussed elsewhere. (See "Congenital ureteropelvic junction obstruction" and "Primary megaureter in infants and children" and "Clinical presentation and diagnosis of posterior urethral valves".)

UTI that occurs as a result of nephrolithiasis is also discussed elsewhere. (See "Diagnosis and acute management of suspected nephrolithiasis in adults".)


UTO is a common problem but a relatively rare cause of significant acute kidney injury (AKI). While there are no extensive published epidemiologic data, based upon our combined clinical experience, it is clear that the incidence of UTO varies considerably with the patient population. As an example, UTO is more common among children than among adults presenting with urinary tract symptoms or renal failure because of the contribution of congenital abnormalities. UTO is more common among men than women, particularly as men age, due to prostatic enlargement.

Overall, UTO is not a common cause of renal failure in adults, but the likelihood of UTO being discovered as an underlying etiology depends upon the clinical setting and the relative risks of other causes of renal failure. UTO is a rare cause of AKI in the hospital setting but is more common in the outpatient setting [1]. UTO is always an important cause of renal failure in patients with cancer.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Gottlieb RH, Weinberg EP, Rubens DJ, et al. Renal sonography: can it be used more selectively in the setting of an elevated serum creatinine level? Am J Kidney Dis 1997; 29:362.
  2. O'Neill WC. Atlas of renal ultrasonography, 1st ed., WB Saunders, Philadelphia 2000.
  3. Frokiaer J, Zeidel M. Urinary Tract Obstruction. In: Brenner and Rector's The Kidney, 9, Elsevier, New York 2011.
  4. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005; 365:417.
  5. Klahr S. Pathophysiology of obstructive nephropathy. Kidney Int 1983; 23:414.
  6. Hwang SJ, Haas M, Harris HW Jr, et al. Transport defects of rabbit medullary thick ascending limb cells in obstructive nephropathy. J Clin Invest 1993; 91:21.
  7. Weidmann P, Beretta-Piccoli C, Hirsch D, et al. Curable hypertension with unilateral hydronephrosis. Studies on the role of circulating renin. Ann Intern Med 1977; 87:437.
  8. Vaughan ED Jr, Bühler FR, Laragh JH. Normal renin secretion in hypertensive patients with primarily unilateral chronic hydronephrosis. J Urol 1974; 112:153.
  9. Maletz R, Berman D, Peelle K, Bernard D. Reflex anuria and uremia from unilateral ureteral obstruction. Am J Kidney Dis 1993; 22:870.
  10. Batlle DC, Arruda JA, Kurtzman NA. Hyperkalemic distal renal tubular acidosis associated with obstructive uropathy. N Engl J Med 1981; 304:373.
  11. Ellenbogen PH, Scheible FW, Talner LB, Leopold GR. Sensitivity of gray scale ultrasound in detecting urinary tract obstruction. AJR Am J Roentgenol 1978; 130:731.
  12. Kamholtz RG, Cronan JJ, Dorfman GS. Obstruction and the minimally dilated renal collecting system: US evaluation. Radiology 1989; 170:51.
  13. Tang Y, Yamashita Y, Namimoto T, et al. The value of MR urography that uses HASTE sequences to reveal urinary tract disorders. AJR Am J Roentgenol 1996; 167:1497.
  14. Sudah M, Vanninen RL, Partanen K, et al. Patients with acute flank pain: comparison of MR urography with unenhanced helical CT. Radiology 2002; 223:98.
  15. Regan F, Bohlman ME, Khazan R, et al. MR urography using HASTE imaging in the assessment of ureteric obstruction. AJR Am J Roentgenol 1996; 167:1115.
  16. Webb JA. Ultrasonography in the diagnosis of renal obstruction. BMJ 1990; 301:944.
  17. Rascoff JH, Golden RA, Spinowitz BS, Charytan C. Nondilated obstructive nephropathy. Arch Intern Med 1983; 143:696.
  18. Platt JF, Rubin JM, Ellis JH. Acute renal obstruction: evaluation with intrarenal duplex Doppler and conventional US. Radiology 1993; 186:685.
  19. Haddad MC, Sharif HS, Shahed MS, et al. Renal colic: diagnosis and outcome. Radiology 1992; 184:83.
  20. Morin ME, Baker DA. The influence of hydration and bladder distension on the sonographic diagnosis of hydronephrosis. J Clin Ultrasound 1979; 7:192.
  21. Mosli HA, Rawas MM, Farsi HM. Mannitol-induced diuretic renal ultrasonography: a new technique. Urology 1991; 38:267.
  22. Amis ES Jr, Cronan JJ, Pfister RC, Yoder IC. Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 1982; 19:101.
