About hydronephrosis

1. Hydronephrosis
Presented by: Dhanik mk

2. Hydronephrosis
hydronephrosis, -hydro means water, -nephro means
kidneys, and -osis refers to a disease state,
so hydronephrosis refers a disease or condition where
excessive amounts of water, in the form of urine, causes the
kidneys to dilate.
normally, inside the kidneys, urine forms in the nephron and
then drains through the papilla which is an inverted cone
shaped pyramid, that is like a shower head, pours urine into
the calyces, From there it enters the renal pelvis which
funnels the urine into the ureter.

3. ● If there’s an obstruction to this normal flow of urine, then it
can cause urinary pressures to increase and push out on
the walls of these structures making them dilate. This
might happen because of something within the urinary
tract,for example, a kidney stone, or from external
compression, for example, when a fetus pushes up
against the urinary tract during pregnancy.Typically the
dilation starts closest to the site of the problem and then
slowly continues back up towards the kidneys.
● Now, if there’s dilation of just the ureter, it’s called
hydroureter, but if there’s dilation of the ureter, renal
pelvis, and the calyces, it’s called hydroureteronephrosis
or more commonly just hydronephrosis.

4. Unilateral
Hydronephrosis
● Occurs due to some form of
ureteral obstruction at the
level of pelviureteric junction
(PUJ)
Depending on etiology it may be
unilateral or bilateral
Bilateral
Hydronephrosis
● It is generally the result of some
form of ureteral obstruction but
can occur from various causes if
the lesions involve both sides.

5. Causes of unilateral
Hydronephrosis
1) Intraluminal: eg: calculus in the ureter or renal pelvis.
2) Intramural: eg: congenital pelviureteric junction
obstruction, Artesia of ureter, inflammatory stricture,
trauma, neoplasm of ureter or bladder.
3) Extramural: eg: obstruction of upper part of the ureter bu
inferior renal artery or vein, pressure on the ureter from
outside such as carcinoma cervix, prostate,rectum,colon or
caecum and retroperitoneal fibrosis.

6. ● Congenital: eg: atresia of the urethral meatus,
congenital posterior urethral valve.
● Acquired: eg: bladder tumor involving both
ureteric orifices, prostatic enlargement,
prostatic carcinoma and prostatitis, bladder
neck stenosis, inflammatory or traumatic
urethral stricture and phimosis
Hydronephrosis maybe of
congenital or acquired

7. The pathologic changes vary depending upon obstruction , like sudden
& complete or incomplete & intermediate.
Grossly:
● the kidneys are enlargement,
● Initially, there is extrarenal Hydronephrosis characterised by
dilatation of renal pelvis medially in the form of a sac.
● As the obstruction continues, there is dilatation of pelvis and
calyces and pressure atrophy of renal parenchyma.eventually, the
dilated pelvicalyceal system extends deep into renal cortex, so that
thin rim of renal cortex is stretched over the dilated calyces and the
external surface assumes lobulated appearance. This advanced
stage is called as intrarenal Hydronephrosis
Morphology

8. Microscopically:
● the wall of hydronephrotic sac is thickened due to fibrous
scarring and chronic inflammatory cell infiltrate.
● There is progressive atrophy of tubules and glomeruli along
with interstitial fibrosis.
● Stasis of urine in Hydronephrosis causes infection resulting
in filling of the sac with pus, a condition called pyonephrosis

9. Complications
The most common complication of hydronephrosis is the
development of a urinary tract infection (UTI).
When the UTI is associated with a high fever, a kidney
infection is (pyelonephritis) is suspected(This is caused
by bacteria spreading from the bladder to the kidney and
invading the kidney tissue.)

10. Thank you