Hydronephrosis overview: Difference between revisions

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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hydronephrosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
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MRI
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Latest revision as of 18:25, 2 August 2018

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Synonyms and keywords:

Ureteral anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci and John Sampson.In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with renal scarring.

Ureteral anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci drawings and John Sampson dissections.
In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with renal scarring from bacterial infection and the development of hydronephrosis.
In 1952, Hutch performed the first antireflux surgery in paraplegic patients.
In 1717, the first to description of obstruction of the posterior urethra (PUO) was by Morgagni.

Classification


Grade 0	No renal pelvis dilation	Anteroposterior diameter of less than 4 mm in fetuses
Grade 1	Mild renal pelvis dilation	Anteroposterior diameter less than 10 mm in fetuses
Grade 2	Moderate renal pelvis dilation	Anteroposterior diameter between 10 and 15 mm in fetuses
Grade 3	Renal pelvis dilation along with all calyces dilatation
Grade 4	Renal pelvis dilation along with all calyces dilatation with thinning of the renal parenchyma

Pathophysiology

Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine. This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. The rise in ureteral pressure leads to marked changes in glomerular filtration, tubular function, and renal blood flow. The glomerular filtration rate (GFR) declines significantly within hours following acute obstruction. This significant decline of GFR can persist for weeks after relief of obstruction. In addition, renal tubular ability to transport sodium, potassium, and protons and concentrate and to dilute the urine is severely impaired.

Causes

Hydronephrosis is commonly caused by conditions that obstruct urine outflow anywhere between kidneys and urethral opening. It is also caused by non obstructive conditions in some cases. Most common causes of hydronephrosis are renal calculi, ureteropelvic junction obstruction, vesicoureteric reflux, carcinoma involving urinary tract, prostate enlargement and cancer, blood clots retention and external compression from pelvic and abdominal tumors such as ovarian cysts, and retroperitoneal fibrosis.

Differentiating Hydronephrosis from other Diseases

Hydronephrosis must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, pyelonephritis, cystitis, ovarian cyst, pelvic tumor

Epidemiology and Demographics

The incidence and prevalence of hydronephrosis varies according to the underlying cause. Case fatality rate of hydronephrosis is 3.1 per 100 000 individuals.

Risk Factors

Common risk factors in the development of hydronephrosis include renal calculi, external compression from abdominal and pelvic masses and tumors such as prostate enlargement and cancer, cervical cancer, diabetes mellitus and neurogenic bladder, congenital anomalies of the kidney and urinary tract (CAKUT) such as vesicoureteric reflux, ureteropelvic junction obstruction and posterior urethral valves.

Screening

There is insufficient evidence to recommend routine screening for hydronephrosis.

Natural History, Complications and Prognosis

Common complications of hydronephrosis include infections, hyperkalemia, metabolic acidosis, and distal renal tubular acidosis, hypertension and renal failure.

Diagnosis

Diagnostic study of choice

Early diagnosis of hydronephrosis is important because most of the cases can be reversed if not treated promptly lead to irreversible renal injury.Hydronephrosis is usually diagnosed using an ultrasound scan.

History and symptoms

The majority of patients with hydronephrosis are asymptomatic.The most common symptoms of hydronephrosis include alteration in urine output, pain, hematuria and hypertension.

Physical examination

Patients with hydronephrosiscomplain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with abdominal distension, palpable kidney, costovertebral tenderness and palpable bladder may be seen.

Lab findings

Some patients with hydronephrosis may have elevated WBC count, serum creatinine, BUN, potassium levels and pyuria.

EKG

There are no EKG findings associated with hydronephrosis

X-ray

An x-ray may be helpful in the diagnosis of hydronephrosis. Findings on an x-ray suggestive of hydronephrosis include renal enlargement, cortical thinning and rim sigh.

Echocardiogram and Ultrasound

Early diagnosis of hydronephrosis is important because most of the cases can be reversed if not treated promptly lead to irreversible renal injury.Hydronephrosis is usually diagnosed using an ultrasound scan.

CT scan

Abdominal CT scan may be helpful in the diagnosis of hydronephrosis. Findings on CT scan suggestive of hydronephrosis include dilation of the proximal ureter, identification of the site of obstruction and calyceal blunting.

MRI

Abdomen MRI may be helpful in the diagnosis of hydronephrosis. Findings on MRI suggestive of hydronephrosis include renal perfusion and renal diffusion during acute ureteral obstruction.

Other Imaging findings

There are no other imaging findings associated with hydronephrosis.

