obstructive uropathy Flashcards
vesicoureteral reflux (VUR)
urine refluxing from the bladder back into the ureters
what is a “post-renal” acute kidney obstruction
obstructive uropathy leading to acute reduction in kidney function
pre-renal AKI cause
hypoperfusion of the kidneys (dehydration, sepsis, acute blood loss)
presentation of upper urinary tract obstruction
loin to groin or flank pain on the affected side
reduced or no urine output
non-specific systemic symptoms such as vomiting
impaired renal function on blood tests (raised creatinine)
presentation of lower urinary tract obstruction
difficult or inability to pass urine
urinary retention, with an increasingly full bladder
impaired renal function on blood tests (raised creatinine)
common causes of upper urinary tract obstruction
kidney stones
tumours pressing on ureters
ureter strictures (due to scar tissue narrowing the tube)
retroperitoneal fibrosis
bladder cancer
ureterocele (congenital)
causes of lower urinary tract obstruction
benign prostatic hyperplasia
prostate cancer
bladder cancer
urethral strictures
neurogenic bladder
what is neurogenic bladder
abnormal function of the nerves innervating the bladder and urethra
results in overactivity or underactivity in the detrusor muscle in the bladder and the sphincter muscle in the urethra
key causes of neurogenic bladder
multiple sclerosis
diabetes
stroke
parkinson’s
brain or spinal cord injury
spina bifida
management of obstruction caused by ureteral stone
nephrostomy
management of lower urinary tract obstruction
(eg urethral stricture or prostatic hyperplasia)
- urethral catheter
- suprapubic catheter
presentation of hydronephrosis
vague renal angle pain
mass in the kidney area
may be seen on USS, CT or intravenous urogram
management of hypronephrosis
percutaneous nephrostomy
antegrade ureteric stent
