Hydronephrosis - Pathology - Allied Health Sciences

Topic: Hydronephrosis
Faculty: Pathology
Course: BSc RDT - 2nd year

Definition, Causes, Pathogenesis, Morphology, Clinical features, Investigations, Complications

1. HYDRONEPHROSIS Dr. Salman Ansari Dept. of Pathology Kanachur Institute of Medical Sciences

2. Contents Definition Causes Pathogenesis Morphology Clinical features Investigations, Treatment, Complications

3. Hydronephrosis Defined as aseptic dilation of collecting system of kidney due to obstruction of urinary outflow Atrophy of kidney is seen Dilation of the ureter due to obstruction of urine outflow is called hydroureter .

4. Causes Structural Functional

5. Structural causes : Urinary calculi Tumour of prostate, bladder, uterus, cervix BPH in men Congenital abnormalities like urethral stricture Inflammation: prostatitis, urethritis Pregnancy

6. Neurogenic causes : Neurogenic bladder, due to spinal cord injury or diabetic nephropathy

7. Pathogenesis Obstruction : complete or incomplete, which leads to accumulation of urine proximal to obstruction Dilatation : accumulated urine causes dilatation of calyces and pelvis due to back pressure, which is transmitted back into renal tissue Reduced GFR : if obstruction continues, tubule loses concentrating function and GFR decreases Inflammatory reaction in interstitium with fibrosis

8. Morphology Types of obstruction: Sudden and complete obstruction : GFR is reduced and mild dilation of renal pelvis and calyces occurs Intermittent or subtotal obstruction : GFR is not affected and dilation is progressive Level of obstruction: depending upon where the obstruction is, the first part to be affected can be bladder or ureter and then kidney

9. Gross features Obstruction can be unilateral or bilateral, with dilation of ureter(called hydroureter) Kidney enlargement can be slight to massive Thin-walled kidney , with cysts Renal parenchyma shows destruction due to severe pressure atrophy and thinning of cortex

10. thin-walled, lobulated, fluid-filled sac

11. Microscopy Tubules : dilated and atrophied Glomeruli : partial or complete sclerosis Interstitium : fibrosis, chronic inflammatory cells

12. Clinical features Features depend upon cause of obstruction Renal calculus presents with renal colic, whereas BPH presents with bladder symptoms Unilateral hydronephrosis: can be asymptomatic Bilateral partial obstruction: polyuria, nocturia Bilateral complete obstruction: oliguria/anuria

13. Investigations : USG to diagnose obstructive uropathy Treatment : depends upon cause and severity of hydronephrosis

14. Complications : UTI pyelonephritis

15. References: Ramadas Nayak - Textbook of Pathology for Allied Health Sciences Questions: [email protected] Scan for PPT →