Other diagnostic studies

There are no other diagnostic studies associated with hydronephrosis.

Treatment

Medical therapy

The goal of treatment for hydronephrosis is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.The initial care for the patient is aimed at minimizing pain and preventing urinary tract infections. Otherwise, surgical intervention may be required.

Surgery

Surgery is the mainstay of treatment for Hydronephrosis. The type of surgery depends on the underlying cause and also depending on whether the obstruction is acute or chronic.

Primary prevention

There are no established measures for the primary prevention of hydronephrosis

Secondary prevention

There are no established measures for the secondary prevention of hydronephrosis

References

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+{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
+|-
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=mi7XtyHwVHk|350}}
+|-
+|}
 __NOTOC__
-{{
+{{Hydronephrosis}}
-Hydronephrosis
+'''For patient information, click [[Hydronephrosis (patient information)|here]]'''
-}}
+{{CMG}}; {{AE}}{{Vbe}}
-{{CMG}}
-==Overview==
-'''Hydronephrosis''' is distention and [[dilation]] of the [[renal pelvis]], usually caused by [[obstruction]] of the free flow of [[urine]] from the [[kidney]].<ref>{{Cite book | author=Kumar, Vinay; Fausto, Nelson; Fausto, Nelso; Robbins, Stanley L.; Abbas, Abul K.; Cotran, Ramzi S. | authorlink= | title=Robbins and Cotran Pathologic Basis of Disease | date=2005 | edition=7th| publisher=Elsevier Saunders | location=Philadelphia, Pa. | isbn=0-7216-0187-1 | pages=1012–1014}}</ref>
+{{SK}}
+==[[Hydronephrosis overview|Overview]]==
+==[[Hydronephrosis historical perspective|Historical Perspective]]==
+[[Ureteral]] anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci and John Sampson.In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with [[renal]] [[scarring]].
+* [[Ureteral]] anatomy and the function of the ureterovesical junction was first discovered by Galen, Leonardo da Vinci drawings and John Sampson dissections.
+*In 1950s, Hodson and Edwards was the first to discover the association between association of VUR with renal [[scarring]] from [[Bacteria|bacterial]] infection and the development of [[hydronephrosis]].
+*In 1952, Hutch performed the first antireflux [[surgery]] in [[paraplegic]] patients.
+*In 1717,  the first to description of obstruction of the posterior urethra (PUO) was by Morgagni.
+==[[Hydronephrosis classification|Classification]]==
+{| class="wikitable"
+|+
+|Grade 0
+|No [[renal pelvis]] dilation
+|[[Anteroposterior]] diameter of less than 4 mm in fetuses
+|-
+|Grade 1
+|Mild [[renal pelvis]] dilation
+|[[Anteroposterior]] diameter less than 10 mm in fetuses
+|-
+|Grade 2
+|Moderate [[renal pelvis]] dilation
+|[[Anteroposterior]] diameter between 10 and 15 mm in fetuses
+|-
+|Grade 3
+|[[Renal pelvis]] dilation along with all calyces dilatation
+|
+|-
+|Grade 4
+|[[Renal pelvis]] dilation along with all calyces dilatation
+with thinning of the renal [[parenchyma]]
+|
+|}
+==[[Hydronephrosis pathophysiology|Pathophysiology]]==
+[[Hydronephrosis]] can result from [[anatomic]] or [[functional]] processes interrupting the flow of [[urine]]. This interruption can occur anywhere along the [[Urinary tract neoplasm|urinary tract]] from the [[kidneys]] to the [[urethral]] meatus. The rise in [[ureteral]] pressure leads to marked changes in [[glomerular filtration]], tubular function, and [[renal blood flow]]. The [[glomerular]] filtration rate (GFR) declines significantly within hours following acute [[obstruction]]. This significant decline of GFR can persist for [[weeks]] after relief of [[obstruction]]. In addition, [[renal]] [[tubular]] ability to transport [[sodium]], [[potassium]], and [[protons]] and concentrate and to dilute the [[urine]] is severely impaired.
+==[[Hydronephrosis causes|Causes]]==
+Hydronephrosis is commonly caused by conditions that obstruct urine outflow anywhere between kidneys and urethral opening. It is also caused by non obstructive conditions in some cases. Most common causes of hydronephrosis are renal calculi, ureteropelvic junction obstruction, vesicoureteric reflux, carcinoma involving urinary tract, prostate enlargement and cancer, blood clots retention and external compression from pelvic and abdominal tumors such as ovarian cysts, and retroperitoneal fibrosis.
