Impact of Hydronephrosis on CT Scan on Blood Pressure and Serum Creatinine in Patients by Age and Sex
DOI:
https://doi.org/10.54832/phj.v8i2.1594Keywords:
hydronephrosis, CT scan, serum creatinine, blood pressure, laterality, radiological gradeAbstract
Background: Hydronephrosis may impair renal function and contribute to hypertension, particularly when obstruction is severe or bilateral. This study evaluated the associations of hydronephrosis severity and laterality with serum creatinine and blood pressure among adults.
Methods: A retrospective analytic observational study was conducted using medical records of 87 adults with hydronephrosis who underwent abdominal computed tomography at Royal Prima Medan Hospital, North Sumatra, Indonesia. Hydronephrosis was classified from Grade 1 to Grade 4, and obstruction was categorized as unilateral or bilateral. Multiple linear regression models assessed independent predictors of serum creatinine, systolic blood pressure, and diastolic blood pressure after adjustment for age and sex.
Results: The mean participant age was 53.2 ± 14.8 years. Bilateral hydronephrosis was present in 29.9% of participants, while Grade 4 hydronephrosis occurred in 21.8%. Bilateral obstruction was independently associated with higher serum creatinine (B = 1.280 mg/dL; p < 0.001), systolic blood pressure (B = 6.850 mmHg; p = 0.021), and diastolic blood pressure (B = 4.120 mmHg; p = 0.038). Grade 4 hydronephrosis was also associated with increased serum creatinine (B = 1.911 mg/dL; p < 0.001), systolic blood pressure (B = 16.820 mmHg; p < 0.001), and diastolic blood pressure (B = 8.940 mmHg; p = 0.004). Age independently predicted systolic blood pressure (B = 0.521 mmHg/year; p < 0.001).
Conclusion: Bilateral obstruction and severe hydronephrosis were important independent predictors of renal dysfunction and elevated blood pressure. These patients may benefit from closer renal-function and blood-pressure monitoring and timely urological assessment.
Downloads
References
Al-Mashhadi, A., Häggman, M., Läckgren, G., Ladjevardi, S., Nevéus, T., Stenberg, A., Persson, A. E. G., & Carlström, M. (2018). Changes of arterial pressure following relief of obstruction in adults with hydronephrosis. Upsala Journal of Medical Sciences, 123(4), 216–224. https://doi.org/10.1080/03009734.2018.1521890
Carlström, M. (2019). Hydronephrosis and risk of later development of hypertension. Acta Paediatrica, 108(1), 50–57. https://doi.org/10.1111/apa.14482
Chávez-Iñiguez, J. S., Navarro-Gallardo, G. J., Medina-González, R., Alcantar-Vallin, L., & García-García, G. (2020). Acute Kidney Injury Caused by Obstructive Nephropathy. International Journal of Nephrology, 2020, 1–10. https://doi.org/10.1155/2020/8846622
Chen, S., Wang, H., Wu, Y., Li, Z., Huang, Y., He, Y., Xu, Y., Li, X., & Guan, H. (2024). Etiological analysis of hydronephrosis in adults: A single-center cross-sectional study. Journal of Peking University (Health Sciences), 56(5), 913–918. https://doi.org/10.19723/j.issn.1671-167X.2024.05.025
Crowley, S. D., Navar, L. G., Prieto, M. C., Gurley, S. B., & Coffman, T. M. (2024). Kidney Renin–Angiotensin System: Lost in a RAS Cascade. Hypertension, 81(4), 682–686. https://doi.org/10.1161/HYPERTENSIONAHA.123.21367
Demiroğlu, Ç., & Solakhan, M. (2026). Hydronephrosis in pregnancy: Critical factors determining urinary catheter use. Obstetric Medicine, 19(1), 40–45. https://doi.org/10.1177/1753495X251332667
Giacona, J. M., & Vongpatanasin, W. (2026). The 2025 AHA/ACC Hypertension Guidelines: Key Updates, Historical Context, and Clinical Implications. Current Cardiology Reports, 28(1), 90. https://doi.org/10.1007/s11886-026-02413-0
