Hydronephrosis overview: Difference between revisions
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==[[Hydronephrosis classification|Classification]]== | ==[[Hydronephrosis classification|Classification]]== | ||
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|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 | |||
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|- | |||
|Grade 4 | |||
|[[Renal pelvis]] dilation along with all calyces dilatation | |||
with thinning of the renal [[parenchyma]] | |||
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==[[Hydronephrosis pathophysiology|Pathophysiology]]== | ==[[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 causes|Causes]]== | ||
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==[[Hydronephrosis differential diagnosis|Differentiating Hydronephrosis from other Diseases]]== | ==[[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]]== | ==[[Hydronephrosis epidemiology and demographics|Epidemiology and Demographics]]== | ||
Revision as of 16:43, 31 July 2018
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Hydronephrosis overview On the Web |
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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:
Overview
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 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
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies