Hydronephrosis and Ureteral Obstruction in Crohn’s Disease

Abstract

Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnosis. Few reviews in the literature focus on this process and are limited to isolated case reports and case reviews. We performed a PubMed search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR “ureteral obstruction.” References from selected papers were reviewed for relevance and used for information-gathering as well. Ureteral obstruction most commonly occurs on the right side, due to ileal involvement. Clinical diagnosis is difficult, as symptoms are notably not genitourinary in origin; rather they are more musculoskeletal in nature. Treatment centers on disease control and temporary drainage of the affected kidney. Though rare, hydronephrosis and ureteral obstruction may develop as a result of inflammatory bowel disease. Due to atypical presenting symptoms, a high clinical suspicion is needed to affirm the diagnosis and ensure proper treatment.

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R. Jansen and S. Zaslau, "Hydronephrosis and Ureteral Obstruction in Crohn’s Disease," Open Journal of Urology, Vol. 3 No. 5, 2013, pp. 219-221. doi: 10.4236/oju.2013.35041.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. A. Hyams, S. R. Weinberg and J. L. Alley, “Chronic Ileitis with Concomitant Ureteritis,” The American Journal of Surgery, Vol. 61, No. 1, 1943, pp. 117-120. doi:10.1016/S0002-9610(43)90368-X
[2] P. Fleckenstein, L. Knudsen, E. B. Pedersen, H. Marcussen and S. Jarnum, “Obstructive Uropathy in Chronic Inflammatory Bowel Disease,” Scandinavian Journal of Gastroenterology, Vol. 12, No. 5, 1977, pp. 519-523. doi:10.3109/00365527709181328
[3] H. Ben-Ami, Y. Ginesin, D. M. Behar, D. Fischer, Y. Edoute and A. Lavy, “Diagnosis and Treatment of Urinary Tract Complications in Crohn’s Disease: An Experience over 15 Years,” Canadian Journal of Gastroenterology, Vol. 16, No. 4, 2002, pp. 225-229.
[4] P. F. Schofield, W. G. Staff and T. C. Moore, “Ureteral Involvement in Regional Ileitis (Crohn’s Disease),” Journal of Urology, Vol. 99, No. 4, 1968, pp. 412-416.
[5] F. Steigmann, “Urinary Tract Complications in Regional Enteritis,” The American Journal of Gastroenterology, Vol. 59, No. 5, 1973, pp. 389-396.
[6] S. Angelberger, K. G. Fink, W. Schima, et al., “Complications in Crohn’s Disease: Right-Sided Ureteric Stenosis and Hydronephrosis,” Inflammatory Bowel Diseases, Vol. 13, No. 8, 2007, pp. 1056-1057. doi:10.1002/ibd.20130
[7] D. H. Present, J. G. Rabinowitz, P. A. Banks and H. D. Janowitz, “Obstructive Hydronephrosis. A Frequent but Seldom Recognized Complication of Granulomatous Disease of the Bowel,” The New England Journal of Medicine, Vol. 280, No. 10, 1969, pp. 523-528. doi:10.1056/ NEJM196903062801002
[8] G. E. Block, W. E. Enker and J. B. Kirsner, “Significance and Treatment of Occult Obstructive Uropathy Complicating Crohn’s Disease,” Annals of Surgery, Vol. 178, No. 3, 1973, pp. 322-332. doi:10.1097/ 00000658-197309000-00012
[9] G. G. Kent, G. E. McGowan, J. S. Hyams and A. M. Leichtner, “Hypertension Associated with Unilateral Hydronephrosis as a Complication of Crohn’s Disease,” Journal of Pediatric Surgery, Vol. 22, No. 11, 1987, pp. 1049-1050. doi:10.1016/S0022-3468(87)80518-3
[10] A. Vecchioli, M. G. Brizi, A. De Franco, L. Natale and A. L. Valentini, “Hydroureteronephrosis in Crohn’s Disease,” Rays, Vol. 14, 1989, pp. 163-166.
[11] A. J. Megibow, M. A. Bosniak, M. A. Ambos and P. E. Redmond, “Case Report. Crohn’s Disease Causing Hydronephrosis,” Journal of Computer Assisted Tomography, Vol. 5, No. 6, 1981, pp. 909-911. doi:10.1097/00004728-198112000-00025
[12] R. A. Mooney and G. R. Sant, “Obstructive Uropathy in Granulomatous Bowel Disease,” British Journal of Surgery, Vol. 60, No. 7, 1973, pp. 525-527. doi:10.1002/bjs.1800600707
[13] R. Kutcher, A. Rosenbaum and N. H. Messinger, “Isolated Left Hydronephrosis Complicating Ileocaecal Granulomatous Disease,” British Journal of Radiology, Vol. 47, No. 560, 1974, pp. 490-492. doi:10.1259/ 0007-1285-47-560-490
[14] H. Ben-Ami, A. Lavy, D. M. Behar, Y. Ginesin, D. Fischer and Y. Edoute, “Left Hydronephrosis Caused by Crohn Disease Successfully Treated Conservatively,” The American Journal of the Medical Sciences, Vol. 320, No. 4, 2000, pp. 286-287. doi:10.1097/00000441-200010000-00011
[15] J. M. Siminovitch and V W. Fazio, “Ureteral Obstruction Secondary to Crohn’s Disease: A Need for Ureterolysis?” The American Journal of Surgery, Vol. 139, No. 1, 1980, pp. 95-98. doi:10.1016/0002-9610(80)90236-6

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