Hydronephrosis: The Daily PANCE Blueprint

The answer is D. Renal Ultrasound

Hydronephrosis is defined by dilatation/distension of the renal collecting system due to some sort of obstruction of urine outflow in the ureter, bladder, or urethra. Usually, patients are asymptomatic, but they may complain of urinary urgency, hematuria, or changes in urine output. Labs may show increased serum creatinine, hematuria, pyuria, and hyperkalemia. The best initial test is a renal US to exclude or diagnose any obstruction of the urinary tract. Management depends on what the cause is and how severe the condition is (i.e., AKI, urosepsis, metabolic derangements, etc.). For example, if bladder dysfunction or the lower urinary tract is the issue, a urinary catheter can be placed. If the patient has an upper urinary tract obstruction, then a ureteral stent could be placed. Other causes (e.g., BPH, kidney stones, prolapse, cancer, etc) are dealt with separately / differently. Antibiotics should be started if the patient has a concurrent UTI.