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Obstructive uropathy
     
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Obstructive uropathy

Uropathy - obstructive

 

Obstructive uropathy is a condition in which the flow of urine is blocked. This causes the urine to back up and injure one or both kidneys.

Causes

 

Obstructive uropathy occurs when urine cannot drain through the urinary tract. Urine backs up into the kidney and causes it to become swollen. This condition is known as hydronephrosis.

Obstructive uropathy can affect one or both kidneys. It can occur suddenly, or be a long-term problem.

Common causes of obstructive uropathy include:

  • Bladder stones
  • Kidney stones
  • Benign prostatic hyperplasia (enlarged prostate)
  • Advanced prostate cancer
  • Bladder or ureteral cancer
  • Colon cancer
  • Cervical or uterine cancer
  • Ovarian cancer
  • Any cancer that spreads
  • Scar tissue that occurs inside or outside of the ureters
  • Scar tissue that occurs inside the urethra
  • Problems with the nerves that supply the bladder

 

Symptoms

 

Symptoms depend on whether the problem starts slowly or suddenly, and if one or both kidneys are involved. Symptoms may include:

  • Mild to severe pain in the flank. The pain may be felt on one or both sides.
  • Fever.
  • Nausea or vomiting.
  • Weight gain or swelling (edema) of kidney.

You may also have problems passing urine, such as:

  • Urge to urinate often
  • Decrease in the force of urine stream or difficulty urinating
  • Dribbling of urine
  • Not feeling as if the bladder is emptied
  • Need to urinate more often at night
  • Decreased amount of urine
  • Leakage of urine (incontinence)
  • Blood in urine

 

Exams and Tests

 

Your health care provider will order functional or imaging studies to detect obstructive uropathy. Commonly used tests include:

  • Ultrasound of abdomen or pelvis
  • CT scan of abdomen or pelvis
  • Intravenous pyelogram (IVP)
  • Voiding cystourethrogram
  • Renal nuclear scan
  • MRI
  • Urodynamic test
  • Cystoscopy

 

Treatment

 

Medicines may be used if the cause is an enlarged prostate.

Stents or drains placed in the ureter or in a part of the kidney called the renal pelvis may provide short-term relief of symptoms.

Nephrostomy tubes, which drain urine from the kidneys through the back, may be used to bypass the blockage.

A Foley catheter, placed through the urethra into the bladder, may also help urine flow.

Short-term relief from the blockage is possible without surgery. However, the cause of the blockage must be removed and the urinary system repaired. Surgery may be needed for long-term relief from the problem.

The kidney may need to be removed if the blockage causes severe loss of function.

 

Outlook (Prognosis)

 

If the blockage comes on suddenly, kidney damage is less likely if the problem is detected and repaired right away. Often, the damage to the kidneys goes away. Long-term damage to the kidneys may occur if the blockage has been present for a long time.

If only one kidney is damaged, chronic kidney problems are less likely.

You may need dialysis or a kidney transplant if there is damage to both kidneys and they do not function, even after the blockage is repaired.

 

Possible Complications

 

Obstructive uropathy can cause permanent and severe damage to the kidneys, resulting in kidney failure.

If the problem was caused by a blockage in the bladder, the bladder may have long-term damage. This may lead to problems emptying the bladder or leakage of urine.

Obstructive uropathy is linked to higher chances of urinary tract infections.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of obstructive uropathy.

 

Prevention

 

Obstructive uropathy can be prevented by treating disorders that can cause it.

 

 

References

Frøkiaer J. Urinary tract obstruction. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Gallagher KM, Hughes J. Urinary tract obstruction. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 58.

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  • Bladder catheterization - female

    Bladder catheterization - female

    illustration

  • Bladder catheterization - male

    Bladder catheterization - male

    illustration

  • Female urinary tract

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract

    illustration

    • Bladder catheterization - female

      Bladder catheterization - female

      illustration

    • Bladder catheterization - male

      Bladder catheterization - male

      illustration

    • Female urinary tract

      Female urinary tract

      illustration

    • Male urinary tract

      Male urinary tract

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Obstructive uropathy

           
             

            Review Date: 1/15/2020

            Reviewed By: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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