Hydronephrosis Flashcards
What is it?
Dilation of the kidney caused by urinary tract obstruction resulting in proximal distension
What things within the lumen cause it? (4)
Blood clots, Calculi, Sloughed papillae, tumour of the renal pelvis or ureter
What things within the walls cause it? (7)
strictures, congenital megaureter, bladder neck obstruction, congenital urethral valves, Pinhole meatus, neurogenic bladder, functional failure e.g spinal trauma
What things outside of the urinary tract cause it? (7)
Tumours, Benign Prostatic Hyperplasia, Retroperitoneal Fibrsosis, Pancreatitis, Crohn’s, Chronic granulomatous disease, pregnancy
Is it bilateral or uni lateral?
It can be either
Where are the most susceptible areas to obstruction? (3)
Pelvi-ureteric junction, Ureters crossing the pelvic brim, Vesico-ureteric junction
Is it common?
15 per 1000 men, 1 in 100 foetuses have it
Who does it affect?
Mainly men due to BPH, in women caused by pelvic tumours, prolapse or pregnancy
Symptoms (9)
Flank pain, colicky pain, radiation to inguinal area, ipsilateral back pain, restlessness, nausea, vomiting, incompletely emptied bladder, narrow/weak stream
Signs (3)
Loin tenderness, enlarged kidney on palpation, anuria/oliguria
What bloods would you do? (4)
FBC, U&E, eGFR, Serum PSA
Other investigations (7)
Urinalysis, Midstream urine MC&S, blood cultures, USS, CT, Intravenous Urography, Cytoscopy
Treatment (7)
*a urological emergency= complete urinary tract obstruction, obstruction with fever, CKD, suspicion of neurological dysfunction, uncontrolled pain, nausea & vomiting
Hydration, analgesics, catheterisation, ureter stenting, treat the obstruction, antibiotics if infected, may need a nephrostomy
Complications (7)
Infection, urinary extravasation, fistula formation, renal insufficiency, CKD, bladder dysfunction, severe pain
Is there a good prognosis?
Dependent on the cause, location, degree and duration of obstruction, concamitant infection worsens the prognosis
