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Hydronephrosis
Hydronephrosis
Definition
Definition
An aseptic dilatation of the renal pelvis and calyces due to partial or intermittent obstruction to
An aseptic dilatation of the renal
pelvis and calyces due to partial or
intermittent obstruction to the
outflow of urine.
Etiology
Etiology
 It can be unilateral or bilateral
 It can be unilateral or bilateral

Unilateral

Hydronephrosis
Hydronephrosis
Extramural Causes- • Obstruction by renal vessels (vein or artery) • Compression by growth (CA cervix
Extramural Causes-
• Obstruction by renal vessels (vein or
artery)
• Compression by growth (CA cervix
or carcinoma rectum)
• Retroperitoneal fibrosis
Intramural causes- • Congenital pelviuretric junction obstruction • Ureterocele • Neoplasm of ureter • Narrow ureteric
Intramural causes-
• Congenital pelviuretric junction
obstruction
• Ureterocele
• Neoplasm of ureter
• Narrow ureteric orifice
• Stricture ureter following removal of
stone, pelvic surgeries or tuberculosis of
ureter
Intraluminal causes- • Stone in the renal pevis or ureter • Sloughed papilla in papillary necrosis
Intraluminal causes-
• Stone in the renal pevis or ureter
• Sloughed papilla in papillary
necrosis

Bilateral Hydronephrosis

Congenital causes
Congenital causes
• Congenital stricture of external urethral meatus or pin-hole meatus • Congenital posterior urethral valve
• Congenital stricture of external
urethral meatus or pin-hole meatus
• Congenital posterior urethral valve
Acquired causes
Acquired causes
Acquired causes • BPH • Carcinoma prostate • Bladder carcinoma • Inflammatory/traumatic urethral stricture • Phimosis

BPH Carcinoma prostate Bladder carcinoma Inflammatory/traumatic urethral stricture Phimosis Postoperative bladder neck scarring Carcinoma cervix

Acquired causes • BPH • Carcinoma prostate • Bladder carcinoma • Inflammatory/traumatic urethral stricture • Phimosis

Obstructive lesions of the urinary

Pathophysiology  Anatomic and functional processes interrupts the flow of urine  There is raise in
Pathophysiology
Anatomic and functional processes
interrupts the flow of urine
There is raise in ureteral pressure causing
stretching and dilatation; if pressure
continue to raise, it leads to decline in renal
blood flow and GFR
When significant obstruction is persistent,
it affects renal tissue and results in varying
degrees of cystic dysplasia and renal
impairment

Obstruction can be sudden or insidious, partial or complete, unilateral or bilateral

May occur at any level from urethra to the renal pelvis

Obstruction increases succeptibility to infection and to stone formation

Unrelieved obstruction almost always leads to permanent renal atrophy

Initially pressure burden is taken up by the pelvis ,later calyces and renal parenchyma

Gradually parenchyma thins out due to destruction and it dilates

Eventually secretory function gets compromised

Parenchymal thickness of less thn 2mm is unlikely to function.in bilateral cases such patients go for renal failure

  • The high pressure in the pelvis is transmitted back through the collecting ducts into the cortex, causing

renal atrophy

  • It also compresses the renal vasculature of the medulla, causing a diminution in inner medullary blood

flow

  • The medullary defects are reversible initially but lead to medullary functional disturbances

  • The initial functional alterations caused by obstruction are largely tubular, manifested primarily by impaired concentrating ability

  • Only later the GFR begins to fall

  • Obstruction also triggers an interstitial inflammatory reaction leading eventually to interstitial fibrosis

The kidney may be slightly to massively enlarged, depending upon the degree and

duration of the obstruction Earlier features are dilatation of renal pelvis and the calyces with significant interstitial

inflammation In chronic cases the picture is one of cortical tubular atrophy with marked diffuse interstitial

fibrosis Progressive blunting of the apices of pyramid occurs and eventually becomes cupped In advanced cases,kidney may become cystic structure having a diameter of 15-20cm

club broadened
club
broadened

Stages of

Hydronephrosis

cup flat
cup
flat
  • types of renal pelvis

Intrarenal

extrarenal

  • Extrarenal pelvis refers to the presence of the renal pelvis outside the confines of the renal hilum. It is a normal variant that is found in ~10% of the population .

  • The renal pelvis is formed by all the major calyces. An extarenal pelvis usually appears dilated giving a false indication of an obstructive

pathology. Subsequent investigation with CT, usually clarifies the false interpretation on ultrasound.