Hydronephrosis and hydroureter are typical clinical problems encountered not only by urologists but also by emergency medicine specialists and also primary care physicians. Hydronephrosis is defined as distention that the renal calyces and also pelvis v urine together a result of obstruction the the outflow of urine distal to the renal pelvis. Analogously, hydroureter is defined as a dilation that the ureter. <44>

The visibility of hydronephrosis or hydroureter can be physiologic or pathologic. It might be acute or chronic, unilateral or bilateral. It have the right to be secondary to obstruction that the urinary tract, but it can likewise be current even without obstruction.

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Obstructive uropathy refers to the sensible or anatomic obstruction the urinary flow at any kind of level that the urinary tract. Obstructive nephropathy is present when the obstruction causes functional or anatomic renal damage. Rarely, obstructive nephropathy may happen in the lack of hydronephrosis. <1> Thus, the state hydronephrosis and also obstruction must not be supplied interchangeably.

The etiology and presentation the hydronephrosis and/or hydroureter in adults differ from that in neonates and also children. Anatomic abnormalities (including urethral valves or stricture, and also stenosis at the ureterovesical or ureteropelvic junction) account for the bulk of instances in children. In comparison, calculi space most usual in young adults, while prostatic hypertrophy or carcinoma, retroperitoneal or pelvic neoplasms, and also calculi are the primary reasons in larger patients. <2, 3>


Hydronephrosis or hydroureter is a typical finding in pregnant women. The renal pelvises and also caliceal systems might be dilated as a result of progesterone effects and also mechanical compression of the ureters in ~ the pelvic brim. Dilatation of the ureters and renal pelvis is much more prominent top top the best side than the left side and also is checked out in approximately 80% of pregnant women. <4> These changes can be visualized ~ above ultrasound check by the 2nd trimester, and they may not settle until 6-12 weeks write-up partum.


For conversation of fetal hydronephrosis, seeAntenatal Hydronephrosis.


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Pathophysiology


Hydronephrosis can an outcome from anatomic or functional processes interrupting the circulation of urine. This interruption deserve to occur everywhere along the urinary street from the kidneys to the urethral meatus. The increase in ureteral press leads to significant changes in glomerular filtration, tubular function, and renal blood flow. The glomerular filtration price (GFR) declines significantly within hours complying with acute obstruction. This significant decrease of GFR can persist because that weeks ~ relief the obstruction. In addition, renal tubular capacity to transfer sodium, potassium, and also protons and concentrate and also to dilute the pee is severely impaired.


The extent and also persistence that these functional insults is directly related to the duration and also extent of the obstruction. Short disruptions are limited to reversible functional disturbance with small associated anatomic changes. Much more chronic interruptions lead to extensive tubular atrophy and permanent nephron loss.


Increased ureteral pressure additionally results in pyelovenous and also pyelolymphatic backflow. Gross alters within the urinary tract likewise depend ~ above the duration, degree, and also level the obstruction. Within the intrarenal collecting system, the level of dilation is limited by neighboring renal parenchyma. However, the extrarenal components can dilate to the allude of tortuosity.


To identify acute and also chronic hydronephrosis, one may take into consideration acute as hydronephrosis that, when corrected, enables full restore of renal function. Whereas in chronic hydronephrosis the ns of duty is irreversible also with correction of the obstruction. Early on experiments v dogs confirmed that if acute unilateral obstruction is corrected in ~ 2 weeks, complete recovery that renal role is possible. However, ~ 6 weeks of obstruction, duty is irreversibly lost.

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Grossly, an acutely hydronephrotic system have the right to be linked with tiny anatomic disturbance come renal parenchyma. On the other hand, a chronically dilated system might be associated with compression the the papillae, thinning the the parenchyma roughly the calyces, and coalescence of the septa in between calyces. Eventually, cortical atrophy progresses to the allude at which only a thin rim of parenchyma is present. Microscopic transforms consist of dilation that the tubular lumen and flattening of the tubular epithelium. Fibrotic changes and also increased collagen deposition space observed in the peritubular interstitium.