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It can also be caused by primary megaureter and posterior urethral valve (Figure 13). In the latter, both kidneys will be affected[[File:Ultrasonography of keyhole sign of lower urinary tract obstruction. In adults, hydronephrosis can be caused by urolithiasis, obstructing the outlet jpg|thumb|Ultrasound of the renal pelvis or the ureterurinary bladder, and compression of showing the ureter from, e"keyhole sign" indicating lower urinary tract obstruction.g., pregnancy The main "hole" corresponds to a distended urinary bladder (white arrow) and retroperitoneal fibrosisthe slit (black arrow) is a distended proximal urethra. Urolithiasis is the most common cause ]]In case of hydronephrosis in of both kidneys, look at the adult patient and has bladder since it may indicate a prevalence of 10%–15%lower urinary tract obstruction.<ref name="Hansen2015" />
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==Evaluation==
[[Hydronephrosis]] is seen as an anechoic fluid-filled interconnected space within the renal sinus.<ref name="Hansen2015" /> If it is not interconnected, consider parapelvic [[Ultrasonography_of_the_urinary_system#Cystic_renal_masses|renal cysts]]. Normally, the dilated pelvis can be differentiated from the dilated calyces.<ref name=Hansen2015/>
Look at both kidneys as well as the urinary bladder.
[[File:Ultrasonography of hydronephrosis due to ureteropelvic junction obstruction.jpg|thumb|Figure 13. Hydronephrosis due to ureteropelvic junction obstruction in a pediatric patient.<ref name="Hansen2015" />]]
===Causes===
Look particularly at the most distal end of dilation of the renal pelvis or ureter for a possible cause, including:
*Stone, which is the most common cause in adults.<ref name="Hansen2015" /> If found, see [[Ultrasonography of kidney stone disease]]
*Abscess<ref name="Hansen2015" />
*Tumor<ref name="Hansen2015" />
*Ectopic inserted ureter<ref name="Hansen2015" />
[[File:Ultrasonography of dilatation of the ureter due to vesicoureteric reflux.jpg|thumb|Figure 14. Bilateral dilatation of the ureters due to vesicoureteric reflux in a pediatric patient.<ref name="Hansen2015" />]]
