Bilateral hydronephrosis means that urine has accumulated within the drainage systems of both kidneys, causing them to become enlarged or swollen.

Normally, urine flows from each kidney through a ureter into the bladder and then leaves the body through the urethra. If urine cannot drain normally, pressure can build up above the blockage.

Hydronephrosis is therefore usually a sign of an underlying urinary drainage problem, rather than a disease by itself. The cause may be a blockage, abnormal urinary flow, reflux or another condition affecting the urinary tract.

When both kidneys are affected, identifying the cause promptly is particularly important because prolonged urinary obstruction can impair kidney function and, in severe cases, cause lasting kidney damage.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized assessment of kidney function and kidney-related complications associated with urinary obstruction and hydronephrosis.

Why Does Hydronephrosis Affect Both Kidneys?

Bilateral hydronephrosis generally occurs when urine drainage is obstructed at a location that affects both kidneys or when there are problems affecting both urinary drainage pathways.

Possible causes include:

• Bladder outlet obstruction

• Enlarged prostate in men

• Urethral narrowing or blockage

• Bladder dysfunction

• Stones affecting both sides

• Bilateral ureteric obstruction

• Pelvic or abdominal masses

• Certain cancers

• Scar tissue or ureteral narrowing

• Retroperitoneal fibrosis

• Congenital urinary tract abnormalities

• Vesicoureteral reflux in selected situations

An enlarged prostate can prevent the bladder from emptying properly, allowing urine to back up toward both kidneys. Tumors, stones and narrowed ureters can also interfere with normal urine drainage.

Is Bilateral Hydronephrosis Serious?

It can be serious, particularly when the obstruction is significant, persistent or associated with infection or declining kidney function.

Mild hydronephrosis may sometimes be monitored when the underlying cause is not causing significant obstruction or kidney damage.

However, untreated severe obstruction can lead to kidney damage. Ureteral obstruction may also increase the risk of urinary infections.

The severity of hydronephrosis on an ultrasound report should therefore not be interpreted in isolation. Kidney function, urine output, symptoms and the location and cause of obstruction are also important.

What Symptoms Can Bilateral Hydronephrosis Cause?

Some people with hydronephrosis have few or no symptoms, particularly when the condition develops gradually.

When symptoms occur, they may include:

• Pain in the side or back

• Lower abdominal discomfort

• Difficulty passing urine

• Frequent urination

• Urgent need to urinate

• Pain or burning during urination

• Blood in the urine

• Nausea or vomiting

• Fever

• Reduced urine output

Hydronephrosis symptoms vary according to the underlying cause and how quickly the obstruction develops.

Can Bilateral Hydronephrosis Cause Kidney Failure?

Severe or prolonged urinary obstruction can impair kidney function.

When urine cannot drain normally, pressure can build up within the urinary system. If the obstruction continues, kidney tissue may become damaged.

The risk is particularly important when:

• Both kidneys are obstructed

• Urine output is falling

• Creatinine is increasing

• Infection is present

• The obstruction is severe or prolonged

• The patient already has chronic kidney disease

Ureteral obstruction can cause kidney damage that may become irreversible if not appropriately treated.

This is why bilateral hydronephrosis accompanied by abnormal kidney-function tests requires timely medical evaluation.

What Causes Bilateral Hydronephrosis in Adults?

Enlarged Prostate

In older men, benign prostate enlargement can interfere with bladder emptying. Persistent urinary retention can cause urine to back up toward both kidneys.

Urinary Stones

Stones can obstruct one or both ureters. Bilateral obstruction is less common but can occur, particularly in patients with multiple or recurrent stones.

Urethral Stricture

Scar tissue can narrow the urethra and make it difficult for urine to leave the bladder.

Bladder Dysfunction

Neurological disorders, diabetes-related nerve damage and other conditions can interfere with bladder emptying.

Tumors or Pelvic Masses

Certain cancers or masses in the pelvis or abdomen can compress or invade the urinary tract and interfere with urine drainage.

