This document provides tips for using a PowerPoint presentation on hydronephrosis: 1. The presentation contains blank slides for active learning where the user or students can provide information before the next slide is shown. 2. It covers topics like the definition, causes, epidemiology, pathology, clinical features, diagnostic studies, differential diagnosis, and treatment of hydronephrosis. 3. By displaying blank slides and having the user or students think about and discuss each topic before showing the next slide, this presentation aims to create an active learning session that can benefit both individual and group study.

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2. Hydronephrosis.

3. Hydronephrosis.
• Hydronephrosis is the term to
describe dilation of the renal
pelvis and calyces with urine
associated with progressive
atrophy of the kidney due to
obstruction to the outflow of
urine.

4. Types of Obstruction

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

6. Epidemiology

7. Epidemiology
• Autopsy 3.1%.
• Differences based on sex did not become
apparent until age 20 years.
• At age 20-60 years, hydronephrosis was
more common in women, which was
suggested to be due to pregnancy and
gynecologic malignancy.
• In men, prostatic diseases were indicated as
the cause of the rise in prevalence after age
60 years.

8. Epidemiology
• Autopsy studies also indicate that
hydronephrosis is present in 2-2.5% of
children.
• The prevalence is slightly increased in boys,
most of whom in the study were younger
than 1 year.
• These occurrence rates likely underestimate
the prevalence because conditions such as
temporary obstruction due to prior
pregnancy or calculi were not included.

10. Types of Lesions

11. Types of Lesions
It can be caused by lesions that are
• Intrinsic to the urinary tract or
• Extrinsic lesions that compress
the ureter.

12. Obstructive lesions of the urinary tract

13. Etiology

14. Etiology
• 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

15. Etiology
• Anatomic abnormalities (including urethral
valves or stricture, and stenosis at the
ureterovesical or ureteropelvic junction)
account for the majority of cases in
children.
• Calculi are most common in young adults,
• Prostatic hypertrophy or carcinoma,
retroperitoneal or pelvic neoplasms, and
calculi are the primary causes in older
patients.

16. Physiological

17. Physiological
• Hydronephrosis or hydroureter is a normal
finding in pregnant women.
• progesterone effects and mechanical
compression of the ureters at the pelvic
brim.
• More prominent on the right
• These changes can be visualized on
ultrasound examination by the second
trimester, and they may not resolve until 6-
12 weeks post partum.

20. Acute Vs. Chronic

21. Acute Vs. Chronic
• We may consider acute as hydronephrosis
that, when corrected, allows full recovery of
renal function.
• Chronic hydronephrosis is a situation in
which the loss of function is irreversible
even with correction of the obstruction.
• Early experiments with dogs showed that if
acute unilateral obstruction is corrected
within 2 weeks, full recovery of renal
function is possible. However, after 6
weeks of obstruction, function is

22. 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.

23. • When the obstruction is
•SUBTOTAL or
INTERMITTENT,
GLOMERULAR
FILTRATION IS NOT
SUPPRESSED, and
PROGRESSIVE
DILATION ENSUES

24. The kidney may be slightly to
massively ENLARGED,
depending on
the degree and the duration of
the obstruction.

25. • 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.

26. Pathology
•

27. Pathology
• Compression of the papillae, thinning of
the parenchyma around the calyces, and
coalescence of the septa between calyces.
• Dilation of the tubular lumen and flattening
of the tubular epithelium.
• Fibrotic changes and increased collagen
deposition are observed in the peritubular
interstitium.

28. Complications

29. Complications
• Urinary stasis may result in
• Infection
• Renal scarring
• Calculus formation
• Sepsis
• Renal failure
• Hypertension

30. Clinical Features

31. Clinical Features
I. Acute obstruction –
• PAIN due to distention of the
collecting system or renal capsule.
• The site of obstruction determines the
location of pain. Upper ureteral or
renal pelvic lesions lead to flank pain
or tenderness, whereas lower ureteral
obstruction causes pain that may
radiate to the ipsilateral testicle or
labia.

