Hydronephrosis Flashcards Preview

RENAL Pathology > Hydronephrosis > Flashcards

Flashcards in Hydronephrosis Deck (34):
1

Intrinsic obstruction of the UT can occur from ?

stones, clotted blood, sloughed cells, or transitional neoplasms

2

Extrinsic obstructions can occur from?

pregnancy, tumors, or inflammatory conditions including fibrosis

3

The most common points of intrinsic obstruction are?

the renal pelvis, uteropelvic junction and the urethra

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

Bilateral unilateral

5

Congenital anomalies which can produce an obstruction

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

6

A number of intrinsic tumors can produce obstruction including?

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

7

Extrinsic tumors such as (1) can also produce obstruction

prostate cancer or cervical cancer

8

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

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

9

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

decrease filtration

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)

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

11

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

capsular distension and acute pain

12

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

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

13

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

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

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

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

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)

1. tubular damage 2. renal concentrating ability.

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.

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

17

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

complete obstruction; partial obstruction

18

Intrinsic obstruction causes in adults:

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

19

Intrinsic obstruction causes in elderly

Post-operative stones—if the ureter is compromised

20

•Extrinsic tumors:

•Men: ____ and ____

•Females: GYN malignancy (carcinoma of the cervix or uterus).

Both: ___ and ____

BPH, Prostate cancer;

retroperitoneal pelvic malignancy (retroperitoneal lymphoma); bladder tumors

21

Extrinsic obstruction can be caused by:

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

ureteral dilatation; right

22

•Far-advanced cases of obstruction:

What does it cause? (1)

 What does this look like grossly? (2)

 

(1) causes very large cystic-looking kidneys.**not reversible*

(2)Thin-walled cystic structure; 15-20 cm diameter; Loss of pyramids;Thin cortex

23

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

SUDDEN COMPLETE; renal capsule

24

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

renal capsule

25

partial bilateral vs. complete bilateral symptoms

Partial --> Impaired renal concentration; therefore POLYURIA and nocturia

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

26

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

Hydronephrosis

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 ____

GFR; interstitium of kidney; perirenal spaces;

Renal atrophy; inner medullary blood flow;

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

 

TUBULAR effects;

Glomeruli

29

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

 impaired concentrating ability; ↑DILUTE urine

30

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

interstitial fibrosis

31

Grossly: Dilatation is ___ to obstruction

PROXIMAL

32

Hydronephrosis:

First--> Dilation of ___;

Then--> Dilation of ____ 

Finally--> ___ become widely dilated leading to ____

Collecting ducts;

Distal convoluted tubule (some proximal also)

Finally--> proximal convoluted tubule; tubule loss;

33

Frequency, dysuria, urgency, hesitancy, and hematuria

•Hydronephrosis:

34

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

stasis