  23. Fried AM, Woodring JH, Thompson DJ. Hydronephrosis of pregnancy: a prospective sequential study of the course of dilatation. J Ultrasound Med 1983; 2:255.
  24. Peake SL, Roxburgh HB, Langlois SL. Ultrasonic assessment of hydronephrosis of pregnancy. Radiology 1983; 146:167.
  25. Gottlieb RH, Voci SL, Cholewinski SP, et al. Sonography: a useful tool to detect the mechanical causes of renal transplant dysfunction. J Clin Ultrasound 1999; 27:325.
  26. Amante AJ, Kahan BD. Technical complications of renal transplantation. Surg Clin North Am 1994; 74:1117.
  27. Ghasemian SM, Guleria AS, Khawand NY, Light JA. Diagnosis and management of the urologic complications of renal transplantation. Clin Transplant 1996; 10:218.
  28. Balchunas WR, Hill MC, Isikoff MB, Morillo G. The clinical significance of dilatation of the collecting system in the transplanted kidney. J Clin Ultrasound 1982; 10:221.
  29. Pozniak MA, Dodd GD 3rd, Kelcz F. Ultrasonographic evaluation of renal transplantation. Radiol Clin North Am 1992; 30:1053.
  30. O'neill WC, Baumgarten DA. Ultrasonography in renal transplantation. Am J Kidney Dis 2002; 39:663.
  31. Sacks SH, Aparicio SA, Bevan A, et al. Late renal failure due to prostatic outflow obstruction: a preventable disease. BMJ 1989; 298:156.
  32. Better OS, Arieff AI, Massry SG, et al. Studies on renal function after relief of complete unilateral ureteral obstruction of three months' duration in man. Am J Med 1973; 54:234.
  33. Bander SJ, Buerkert JE, Martin D, Klahr S. Long-term effects of 24-hr unilateral ureteral obstruction on renal function in the rat. Kidney Int 1985; 28:614.
  34. Chagnac A, Kiberd BA, Fariñas MC, et al. Outcome of the acute glomerular injury in proliferative lupus nephritis. J Clin Invest 1989; 84:922.
  35. Klahr S. New insights into the consequences and mechanisms of renal impairment in obstructive nephropathy. Am J Kidney Dis 1991; 18:689.
  36. Tanner GA, Knopp LC. Glomerular blood flow after single nephron obstruction in the rat kidney. Am J Physiol 1986; 250:F77.
  37. Klotman PE, Smith SR, Volpp BD, et al. Thromboxane synthetase inhibition improves function of hydronephrotic rat kidneys. Am J Physiol 1986; 250:F282.
  38. Gaudio KM, Siegel NJ, Hayslett JP, Kashgarian M. Renal perfusion and intratubular pressure during ureteral occlusion in the rat. Am J Physiol 1980; 238:F205.
  39. Michaelson G. Percutaneous puncture of the renal pelvis, intrapelvic pressure and the concentrating capacity of the kidney in hydronephrosis. Acta Med Scand Suppl 1974; 559:1.
  40. Tanner GA, Evan AP. Glomerular and proximal tubular morphology after single nephron obstruction. Kidney Int 1989; 36:1050.
  41. Muto S, Asano Y. Electrical properties of the rabbit cortical collecting duct from obstructed kidneys after unilateral ureteral obstruction. Effects of renal decapsulation. J Clin Invest 1994; 94:1846.
  42. Schreiner GF, Kohan DE. Regulation of renal transport processes and hemodynamics by macrophages and lymphocytes. Am J Physiol 1990; 258:F761.
  43. Ophascharoensuk V, Giachelli CM, Gordon K, et al. Obstructive uropathy in the mouse: role of osteopontin in interstitial fibrosis and apoptosis. Kidney Int 1999; 56:571.
  44. Moon JA, Kim HT, Cho IS, et al. IN-1130, a novel transforming growth factor-beta type I receptor kinase (ALK5) inhibitor, suppresses renal fibrosis in obstructive nephropathy. Kidney Int 2006; 70:1234.
  45. Shin GT, Kim WH, Yim H, et al. Effects of suppressing intrarenal angiotensinogen on renal transforming growth factor-beta1 expression in acute ureteral obstruction. Kidney Int 2005; 67:897.
  46. Green J, Vardy Y, Munichor M, Better OS. Extreme unilateral hydronephrosis with normal glomerular filtration rate: physiological studies in a case of obstructive uropathy. J Urol 1986; 136:361.
  47. Cohen EP, Sobrero M, Roxe DM, Levin ML. Reversibility of long-standing urinary tract obstruction requiring long-term dialysis. Arch Intern Med 1992; 152:177.
  48. Hwang SJ, Harris HW Jr, Otuechere G, et al. Transport defects of rabbit inner medullary collecting duct cells in obstructive nephropathy. Am J Physiol 1993; 264:F808.
  49. Murer L, Addabbo F, Carmosino M, et al. Selective decrease in urinary aquaporin 2 and increase in prostaglandin E2 excretion is associated with postobstructive polyuria in human congenital hydronephrosis. J Am Soc Nephrol 2004; 15:2705.