32. Clinical Features
• II Unilateral complete or partial
hyd ronephrosis 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 USG or
INTRAVENOUS PYELOGRAPHY.

33. Clinical Features
III. In bilateral partial
obstruction the earliest
manifestation is inability to
concentrate the urine,
reflected by
POLYURIA AND
NOCTURIA.
.

34. Clinical Features
Other symptoms
• Anuria
• Hematuria
• Fever
• Antenatal USG.

35. Clinical Features:Physical Exam
• With severe hydronephrosis, the kidney
may be palpable.
• With bilateral hydronephrosis, lower
extremity edema may occur.
• Costovertebral angle tenderness on the
affected side is common.
• A palpably distended bladder

36. Diagnostic Studies

37. Diagnostic Studies
• Laboratory Tests
• Imaging
– X-ray + Contrast studies.
– USG
– CT
– MRI
– Nuclear Scan
• Other Tests

38. Laboratory Studies

39. Laboratory Studies
• Urinalysis-
– Pyuria suggests the presence of infection.
– Microscopic hematuria may indicate the
presence of a stone or tumor.
• CBC leukocytosis, which may indicate
acute infection.
• Serum Creatinine levels
• Hypercalemia can be a life-threatening
condition.

40. Imaging studies

41. Imaging studies
• Renal ultrasonography is the test of choice
• Intravenous Urography
• CT Indications :
– Ultrasonography results are equivocal
– The kidneys cannot be well visualized
– The cause of the obstruction cannot be
identified.

42. Imaging studies
• Diuretic Renography with technetium Tc
99m-mercaptoacetyltriglycine
(Tc99mMAG3),
• A perfusion pressure flow study
• Diffusion-weighted magnetic resonance
imaging (MRI)
• Antegrade or retrograde pyelography is
usually used to relieve, rather than
diagnose, urinary tract obstruction.

43. Imaging in children

44. Imaging in children
• Detection of antenatal hydronephrosis by
ultrasound usually occurs in the second
trimester with a renal pelvic dilation (RPD)
cutoff of greater than or equal to 4 mm.
• Postnatal ultrasound.
• A voiding cystourethrography (VCUG) is
performed to detect VUR and, in boys, to
evaluate the posterior urethra.
• Diuretic renography
• Magnetic resonance urography (MRU)

45. Differential Diagnosis

46. Differential Diagnosis
• Other problems to consider in the
differential diagnosis include the following:
• Peripelvic cyst
• Congenital megacalices
• Calyceal diverticula
• Capacious extrarenal pelvis<>
• High urine flow
• Pyelonephritis

47. Non Operative Therapy
•

48. Non Operative Therapy
• Pain control
• Treatment or prevention of infection
• Oral alkalinization therapy for uric acid
stones and
• Steroid therapy for retroperitoneal fibrosis.

49. Minimally invasive Therapy

50. Minimally invasive Therapy
• Extracorporeal shockwave lithotripsy
• Urethral Catheterisation.
• SPC
• Ureteral catheterisation +- stent
• Nephrostomy
• Post. Urethral Valve fulguration.

51. Operative Therapy:Indications

52. Operative Therapy:Indications
• Any signs of infection Fever, leucocytosis
• The potential for loss of renal function also
adds to the urgency (eg, hydronephrosis or
hydroureter bilaterally or in a solitary
kidney).
• Refractory pain in a patient with an
obstructing ureteral calculus necessitates
intervention,
• Intractable nausea and vomiting.

53. Operative Therapy
Mostly extrinsic
• Retroperitoneal fibrosis,
• Retroperitoneal tumors
• Aortic aneurysms.
• Some stones that cannot be treated
endoscopically or with extracorporeal
shockwave lithotripsy
• Ureteral tumors,

54. On The Horizon
• Fetal Surgery VAS –VesicoAmniotic
Shunting

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