IT’S NOT HYDRONEPHROSIS - IT IS PSEUDOHYDRONEPHROSIS!

IT’S NOT HYDRONEPHROSIS - IT IS PSEUDOHYDRONEPHROSIS!

Bilateral hydronephrosis remains the sine qua non diagnostic criterion for clinically relevant obstructive uropathy. Therefore, renal ultrasound examination is often utilized for this non-invasive and easily available diagnostic step, without exposure to radiation. Conversely, pseudohydronephrosis, which is defined as renal imaging characteristics that mimic obstructive uropathy without obstructive pathology, has only been very scantily reported. To our knowledge, pseudohydronephrosis, very rarely reported, was first described in 1949. The misdiagnosis of true hydronephrosis in such scenarios raises the specter of unnecessary, expensive, invasive, and potentially dangerous investigations and procedures.

To our knowledge, pseudohydronephrosis, very rarely reported, was first described in 1949. The risk of unnecessary, expensive, invasive, and potentially dangerous investigations and procedures remain significant concerns. Clearly, the absence of hydroureters concurrent with the apparent appearance of bilateral hydronephrosis on the renal sonogram should have raised the possibility that what was observed and initially interpreted on renal sonogram as bilateral hydronephrosis may not be what it appeared to be. The treating physician must always consider other differential diagnoses of rising creatinine. Here, the absence of bilateral hydroureters, on imaging, was strongly indicative of some misinterpretation and this notion was confirmed with the contrast-enhanced CT examination. Kidney function improved following hydration and the withdrawal of Bactrim, Lisinopril, and Atorvastatin, without any other intervention. This was not a case of bilateral hydronephrosis. It was not obstructive uropathy – it was pseudohydronephrosis!