Hydronephrosis.pdf
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- 2. Hydronephrosis hydronephrosis, -hydro meanswater, -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’san 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 dueto 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 changesvary 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 wallof 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 commoncomplication 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.)
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