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Dr. Andrew Rynne

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Suggest treatment for hydronephrosis

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Dr. Albana Sejdini

General & Family Physician

Practicing since :2006

Answered : 5469 Questions

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Posted on Thu, 10 Sep 2015 in Elderly Problems
Question: My father (71) entered the hospital because he was feeling poorly on July 19. He was quickly diagnosed with acute renal failure, stemming from a grossly enlarged prostrate, a full bladder, and resultant pressure on kidneys. He was suffering from bilateral hydronephrosis. He treated there for several days and began dialysis and was given a foley catheter. He felt dramatically better. He was sent to a Long Term Acute Care facility to see if his kidneys would come back. Within days, he had spiked a fever of 103-104. The facility could not get it down so he was sent back to hospital and, subsequently, ICU. They got temp down after a few days, but his cognitive abilities declined dramatically and he was shaking all the time. They figured it was a metabolic encephalopathy and was related to toxins from medication in his body and that he would get better as dialysis and nutrition improved. Four days later he could not talk and was rigid and his cognitive abilities were sparse, at best. We had him transferred to a better hospital's ICU. That was on August 6. Within a few days, he became nealry comatose and seemed unable to recognize anyone or respond to anything. On August 10, he began to talk very minimally. The next day he was talking more and more. Each day he seems to improve a little bit. I do not believe that anyone has figured out the source of his problem or how much more he will improve, but we are happy he is improving. That said, the doctors told me that he was going to have an ultrasound tomorrow. One of the reasons was to look at his kidneys, again. The nurse told me that his hydronephrosis was worse on August 9 than the prior scan so they want to see if the kidneys are better, worse, or the same. I apologize for the long winded question, but how on Earth can his kidneys have been more swollen on August 9 after many rounds of dialysis than they were when he initially went to the hospital unable to pass urine and before ever undergoing dialysis in his life? It does not make sense. If you have any thoughts on the rest of the course of his treament, that would be great, too.
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Answered by Dr. Albana Sejdini 3 hours later
Brief Answer:
Detailed below. ..

Detailed Answer:
Hi,

I am sorry for the health situation your father is in. I am also happy about his improvement.

Hydronephrosis is referred to the swelling of kidneys due to accumulation of urine.
There are many factors causing blockage of urine. In your father's case, it is due to enlarged prostate that is not allowing a full emptying of blader thus urine is getting back and blocked in the kidneys.

The treatment consists of treating the cause of blockage.
In your father's case, you have treated infection and clearing his body from wastes through dialysis. However, so far you do not mention any treatment for his enlarged prostate which is the main cause to his hydronephrosis.
This explains why his kidneys keep swelling due to incomplete emptying.
And this can be checked by ultrasound.
The final treatment is reducing the size of his prostate.
Hope it answered to your question.
Dr.Albana
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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