Managing Bilateral Hydronephrosis: Insights on Treatment and Kidney Function

Bilateral hydronephrosis

Hello Doctor: Due to endometriosis causing ureteral stricture and hydronephrosis, I have had three double-J stents placed in my right kidney over the past four years, with no significant improvement and persistent hydronephrosis.
Recent examinations revealed extremely low renal function in the right kidney.
This year, the left side also developed hydronephrosis due to ureteral stricture from endometriosis, and I underwent ureteral reconstruction surgery in early May.
Currently, an ultrasound of the left kidney shows no signs of hydronephrosis, but my creatinine has risen to 1.24 (GFR = 53.62).
I would like to ask: 1.
Given the extremely low function of the right kidney, will it need to be removed in the future? The attending physician mentioned this before the May surgery, but I did not address it at that time.
2.
Is the current absence of hydronephrosis in the left kidney affecting the creatinine and GFR levels due to the right kidney's condition? 3.
After the surgery, the doctor prescribed antibiotics (Sulfamethoxazole/Trimethoprim) 250 mg for 14 days.
During the medication period, I experienced skin itching, and even after completing the medication, I still have mild itching.
Is this a side effect of the medication or a symptom of chronic kidney disease? 4.
If the left kidney develops hydronephrosis again in the future, will I need to face dialysis or a kidney transplant?

Guo Xiaojie, 30~39 year old female. Ask Date: 2016/07/14

Dr. Wu Hongjie reply Internal Medicine

Dear Friend,
1.
The decision regarding the first issue depends on the circumstances.
In principle, severely reduced kidney function is not an indication for nephrectomy unless there are recurrent, persistent infections that have led to abscess formation, or the presence of malignancy, in which case nephrectomy may be necessary.
Further discussion with a urologist is advised.
2.
Based on your description, the elevated creatinine (CRE) and glomerular filtration rate (GFR) may initially be attributed to the right kidney's condition.
If the right kidney's function has deteriorated to a significant extent, the left kidney may need to compensate by taking on additional workload, potentially leading to compensatory hypertrophy of the left kidney.
Over time, this compensation may result in a decline in the function of the left kidney as well.
Therefore, your situation may have initially involved the right kidney deteriorating, causing the rise in CRE.
3.
Pruritus associated with chronic kidney disease typically occurs in stages 3 and above (eGFR < 60).
Therefore, a CRE of 1.4 is unlikely to be associated with uremic pruritus.
You may consider trying antipruritic medications or topical ointments and discontinuing any potentially offending medications.
4.
Bilateral hydronephrosis due to endometriosis requires addressing the obstruction as a priority.
It is advisable to seek assistance from urology and obstetrics/gynecology or a specialized women's urology clinic.
In addition to relieving the obstruction, it is important to manage the recurrence of endometriosis.
If both kidneys are hydronephrotic and not promptly relieved, it will ultimately lead to deterioration of kidney function.
Any chronic kidney disease (defined as abnormal CRE for more than three months) may present with uremic symptoms (in diabetic patients, CRE is typically > 6.0, while in non-diabetic patients, it may exceed 10.0 before symptoms appear), at which point dialysis treatment may need to be considered.
Thank you for your inquiry, and I wish you health and safety.
Sincerely,
Taoyuan Hospital

Reply Date: 2016/07/14

More Info

Managing bilateral hydronephrosis, especially when associated with conditions like endometriosis causing ureteral strictures, can be quite complex. Your situation involves multiple factors, including previous interventions, current kidney function, and potential future complications. Let’s address your questions one by one.

1. Right Kidney Function and Possible Nephrectomy: Given that your right kidney has extremely low function, the decision to remove it (nephrectomy) should be carefully considered. If the kidney is non-functional and contributing to systemic issues, such as hypertension or recurrent infections, nephrectomy may be warranted. However, if the kidney is still producing some urine and not causing significant problems, your physician might recommend monitoring it instead. The decision should involve a thorough discussion with your nephrologist, weighing the risks and benefits of surgery versus conservative management.

2. Impact of Right Kidney on Left Kidney Function: It is possible that the right kidney's poor function is affecting your overall renal function, reflected in the elevated creatinine (CRE) and decreased glomerular filtration rate (GFR) of the left kidney. The kidneys work in tandem, and if one is compromised, it can place additional strain on the other. However, since you have had surgery on the left kidney and it is currently not hydronephrotic, it should ideally improve its function over time. Continuous monitoring of kidney function will be essential.

3. Skin Itching and Medication Side Effects: The itching you are experiencing could be related to several factors. While it can be a side effect of medications like antibiotics, it can also be a symptom of chronic kidney disease (CKD). CKD can lead to skin changes and itching due to the accumulation of waste products in the body. If the itching persists, it would be prudent to discuss this with your healthcare provider. They may consider adjusting your medications or exploring other causes of your symptoms.

4. Future Risk of Hydronephrosis and Dialysis: If your left kidney develops hydronephrosis again, it could indicate a recurrence of the underlying issue, such as ureteral stricture or obstruction. In such cases, further interventions may be necessary to relieve the obstruction. As for dialysis or kidney transplantation, these are typically considered when kidney function declines to a critical level (usually when GFR falls below 15 mL/min). Continuous monitoring of your kidney function will help determine if and when these options might become necessary.

In summary, managing bilateral hydronephrosis, especially with underlying conditions like endometriosis, requires a multidisciplinary approach. Regular follow-ups with your nephrologist and possibly a urologist are crucial to monitor kidney function and address any complications promptly. Lifestyle modifications, such as maintaining hydration and managing blood pressure, are also important. Always communicate openly with your healthcare team about any new symptoms or concerns, as early intervention can significantly impact outcomes.

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