Hydronephrosis for students

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Hydronephrosis for students

  1. 1. Hydronephrosis Lecture 51 Dr Mohammad Manzoor Mashwani Urinary Tract Obstruction (Obstructive Uropathy)
  2. 2. Hydronephrosi s• Hydronephrosis is the term used to describe dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine.
  3. 3. Types of Obstruction • SUDDEN • INSIDIOUS, • PARTIAL or • COMPLETE, • UNILATERAL or • BILATERAL;
  4. 4. Types of Lesions It can be caused by lesions that are •Intrinsic to the urinary tract or •Extrinsic lesions that compress the ureter.
  5. 5. Obstructive lesions of the urinary tract
  6. 6. Types of Hydronephrosis • Primary Hydronephrosis • Secondary Hydronephrosis
  7. 7. Causes • 1. Congenital anomalies • 2. Urinary calculi • 3. Benign prostatic hypertrophy • 4. Tumors • 5. Inflammation • 6. Sloughed papillae or blood clots • 7. Pregnancy • 8. Uterine prolapse and cystocele • 9. Functional disorders
  8. 8. Morphology When the obstruction is SUDDEN and COMPLETE, GLOMERULAR FILTRATION IS REDUCED. • It leads to • MILD DILATION OF THE PELVIS and CALYCES and sometimes to • ATROPHY OF THE RENAL PARENCHYMA.
  9. 9. Morphology • When the obstruction is • SUBTOTAL or INTERMITTENT, GLOMERULAR FILTRATION IS NOT SUPPRESSED, and PROGRESSIVE DILATION ENSUES.
  10. 10. • Depending on the level of urinary block, • The dilation may affect The bladder first, or The ureter and then The kidney.
  11. 11. The kidney may be slightly to massively ENLARGED,depending on the degree and the duration of the obstruction.
  12. 12. The earlier features are those of simple DILATION OF THE PELVIS AND CALYCES, but in addition there is often significant INTERSTITIAL INFLAMMATION, even in the absence of infection.
  13. 13. • In chronic cases the picture is one of •CORTICAL TUBULAR ATROPHY with marked diffuse INTERSTITIAL FIBROSIS. • Progressive blunting of the apices of the pyramids occurs, and these eventually become cupped.
  14. 14. •In far-advanced cases the kidney may become transformed into • A THIN-WALLED CYSTIC STRUCTURE having a diameter of up to 15 to 20 cm • with striking PARENCHYMAL ATROPHY, • TOTAL OBLITERATION OF THE PYRAMIDS, and • THINNING OF THE CORTEX.
  15. 15. Hydronephrosis of the kidney, with marked dilation of the pelvis and calyces and thinning of the renal parenchyma.
  16. 16. Clinical Features I. Acute obstruction may provoke PAIN attributed to distention of the collecting system or renal capsule. • Most of the early symptoms are produced by the underlying CAUSE of the hydronephrosis.
  17. 17. Clinical features: Acute Obstruction • Thus, calculi lodged in the URETERS may give rise to RENAL COLIC, and • PROSTATIC ENLARGEMENTS may give rise to BLADDER SYMPTOMS.
  18. 18. Clinical features II. Unilateral complete or Partial Hydronephrosis • Unilateral complete or partial hydronephrosis may remain SILENT FOR LONG PERIODS, since the unaffected kidney can maintain adequate renal function. • Sometimes its existence first becomes apparent in the course of • INTRAVENOUS PYELOGRAPHY.
  19. 19. Clinical features Unilateral complete or Partial Hydronephrosis • It is regrettable that this disease tends to remain ASYMPTOMATIC, because in its early stages, perhaps the first few weeks, • relief of obstruction leads to reversion to normal function.
  20. 20. III. In bilateral partial obstruction the earliest manifestation is inability to concentrate the urine, reflected by POLYURIA AND NOCTURIA.
  21. 21. • In bilateral partial obstruction : Some patients have • acquired distal tubular acidosis, • renal salt wasting, • secondary renal calculi, and • a typical picture of chronic tubulointerstitial nephritis with scarring and atrophy of the papilla and medulla. • Hypertension is common in such patients.
  22. 22. IV. Complete bilateral obstruction • Complete bilateral obstruction results in OLIGURIA or ANURIAand is incompatible with survival unless the obstruction is relieved.
  23. 23. IV. Complete bilateral obstruction • Curiously, after relief of complete urinary tract obstruction, Postobstructive diuresis occurs. • This can often be massive, with the kidney excreting large amounts of urine that is rich in sodium chloride.

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