Ureteral Narrowing

Previous surgery, radiation, inflammation or scarring can narrow a ureter.

Congenital Conditions

Some people are born with structural abnormalities that interfere with urinary drainage.

Bilateral Hydronephrosis in Children

Hydronephrosis can also occur in children and may sometimes be detected before birth or during childhood imaging.

Possible causes include:

• Ureteropelvic junction obstruction

• Vesicoureteral reflux

• Congenital urinary tract abnormalities

• Ureteral abnormalities

• Bladder outlet problems

The treatment depends on the child's age, severity, cause, kidney function and whether infections or other complications are occurring. Some mild cases may be monitored, while worsening or severe obstruction may require intervention.

Children with significant bilateral disease should be evaluated by an appropriate pediatric kidney and urinary-tract team.

How Is Bilateral Hydronephrosis Diagnosed?

Finding hydronephrosis on an ultrasound is usually only the beginning of the evaluation.

The doctor needs to determine why both kidneys are dilated and whether kidney function is being affected.

Ultrasound

Ultrasound can show:

• Enlargement of the kidney's collecting system

• Hydronephrosis severity

• Bladder abnormalities

• Some urinary stones

• Residual urine after bladder emptying

It is commonly used as an initial imaging examination.

Blood Tests

Blood testing may include:

• Serum creatinine

• eGFR

• Urea

• Sodium

• Potassium

• Bicarbonate

• Complete blood count when indicated

Creatinine and eGFR help determine whether obstruction is affecting kidney function.

Urine Tests

Urinalysis can help identify:

• Blood

• Infection

• Protein

• Other abnormalities

A urine culture may be recommended when infection is suspected.

CT or Other Imaging

Depending on the suspected cause, doctors may recommend CT imaging, CT urography, MRI or other specialized studies.

These tests can help identify stones, masses, narrowing and other causes of urinary obstruction.

Bladder Evaluation

When bladder outlet obstruction or incomplete emptying is suspected, the doctor may assess how much urine remains in the bladder after urination.

Further urological testing may be required depending on the findings.

What Is the Treatment for Bilateral Hydronephrosis?

There is no single medicine that treats bilateral hydronephrosis.

Treatment is directed toward restoring or improving urine drainage and correcting the condition responsible for the obstruction.

The approach depends on:

• Cause

• Severity

• Duration of obstruction

• Kidney function

• Infection status

• Urine output

• Patient's age and overall health

Temporary Urine Drainage

If the kidneys are significantly obstructed, immediate restoration of urine flow may be necessary.

Depending on the location and cause of obstruction, doctors may use:

Ureteral Stent

A ureteral stent is a thin tube placed inside the ureter to help urine pass from the kidney to the bladder.

It may be used when a ureter is blocked by a stone, narrowing or another condition.

Nephrostomy

A nephrostomy tube can drain urine directly from the kidney through the skin into an external collection system.

This may be considered when a ureteral stent cannot adequately relieve the obstruction or when rapid kidney drainage is required.

Urinary Catheter

If the problem is related to bladder outlet obstruction or urinary retention, a urinary catheter may help drain the bladder.

Mayo Clinic notes that treatment of hydronephrosis can involve urinary drainage procedures, medicines or surgery depending on the underlying cause.

Treating the Underlying Cause

After urine drainage is secured when necessary, definitive treatment focuses on the cause.

If Stones Are Responsible

Treatment may involve:

• Observation for selected small stones

• Ureteroscopy

• Laser stone fragmentation

• Shock wave lithotripsy in appropriate cases

• PCNL for selected larger renal stones

• Staged procedures when necessary

The treatment depends on stone size, location, obstruction, infection and kidney function.

If an Enlarged Prostate Is Responsible

Treatment may include medicines or a procedure to improve bladder emptying, depending on the severity of obstruction and the patient's overall condition.

If a Urethral Stricture Is Responsible

Depending on the location and severity, treatment may include dilation, urethrotomy or reconstructive surgery.

