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.

5. Causes
Structural
Functional

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

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

9. 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

10. 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

11. 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

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

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

15. 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

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

17. Complications:
- UTI
- pyelonephritis

18. References:
● Ramadas Nayak - Textbook of Pathology for Allied Health Sciences
Questions:
salman.s.ansari92@gmail.com
Scan for PPT →