+==[[Hydronephrosis differential diagnosis|Differentiating Hydronephrosis from other Diseases]]==
+[[Hydronephrosis]] must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, [[pyelonephritis]], [[cystitis]], ovarian cyst, pelvic tumor
+==[[Hydronephrosis epidemiology and demographics|Epidemiology and Demographics]]==
+The [[incidence]] and [[prevalence]] of [[hydronephrosis]] varies according to the underlying [[cause]]. Case fatality rate of hydronephrosis is 3.1 per 100 000 individuals.
+==[[Hydronephrosis risk factors|Risk Factors]]==
+Common [[Risk-neutral measure|risk]] factors in the development of [[hydronephrosis]] include [[renal calculi]], external compression from [[abdominal]] and [[pelvic]] masses and [[tumors]] such as [[prostate]] enlargement and [[cancer]], [[cervical cancer]], [[diabetes mellitus]] and [[neurogenic bladder]], [[congenital anomalies]] of the [[kidney]] and [[urinary tract]] (CAKUT) such as vesicoureteric reflux, [[ureteropelvic junction obstruction]] and [[posterior urethral valves]].
+==[[Hydronephrosis screening|Screening]]==
+There is insufficient evidence to recommend routine screening for hydronephrosis.
+==[[Hydronephrosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
+Common [[complications]] of [[hydronephrosis]] include [[infections]], [[hyperkalemia]], [[metabolic acidosis]], and distal [[renal tubular acidosis]], [[hypertension]] and [[renal failure]].
+==Diagnosis==
+===Diagnostic study of choice===
+Early diagnosis of [[hydronephrosis]] is important because most of the cases can be reversed if not treated promptly lead to [[irreversible]] renal injury.[[Hydronephrosis]] is usually diagnosed using an [[ultrasound]] scan.
+===History and symptoms===
+The majority of [[patients]] with [[hydronephrosis]] are asymptomatic.The most [[Common- and special-causes|common]] [[symptoms]] of [[hydronephrosis]] include alteration in [[urine output]], [[pain]], [[hematuria]] and [[hypertension]].
+===Physical examination===
+Patients with [[hydronephrosis]]<nowiki/>complain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with [[abdominal distension]], [[palpable]] kidney, [[Costovertebral angle|costovertebral]] tenderness and palpable [[bladder]] may be seen.
+===Lab findings===
+Some patients with [[hydronephrosis]] may have elevated [[WBC]] count, serum [[creatinine]], [[Blood urea nitrogen|BUN]], [[potassium]] levels and [[pyuria]].
+===EKG===
+* There are no EKG findings associated with hydronephrosis
+===X-ray===
+An x-ray may be helpful in the diagnosis of [[hydronephrosis]]. Findings on an x-ray suggestive of [[hydronephrosis]] include renal enlargement, cortical thinning and rim sigh.
+===Echocardiogram and Ultrasound===
+Early diagnosis of [[hydronephrosis]] is important because most of the cases can be reversed if not treated promptly lead to [[irreversible]] renal injury.[[Hydronephrosis]] is usually diagnosed using an [[ultrasound]] scan.
+===CT scan===
+[[Abdomen|Abdominal]] [[CT scan]] may be helpful in the diagnosis of [[hydronephrosis]]. Findings on [[CT scan]] suggestive of [[hydronephrosis]] include dilation of the proximal [[ureter]], identification of the site of obstruction and calyceal blunting.
+===MRI===
+[[Abdomen]] [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of [[hydronephrosis]]. Findings on [[Magnetic resonance imaging|MRI]] suggestive of [[hydronephrosis]] include renal [[perfusion]] and renal [[diffusion]] during acute [[ureteral]] obstruction.
+===Other Imaging findings===
+There are no other [[imaging]] [[findings]] associated with [[hydronephrosis]].
+===Other diagnostic studies===
+There are no other diagnostic studies associated with [[hydronephrosis]].
+==Treatment==
+===Medical therapy===
+The goal of treatment for [[hydronephrosis]] is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.The initial care for the patient is aimed at minimizing pain and preventing [[Urinary tract infections|urinary tract infection]]<nowiki/>s. Otherwise, surgical intervention may be required.
+===Surgery===
+*[[Surgery]] is the mainstay of [[treatment]] for [[Hydronephrosis]]. The type of [[surgery]] depends on the underlying cause and also depending on whether the obstruction is acute or chronic.
+===Primary prevention===
+There are no established measures for the primary [[prevention]] of [[hydronephrosis]]
+===Secondary prevention===
+There are no established measures for the secondary prevention of [[hydronephrosis]]
 ==References==