Gillams, K., Juliebø-Jones, P., Juliebø, S. Ø., & Somani, B. K. (2021). Gender Differences in Kidney Stone Disease (KSD): Findings from a Systematic Review. Current Urology Reports, 22(10), 50. https://doi.org/10.1007/s11934-021-01066-6
Gulati, M., Moore, M. M., & Cibotti-Sun, M. (2025). 2025 High Blood Pressure Guideline-at-a-Glance. JACC, 86(18), 1560–1566. https://doi.org/10.1016/j.jacc.2025.07.010
Iqbal, S., Raiz, I., & Faiz, I. (2017). Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder. Malaysian Journal of Medical Sciences, 24(2), 106–115. https://doi.org/10.21315/mjms2017.24.2.14
Jay, A. P., & Nicol, D. L. (2017). The Pathophysiology of Upper Tract Obstruction. In Ureteric Stenting (pp. 16–28). Wiley. https://doi.org/10.1002/9781119085713.ch3
Khater, Y., Barakat, N., Shokeir, A., Samy, A., & Karrouf, G. (2025). Renal fibrosis progression following partial unilateral ureteral obstruction: mechanisms and therapeutic insights. World Journal of Urology, 43(1), 229. https://doi.org/10.1007/s00345-025-05580-x
Leo, M., Langlois, B., Pare, J., Mitchell, P., Linden, J., Nelson, K., Amanti, C., & Carmody, K. (2017). Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic. Western Journal of Emergency Medicine, 18(4), 559–568. https://doi.org/10.5811/westjem.2017.04.33119
Nørregaard, R., Mutsaers, H. A. M., Frøkiær, J., & Kwon, T.-H. (2023). Obstructive nephropathy and molecular pathophysiology of renal interstitial fibrosis. Physiological Reviews, 103(4), 2847–2892. https://doi.org/10.1152/physrev.00027.2022
Onen, A. (2020). Grading of Hydronephrosis: An Ongoing Challenge. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.00458
Ou, S.-H., Wu, L.-Y., Chen, H.-Y., Huang, C.-W., Hsu, C.-Y., Chen, C.-L., Chou, K.-J., Fang, H.-C., & Lee, P.-T. (2020). Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy. International Journal of Environmental Research and Public Health, 17(19), 7260. https://doi.org/10.3390/ijerph17197260
Özsoy, M., Somani, B., Seitz, C., Veser, J., & Kallidonis, P. (2019). Sex differences in the therapy of kidney and ureteral stones. Current Opinion in Urology, 29(3), 261–266. https://doi.org/10.1097/MOU.0000000000000604
Patel, K., & Batura, D. (2020). An overview of hydronephrosis in adults. British Journal of Hospital Medicine, 81(1), 1–8. https://doi.org/10.12968/hmed.2019.0274
Pérez-Aizpurua, X., Benavente, R. C., Serrano, G. B., Peral, J. M. A., Mañas, B. G.-J., Jaumot, J. T. i, Blanco, J. R. de C., Ospina, F. O., & Gonzalez-Enguita, C. (2024). Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury. World Journal of Nephrology, 13(2). https://doi.org/10.5527/wjn.v13.i2.93322
Rashid, U., Marra, E. M., & Tran, V. H. (2021). Bilateral Ureteral Obstruction Causing Acute Kidney Injury and Resultant Metformin Toxicity. Cureus. https://doi.org/10.7759/cureus.19635
Thotakura, R., & Anjum, F. (2023). Hydronephrosis and Hydroureter. StatPearls Publishing.
Tian, Q., Zhang, C., Zhao, X., Yu, K., Fang, E., Zhou, X., Niu, Y., & Li, N. (2025). Potential impact of severe hydronephrosis secondary to ureteropelvic junction obstruction on pediatric blood pressure. Journal of Pediatric Urology, 21(1), 108–114. https://doi.org/10.1016/j.jpurol.2024.10.014
Turgut, F., Awad, A., & Abdel-Rahman, E. (2023). Acute Kidney Injury: Medical Causes and Pathogenesis. Journal of Clinical Medicine, 12(1), 375. https://doi.org/10.3390/jcm12010375
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https:doi.org/10.1016/S0140-6736(07)61602-X
Wang, K., Liao, Q., & Chen, X. (2023). Research progress on the mechanism of renal interstitial fibrosis in obstructive nephropathy. Heliyon, 9(8), e18723. https://doi.org/10.1016/j.heliyon.2023.e18723
Yaxley, J., & Yaxley, W. (2023). Obstructive uropathy – acute and chronic medical management. World Journal of Nephrology, 12(1), 1–9. https://doi.org/10.5527/wjn.v12.i1.1
