Hydronephrosis

The basic definition, epidemiology, causative factors, risk factors, pathogenesis and clinical features of Hydronephrosis

1. HYDRONEPHROSIS Dr. Rajshree Singh

2. Overview of Obstructive Uropathy Urinary tract obstruction Increases susceptibility to infection, stone formation and if, unrelieved leads to permanent renal atrophy termed as Hydronephrosis / obstructive Uropathy Sudden or insidious Partial or complete Unilateral or bilateral May occur at any level of urinary tract from urethra to renal pelvis

3. Causes A. Intrinsic lesions I. Congenital Posterior urethral valve & urethral strictures meatal stenosis Bladder neck obstruction Ureteropelvic junction narrowing or obstruction Severe vesicoureteral reflux

4. Causes contd … II. Acquired Urinary calculi Benign prostatic hypertrophy Tumors: Ca. prostate, bladder tumors Sloughed papillae & blood clots Inflammation: prostatis , urethritis , ureteritis Functional disorders: neurogenic (spinal cord neuropathy or diabetic neuropathy) and other functional abnormality of ureter or bladder

5. Causes contd … B. Extrinsic lesion : Compression by pregnant uterus Reteroperitoneal fibrosis Tumors : Ca. cervix, Fibroids Uterine prolapse cystocele

6. Hydronephrosis Definition : Is the term used to describe dilatation of Renal pelvis and calyces associated with progressive atrophy of kidney due to obstruction of outlflow of urine

7. Pathogenesis Obstruction in urinary tract Continued glomerular filtration Dilatation of pelvis & calyces High pressure in pelvis that transmits back through collecting duct Later : Cortical atrophy & decrease GFR Intially : deranged tubular function in medulla  impaired concentrating ability Dilatation of pelvis & calyces and parenchymal atrophy HYDRONEPHROSIS

8. GROSS features When obstruction sudden & complete Mild dilatation of pelvis & calyces Atrophy of renal parenchyma When the obstruction is subtotal or intermittent Glomerular filtration not suppressed Kidney slight to massively enlarged

9. GROSS features contd … Cut section : Early : Dilatation of pelvis & calyces In chronic case : cortical tubular atrophy, fibrosis Progressive blunting of apices of papilla eventually becoming cupped In far advanced case : kidney becomes thin walled cystic structure with striking parenchymal atrophy, total obliteration of pyramids and thinning of cortex

10. Microscopy Renal cortex : Cortico -tubular atrophy Marked diffuse interstitial fibrosis

11. Clinical features Acute obstruction : Pain due to distention of collecting systen or renal capsule unilateral complete or partial hydronephrosis Silent for long periods Asymtomatic in early stages Apparent in intravenous pyelography , USG

12. Clinical features contd … Bilateral partial obstruction Inabilty to concentrate urine reflected polyuria & nocturia Distal tubular acidosis Renal salt wasting Secondary renal calculi Typical picture of chronic tubulointerstitial nephritis

13. Clinical features contd … Complete bilateral obstruction Oliguria & anuria Incompatible to survival unless relieved

14. ANY QUESTIONS ??