Hydronephrosis

Hydronephrosis


Hydronephrosis

  • Aseptic dilatation of the kidney caused by obstruction to the outflow of urine
  • Congenital PUJ and calculus are the commonest causes of unilateral HN
  • Unilateral hydronephrosis more common in women and on the right
  • Dietel’s crisis (Intermittent hydronephrosis): in unilateral hydronephrosis, a swelling in the loin is associated with acute renal pain. Some hours later the pain is relieved and the swelling disappears with passage of large volume of urine
  • USG is the least invasive means of detecting and used to diagnose PUJ obstruction in utero
  • Isotope renography – best test to establish that the dilatation of the renal collecting system is caused by obstruction
  • Obstruction is diagnosed by a combination of USG and isotope renography
  • Whitaker test – a percutaneous puncture of kidney is made through the loin and fluid infused at a constant rate with monitoring of intrapelvic pressure. An abnormal rise in pressure confirms obstruction

Pyeloplasty

  • Anderson-Hynes operation when reasonable functioning parenchyma remains

V-Y pyeloplasty

  • Nephrectomy when renal parenchyma is largely destroyed 

Aberrant renal vessels

  • Aberrant renal artery or vein in the lower pole of kidney can compress the PUJ causing hydronephrosis
  • Multiple renal arteries are most common on the left.
  • Renal arteries are functional end-arteries, so division of an aberrant renal artery leads to infarction of a section of parenchyma.
  • Aberrant renal veins can be divided with impunity. Treatment–ligation
Exam Question
 
  • Presence of hydronephrosis in staging of carci­noma cervix denotes FIGO disease Stage III-B
  • In follow up of BPH, most important indication of surgery is Bilateral hydronephrosis
  • Whitaker test is done for diagnosing  hydronephrosis
  • IOC in Posterior urethral valves of newborn with hydronephrosis is Micturating Cystourethrogram
  • Hydronephrosis with dilated renal pelvis and cortical thinning with a normal ureter treated with Pyeloplasty
  • Mictur­ating cysto urethrogram shows bilateral Grade IV vesico­ureteral reflux with  Ultrasound abdomen showing bilateral hydronephrosis is suggested for Ureteric re-implantation
  •  Recurrent E.coli infection with  Hydroureter and Hydronephrosis as U/S finding & Micturating cysto – urethrogam shows filling defect in urinary bladder are suggestive of Ureterocele
  • Rim sign in IVP is seen in Hydronephrosis
  • Bilateral impacted ureteric stones with hydronephrosis &  RBCs with pus cells in urine should be imediately treated with stent drainage
  • Inadvertent surgical occlusion of the ureter leads to Complete renal atrophy & Hydronephrosis
  • Unilateral hydronephrosis is due to  Carcinoma of prostate
  • During investigation of hydronephrosis, isotope renogram is useful mainly in  Distinguishing between non-obstructed system
  • In follow up of BPH, most important indication of surgery is Bilateral hydronephrosis
  • Catheterization with Foley catheter  is mandatory for acute urinary retention with bilateral hydronephrosis .Spontaneous voiding may return, but a catheter should be left indwelling for 3 days while detruson tone returns
  • History of recurrent ureteric calculi presented with fever treated with Right-sided nephrectomy suggest diagnosis of Chronic pyelonephritis with hydronephrosis
  • Intra uterine hydronephrosis of 32-34 weeks-management Require serial USG and other associated anomalies
Don’t Forget to Solve all the previous Year Question asked on Hydronephrosis

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