Hydronephrosis

Question 1

Intrinsic obstruction of the UT can occur from ?

Answer 1

stones, clotted blood, sloughed cells, or transitional neoplasms

Question 2

Extrinsic obstructions can occur from?

Answer 2

pregnancy, tumors, or inflammatory conditions including fibrosis

Question 3

The most common points of intrinsic obstruction are?

Answer 3

the renal pelvis, uteropelvic junction and the urethra

Question 4

(1) disease is much more likely to present acutely whereas (2) disease can be difficult to diagnose because the other kidney can functionally compensate

Answer 4

Bilateral unilateral

Question 5

Congenital anomalies which can produce an obstruction

Answer 5

posterior urethral valves (often found in young males) along with urethral strictures, bladder neck obstruction and ureteropelvic junction narrowing

Question 6

A number of intrinsic tumors can produce obstruction including?

Answer 6

transitional carcinomas of bladder, ureter or renal pelvis or renal cell carcinoma

Question 7

Extrinsic tumors such as (1) can also produce obstruction

Answer 7

prostate cancer or cervical cancer

Question 8

Inflammatory disorders such as (1) can cause obstruction, as can neurological diseases, including (2)

Answer 8

prostatitis, urethritis and ureteritis spinal cord injury and autonomic dysfunction due to diabetes or other causes

Question 9

Obstruction in the more distal parts of the urinary tract produces back pressure that will ultimately?

Answer 9

decrease filtration

Question 10

Initially, there is continued filtration even with complete obstruction, but this eventually leads to loss of filtration, so there is usually less (1) or dilation of the collecting system as a consequence of (2) than there is from (3)

Answer 10

1. hydronephrosis 2. complete obstruction 3. partial or intermittent obstruction

Question 11

Sudden, complete renal obstruction often causes (1) which can help lead to the diagnosis

Answer 11

capsular distension and acute pain

Question 12

Sudden bilateral obstruction leads to (1), and (2) which can be readily diagnosed and treated

Answer 12

1. oliguria (low urine output) 2. renal failure

Question 13

Bilateral partial obstruction can lead to impaired renal function with impaired (1) which will be observed as (2)

Answer 13

1. concentrating ability 2. frequency and nocturia and renal hypertension

Question 14

After removal of the obstruction there is usually a (1) which produces a large volume of urine flow. However if the obstruction continues, there is eventually (2), which is not reversible

Answer 14

1. post-obstructive diuresis 2. large cystic dilation of the kidney with atrophic cortex

Question 15

Early in the course of obstruction, there is elevated pressure and decreased renal medullary blood flow that initially produces (1). For this reason, the initial injury causes a decrease in (2)

Answer 15

1. tubular damage 2. renal concentrating ability.

Question 16

Microscopically in hydronephrosis there is dilation of the (1) which progresses to dilation of (2) and eventual tubule loss. (3) are generally spared until fairly late in the course of the disease.

Answer 16

1. collecting ducts 2. proximal and distal convoluted tubules 3. Glomeruli

Question 17

There is usually LESS hydronephrosis or dilation of the collecting system in ____ than ______

Answer 17

complete obstruction; partial obstruction

Question 18

Intrinsic obstruction causes in adults:

Answer 18

Urinary calculi (renal or ureter stones) Strictures (caused by STD’s).

Question 19

Intrinsic obstruction causes in elderly

Answer 19

Post-operative stones—if the ureter is compromised

Question 20

• Extrinsic tumors:
• Men: ____ and ____
• Females: GYN malignancy (carcinoma of the cervix or uterus).

Both: ___ and ____

Answer 20

BPH, Prostate cancer;

retroperitoneal pelvic malignancy (retroperitoneal lymphoma); bladder tumors

Question 21

Extrinsic obstruction can be caused by:

•Pregnancy–>Physiologic response leads to ____—usually on the ___ side);

Answer 21

ureteral dilatation; right

Question 22

•Far-advanced cases of obstruction:

What does it cause? (1)

What does this look like grossly? (2)

Answer 22

(1) causes very large cystic-looking kidneys.**not reversible*
(2) Thin-walled cystic structure; 15-20 cm diameter; Loss of pyramids;Thin cortex

Question 23

____ obstruction (aka acute obstruction) produces pain from ____ distention

Answer 23

SUDDEN COMPLETE; renal capsule

Question 24

____has pain receptors–> acute flank pain in the back area if acute aka sudden obstruction

Answer 24

renal capsule

Question 25

partial bilateral vs. complete bilateral symptoms

Answer 25

Partial –> Impaired renal concentration; therefore POLYURIA and nocturia

Complete–> Renal function markedly diminished therefore OLIGURIA or ANURIA and renal failure; INCOMPATIBLE w/ survival.

Question 26

Dilatation of the collecting system—renal pelvis and calyces—within the kidney (if in ureter–> hydroureter)

Answer 26

Hydronephrosis

Question 27

Pathophysiology of hydronephrosis:

1. Filtration and thus ___ continues (even w/ complete obstruction) and then Filtrate diffuses back to ___ and ___ (into lymphatics and venous systems).
2. With time, the BACK PRESSURE leads to:

____: high back pressure hits the cortex, affecting the proximal tubular function (bigger effect on tubular function) and then glomerular function.

Decreased ____

Answer 27

GFR; interstitium of kidney; perirenal spaces;

Renal atrophy; inner medullary blood flow;

Question 28

•Functional loss over time:

• ____ first –> impaired concentrating ability; ↑ DILUTE urine
• ____ are initially spared; late in the course see glomerular disease, AND THUS decreased GFR

Answer 28

TUBULAR effects;

Glomeruli

Question 29

•TUBULAR effects first in hydronephrosis–> what would you see?

Answer 29

impaired concentrating ability; ↑DILUTE urine

Question 30

•Obstruction causes interstitial inflammatory rxn LEADING TO ____ causing further injury

Answer 30

interstitial fibrosis

Question 31

Grossly: Dilatation is ___ to obstruction

Answer 31

PROXIMAL

Question 32

Hydronephrosis:

First–> Dilation of ___;

Then–> Dilation of ____

Finally–> ___ become widely dilated leading to ____

Answer 32

Collecting ducts;

Distal convoluted tubule (some proximal also)

Finally–> proximal convoluted tubule; tubule loss;

Question 33

Frequency, dysuria, urgency, hesitancy, and hematuria

Answer 33

•Hydronephrosis:

Question 34

complication of hyronephrosis: ___ of the urine can lead to infection caused by bacteria

Answer 34

stasis