Nickan Research Institute Journal of Renal Endocrinology 2423-6438 10 1 2024 01 01 No; it’s not hydronephrosis - it is pseudohydronephrosis! e25145 e25145 10.34172/jre.2024.25145 EN Macaulay Amechi Chukwukadibia Onuigbo https://orcid.org/0000-0002-2601-5791 Journal Article 10.34172/jre.2024.25145 2023 11 16 2024 01 05 Bilateral hydronephrosis usually implies the presence of clinically relevant obstructive uropathy and renal ultrasound is often utilized for this non-invasive and easily available diagnostic step. On the other hand, pseudohydronephrosis, defined as renal imaging characteristics that mimic obstructive uropathy without obstructive pathology, has only been very scantily reported. Pseudohydronephrosis 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. We describe herein bilateral renal cysts mimicking bilateral hydronephrosis. Physician caution is warranted.