If a Tumor Is Responsible

Management requires evaluation by the appropriate urology and oncology specialists. Treatment depends on the type, location and stage of the disease.

If a Congenital Abnormality Is Responsible

Children or adults with structural urinary abnormalities may require observation or corrective surgery depending on the severity and effect on kidney function.

What If Bilateral Hydronephrosis Is Associated With Infection?

Hydronephrosis with urinary infection can become an urgent medical problem.

A blocked urinary system may prevent infected urine from draining properly.

Symptoms that should prompt urgent assessment include:

• Fever

• Chills

• Severe flank or abdominal pain

• Vomiting

• Reduced urine output

• Confusion

• Severe weakness

• Rapid deterioration

A kidney infection requires prompt medical attention, and when a urinary blockage is responsible, treating the infection may also require relieving the obstruction.

Antibiotics should be selected and adjusted by a healthcare professional based on the suspected organism, culture results, allergies, kidney function and severity of illness.

Can Bilateral Hydronephrosis Improve Without Surgery?

Sometimes.

If the obstruction is mild, temporary or reversible, hydronephrosis may improve after the underlying problem resolves.

However, significant bilateral obstruction should not simply be left untreated in the hope that it disappears.

Mild hydronephrosis may sometimes resolve on its own, but persistent obstruction may require medication, drainage or surgery depending on its cause.

The appropriate decision requires medical evaluation.

Can Drinking More Water Treat Hydronephrosis?

No.

Hydronephrosis occurs because urine is not draining normally.

Drinking excessive amounts of water does not physically remove a blockage caused by a stone, enlarged prostate, ureteral narrowing or mass.

If significant obstruction is present, excessive fluid intake may worsen discomfort or fluid accumulation in some patients.

Fluid intake should be individualized according to kidney function, urine output, heart health and the doctor's recommendations.

Does Bilateral Hydronephrosis Always Need Surgery?

No.

Treatment may involve observation, medication, bladder drainage, ureteral stenting, nephrostomy or definitive surgery depending on the cause.

For example, a temporary obstruction may resolve after appropriate treatment, whereas a persistent anatomical blockage may require a procedure.

The important objective is to ensure adequate urine drainage and protect kidney function.

What Happens to Creatinine in Bilateral Hydronephrosis?

Creatinine may increase if bilateral obstruction significantly reduces kidney filtration.

However, the creatinine level alone cannot determine how severe the obstruction is or whether kidney damage is permanent.

Doctors may compare:

• Current creatinine

• Previous creatinine

• eGFR

• Urine output

• Electrolytes

• Imaging findings

If obstruction is relieved promptly, kidney function may improve in some patients.

The extent of recovery depends on factors such as the severity and duration of obstruction and the patient's underlying kidney health.

Can Bilateral Hydronephrosis Cause Permanent Kidney Damage?

It can.

The longer significant obstruction persists, the greater the concern for kidney injury and potentially irreversible damage.

However, the degree of recovery varies considerably.

Early recognition and appropriate treatment can help reduce the risk of permanent loss of kidney function.

What Should You Do If an Ultrasound Shows Bilateral Hydronephrosis?

If an ultrasound report mentions bilateral hydronephrosis, do not focus only on the degree of swelling.

Ask the treating doctor about:

1. What is causing the obstruction?

2. Are both kidneys draining properly?

3. Is there a stone, prostate problem, ureteral narrowing or another blockage?

4. Is kidney function normal?

5. Is there evidence of infection?

6. Is urgent drainage necessary?

7. What additional imaging is required?

The answer to these questions determines the appropriate treatment pathway.

When Should You Seek Emergency Medical Care?

Seek urgent medical attention if bilateral hydronephrosis is associated with:

• Very little or no urine

• Fever or chills

• Severe flank or abdominal pain

• Persistent vomiting

• Confusion

• Severe weakness

• Difficulty passing urine

• Rapidly worsening swelling or breathlessness

• Sudden deterioration in general health

Severe pain with fever, vomiting or difficulty passing urine can indicate a significant urinary obstruction or infection requiring prompt assessment.

