Hydronephrosis

Hydronephoresis

1. Hydronephrosis SUNIL KUMAR.P

2. 8/18/2013 Hydronephrosis - Intro 2 Definition Hydronephrosis is the aseptic dilatation of the renal pelvis or calyces. It may be associated with obstruction but may be present in the absence of obstruction. There is accompanied destruction of kidney parenchyma.

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4. Types of Obstruction SUDDEN • INSIDIOUS, • PARTIAL or COMPLETE, • UNILATERAL or BILATERAL;

5. Obstructive lesions of the urinary tract

6. 8/18/2013 Hydronephrosis - Intro 7 E tiology It can be Unilateral or bilateral. Unilateral maybe extramural, intramural or Intraluminal Bilateral causes are either congenital or acquired

7. Unilateral hydronephrosis By some form of ureteric obstruction, with the ureter above the obstruction being dilated. Causes Extramural obstruction Intramural (in the walls) Intraluminal 8/18/2013 Hydronephrosis - Intro 8

8. 8/18/2013 Hydronephrosis - Intro 9 Causes of Unilateral hydronephrosis Extramural Obstruction by Aberrant renal vessels (vein or artery). It is common on left side. Compression by growth ( CA cervix, carcinoma rectum) Retroperitoneal fibrosis (Ormond disease) Retrocaval ureter

9. B. Intramural 1. Congenital PUJ obstruction Ureterocele Neoplasm of ureter Narrow ureteric orifice Stricture ureter following removal of stone, pelvic surgeries or tuberculosis of ureter. 8/18/2013 Hydronephrosis - Intro 10

10. C. Intraluminal Stone in the renal pelvis Sloughed papilla in papillary necrosis 8/18/2013 Hydronephrosis - Intro 11

11. Bilateral Hydronephrosis Result of urethral obstruction ; but may also be caused by one of the lesions described above occurring on both sides 8/18/2013 Hydronephrosis - Intro 12

12. 8/18/2013 Hydronephrosis - Intro 13 Causes of Bilateral hydronephrosis Congenital Congenital stricture of external urethral meatus, pin-hole meatus. Congenital posterior urethral valve. Acquired BPH Carcinoma prostate Postoperative bladder neck scarring Inflammatory / traumatic urethral stricture Phimosis Carcinoma cervix Bladder carcinoma

13. Classification Classification I — Unilateral HN — Bilateral HN without renal failure — Bilateral HN with renal failure Classification II Intermittent HN Persistent HN Classification III HN only HN with hydroureter Classification IV – Extrarenal pelvic HN (80%) 8 – /18/20 I 1 n 3 trarenal pelvic HN (20% H ) ydronephrosis - Intro 11

14. PATHOHYSIOLOGY

15. MORPHOLOGICAL FEATURES The pathologic changes vary depending upon whether the obstruction is sudden and complete, or incomplete and intermittent.

16. Gross findings The kidneys may have moderate to marked enlargement Extra renal hydronephrosis Dilatation of renal pelvis medially in the form of sac Atrophy of renal parenchyma Advanced stage is called intra renal hydronephrosis

17. Microscopic findings The wall of hydronephrotic sac is thickened due to fibrous scarring and chronic inflammation. There is progressive atrophy of tubules and glomeruli along with interstitial fibrosis. Pyonephrosis.

18. Laboratory Studies Urinalysis----- Hematuria Pyuria CBC---- Leukocytosis Biochemical--- Elevated BUN, creatinine, hyperkalemia .

19. Imaging studies USG CT SCAN MRI SCAN diuretic renography radionuclide renal scanning perfusion pressure flow studies A voiding cystourethrography (VCUG) is performed to detect VUR Gravity-assisted drainage imaging Magnetic resonance urography (MRU)