Can Dialysis Cause Hydronephrosis?
No, dialysis does not cause hydronephrosis—dialysis is a treatment used to manage complications that may arise from hydronephrosis-related kidney injury, not a cause of the condition itself. 1
Understanding the Relationship
Hydronephrosis represents urine-filled dilation of the renal pelvis and calyces, typically resulting from urinary obstruction or reflux—not from dialysis therapy. 1 The causes of hydronephrosis include urolithiasis, malignant obstruction, strictures, bladder outlet obstruction, retroperitoneal fibrosis, and congenital abnormalities. 1
When Dialysis and Hydronephrosis Intersect
Dialysis as Treatment for Hydronephrosis Complications
Dialysis may be required when bilateral hydronephrosis causes acute kidney injury with life-threatening complications including persistent hyperkalemia, severe metabolic acidosis, volume overload unresponsive to diuretics, or overt uremic symptoms. 1
Emergency hemodialysis becomes necessary when hydronephrosis leads to severe, therapy-resistant hyperkalemia, particularly in cases of kidney rupture (blowout) where reversed intraperitoneal dialysis can occur. 2
Hydronephrosis in Dialysis Patients
Patients already on chronic dialysis can develop hydronephrosis from the same causes as the general population—most commonly urolithiasis, with stones often composed of organic matrix and protein material in dialysis patients. 3
CT imaging is particularly valuable for diagnosing acute ureteral obstruction in dialysis patients with contracted kidneys, as these patients may present with acute flank pain and non-radiopaque stones that are difficult to visualize on plain radiography. 3
Hydronephrosis in end-stage renal disease patients on dialysis can result from ureteral strictures (such as from previous radiation injury), pyonephrosis, or stone disease, presenting with severe complications including sepsis. 4
Clinical Pitfalls to Avoid
Do not confuse the temporal association of dialysis with hydronephrosis as causation. When hydronephrosis occurs in dialysis patients, investigate the same etiologies as in non-dialysis patients: obstruction from stones, strictures, malignancy, or infection. 1, 4, 3
Recognize that dialysis preserves residual kidney function rather than causing urinary tract pathology. Strategies to maintain hemodynamic stability during hemodialysis, including avoidance of excessive ultrafiltration and hypotension, actually help preserve remaining renal function. 1