Bilateral Hydronephrosis and Kidney Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized kidney evaluation for patients with hydronephrosis and impaired kidney function.

Depending on the clinical situation, assessment may include:

• Review of ultrasound and CT reports

• Creatinine and eGFR assessment

• Electrolyte evaluation

• Urine testing and infection assessment

• Evaluation of reduced urine output

• Assessment of obstructive kidney injury

• Monitoring kidney-function recovery after obstruction is relieved

• Management of associated chronic kidney disease

• Dialysis-related evaluation when severe kidney dysfunction is present

• Coordination with urology when a procedure or surgical treatment is required

Because hydronephrosis is usually caused by a urinary drainage problem, appropriate urological evaluation and nephrology care may both be important, particularly when kidney function has been affected.

Frequently Asked Questions

What is the best treatment for bilateral hydronephrosis?

There is no single best treatment for every patient. Treatment depends on the cause, severity, kidney function, infection status and location of the obstruction. Options may include observation, medicines, bladder drainage, ureteral stenting, nephrostomy or surgery.

Is bilateral hydronephrosis dangerous?

It can be serious if both kidneys are significantly obstructed, particularly when kidney function is declining or infection is present. Prolonged obstruction can cause kidney damage.

Can bilateral hydronephrosis cause high creatinine?

Yes. Significant obstruction affecting both kidneys can reduce kidney filtration and cause creatinine to rise.

Can hydronephrosis be cured?

Hydronephrosis itself is usually managed by treating its underlying cause and restoring appropriate urine drainage. Some cases resolve after the obstruction is corrected.

Does bilateral hydronephrosis mean kidney failure?

No. Hydronephrosis does not automatically mean kidney failure. Kidney function needs to be assessed using blood tests, urine output and the clinical situation.

Can kidney stones cause bilateral hydronephrosis?

Yes. Stones can obstruct urinary drainage, although simultaneous obstruction of both sides is less common. Multiple stones or stones affecting important drainage points can produce significant obstruction.

Can an enlarged prostate cause hydronephrosis in both kidneys?

Yes. Severe bladder outlet obstruction from prostate enlargement can prevent proper bladder emptying and cause urine to back up toward both kidneys.

Is surgery always required for bilateral hydronephrosis?

No. The treatment may be observation, medication or a drainage procedure rather than surgery. However, significant or persistent obstruction may require intervention to protect kidney function.

Can bilateral hydronephrosis improve after treatment?

Yes. Kidney drainage may improve after the obstruction is relieved or the underlying condition is treated. The degree of kidney recovery depends on the cause, severity and duration of obstruction.

Conclusion

Bilateral hydronephrosis treatment begins with finding out why urine is not draining normally from both kidneys. Stones, prostate enlargement, ureteral narrowing, bladder dysfunction, tumors, congenital abnormalities and other urinary conditions can produce this finding.

The condition should not be treated simply by trying to increase water intake. Doctors may use blood and urine tests, ultrasound, CT or other investigations to identify the obstruction and determine whether kidney function is affected.

Treatment can range from observation in selected mild cases to bladder drainage, ureteral stenting, nephrostomy or definitive treatment of the underlying blockage. When infection, very low urine output or worsening kidney function occurs, prompt medical assessment is especially important.

For individualized assessment of bilateral hydronephrosis, kidney-function changes and associated complications, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and is not a substitute for professional medical diagnosis, treatment or individualized medical advice. Bilateral hydronephrosis can have different causes, and the appropriate treatment depends on the location and severity of obstruction, infection status, kidney function, urine output and the patient's overall health. Do not attempt to treat urinary obstruction by drinking excessive amounts of water or taking unprescribed medicines. Do not delay medical evaluation if an imaging report shows significant bilateral hydronephrosis. Seek urgent medical attention for fever or chills with urinary obstruction, very little or no urine, severe pain, persistent vomiting, confusion, difficulty passing urine or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist and, when appropriate, a urologist for individualized care.