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Hydronephrosis

**{{{Name|Hydronephrosis}}}**
[[Image:{{{Image}}}\|190px\|center\|]] {{{Caption\|}}}
ICD-10	N13.0-N13.3
ICD-O:	{{{ICDO}}}
ICD-9	591
OMIM	}}}
MedlinePlus	}}}
eMedicine	}}}
DiseasesDB	}}}

Hydronephrosis is distention and dilationof the renal pelvis, usually caused by obstructionof the free flow of urinefrom the kidney.

Inhaltsverzeichnis

1 Signs and symptoms
2 Etiology
3 Tests
4 Complications
5 Treatment
6 See also

Signs and symptoms

The signs and symptoms of hydronephrosis depends upon whether the obstruction is acute or chronic. Unilateralhydronephrosis may even occur without symptoms.

Blood tests can show elevated creatinineand electrolyteimbalance. Urinalysismay show an elevated pH due to the secondarydestruction of nephronswithin the affected kidney.

Symptoms that occur regardless of where the obstruction lies include loinor flankpain. An enlargedkidneymay be palpableon examination.

Where to obstruction occurs in the lower urinary tract, suprapubic tenderness (with or without a history of bladder outflow obstruction) along with a palpablebladderare strongly suggestive of acuteurinaryretention, which left untreated is highly likely to cause hydronephrosis.

Upper urinary tract obstruction is characterised by pain in the flank, often radiating to either the abdomenor the groin. Where the obstruction is chronicrenal failuremay also be present. If the obstruction is complete, an enlarged kidney is often palpableon examination.

Etiology

The obstruction may be either partial or complete and can occur anywhere from the urethralmeatusto the calycesof the renal pelvis.

The obstruction may arise from either inside or outside the urinary tractor may come from the wall of the urinary tract itself. Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder. Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurologicaldefecits. Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urnary tract.

Tests

Blood (U&E, creatinine) and urine (MSU, pH) tests should be taken. IVUs, ultrasounds, CTs and MRIs are also important tests. Ultrasound allows for visualisation of the ureters and kidneys and can be used to assess the presence of hydronephrosis and/or hydroureter. An IVU is useful for assessing the position of the obstruction. Antegrade or retrograde pyelography will show similar findings to an IVU but offer a therapeutic option aswell.

Complications

Left untreated bilateralobstruction (obstruction occurring to both kidneysrather than one) has a poor prognosis.

Treatment

Treatment of hydronephrosis focuses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies, and whether it is acuteor chronic.

Acuteobstruction of the upper urinary tract is usually treated by the insertion of a nephrostomytube. Chronic upper urinary tract obstruction is treated by the insertion of a ureteric stentor a pyeloplasty.

Lower urinary tract obstruction (such as that caused by bladder outflow obstruction secondary to prostatic hypertrophy) is usually treated by insertion of a urinary catheteror a suprapubic catheter.