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