obstructive uropathy

DEFINE OBSTRUCTIVE UROPATHY

It is structural or functional disturbance of normal urine flow, sometimes leading to

renal dysfunction (obstructive nephropathy

LIST Urethral Causes of Obstructive uropathy

Congenital phimosis(Narrow prepuce or foreskin of penis), congenital stenosis of

external meatus, congenital valves of the prostatic urethra, post-traumatic or

post-inflammatory stricture, and tumors.

List Prostatic Cause of Obstructive uropathy

Senile hyperplasia, chronic prostatitis, and carcinoma

List Bladder Causes of Obstructive uropathy

a) Obstruction of the urethral or ureteral orifices by congenital stenosis, calculi, or

tumors.

(b) Loss of nervous control of the sphincters as in mechanical injury and cord

compression.

List Ureteric lesions of Obstructive uropathy

Congenital or post-inflammatory strictures, calculi, malignant infiltration by tumors of

neighboring structures such as cervical carcinoma, and pressure by gravid uterus or

pelvic tumors.

List Kidney lesions of Obstructive uropathy

Pressure of an aberrant renal artery on renal pelvis, calculi, tumors(hypernephroma or

renal cell carcinoma ), and movable kidney

Discuss The Effect of Obstruction According To it's severity or Grade

Early: Simple, dilated pelvis & calyces.

Interstitial inflammation even in absence of infection.

Chronic: Cortical tubular atrophy, diffuse interstitial fibrosis, progressive blunting of

apices of pyramids then cupped.

Advanced: Thin-walled cystic structure with parenchymal atrophy.

DEFINE Hydronephrosis

Definition:

Dilatation of renal pelvis & calyces associated with progressive atrophy of renal

parenchyma due to obstruction to outflow of urine.

May be accompanied by dilatation of ureter → hydroureter.

Describe Morphology Of kidney in Hydronephrosis According to severity and grade

Depends on onset & level of obstruction.

Kidney:

1. Slight to massive enlargement.

2. Atrophy with interstitial fibrosis.

3. Progressive blunting of apices of pyramids then become cupped

In advanced cases:

1. Thin-walled cystic structure.

2. May have diameter up to 15 or 20 cm.

3. Parenchymal atrophy (cortex, medulla).

Discuss Complications Of Hydronephrosis

1. Renal failure due to renal atrophy.

2. Infection changes hydronephrosis to pyonephrosis.

3. Secondary hypertension(malignant hypertension )

Define Pyonephrosis:

Chronic suppurative pyelonephritis (inflammation of renal parenchyma) associated

with marked dilatation of the renal pelvis secondary to obstruction in the urinary tract.

Discuss Etiology of pyonephrosis

1. Bacterial infection of hydronephrosis.

2. Pyelonephritis with early marked obstruction.

Discuss Pathology of pyonephrosis

The kidney tissue is destroyed by suppuration.

The calyces and pelvis are dilated and distended with pus.

Their mucosa is congested and ulcerated, and the walls are thickened by fibrosis.

Direct spread of infection from the kidney causes perinephritis.

Healing of perinephritis by fibrosis causes fixation of the kidney to the surrounding