Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis
- Mark L Zeidel, MD
Mark L Zeidel, MD
- Hermann L. Blumgart Professor of Medicine
- Harvard Medical School Physician-in-Chief and Chair
- Department of Medicine Beth Israel Deaconess Medical Center
- W Charles O'Neill, MD
W Charles O'Neill, MD
- Professor of Medicine
- Emory University School of Medicine
Obstruction to urinary flow may occur at any site in the urinary tract. Urinary tract obstruction (UTO) may be acute or chronic, partial or complete, and unilateral or bilateral. UTO is important to recognize since it is readily reversible if quickly corrected. If uncorrected, UTO may predispose to urinary tract infection (UTI) and urosepsis and eventually cause end-stage renal disease (ESRD).
This topic reviews the diagnosis of UTO and hydronephrosis in adults. Hydronephrosis in infants and children is discussed elsewhere. (See "Congenital ureteropelvic junction obstruction" and "Primary megaureter in infants and children" and "Clinical presentation and diagnosis of posterior urethral valves".)
UTI that occurs as a result of nephrolithiasis is also discussed elsewhere. (See "Diagnosis and acute management of suspected nephrolithiasis in adults".)
UTO is a common problem but a relatively rare cause of significant acute kidney injury (AKI). While there are no extensive published epidemiologic data, based upon our combined clinical experience, it is clear that the incidence of UTO varies considerably with the patient population. As an example, UTO is more common among children than among adults presenting with urinary tract symptoms or renal failure because of the contribution of congenital abnormalities. UTO is more common among men than women, particularly as men age, due to prostatic enlargement.
Overall, UTO is not a common cause of renal failure in adults, but the likelihood of UTO being discovered as an underlying etiology depends upon the clinical setting and the relative risks of other causes of renal failure. UTO is a rare cause of AKI in the hospital setting but is more common in the outpatient setting . UTO is always an important cause of renal failure in patients with cancer.
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- CLINICAL PRESENTATION
- Symptoms and signs
- Characteristic laboratory findings
- - Increased serum creatinine
- - Urinalysis
- - Hyperkalemic renal tubular acidosis
- Radiographic findings
- DIFFERENTIAL DIAGNOSIS
- HYDRONEPHROSIS WITHOUT OBSTRUCTION
- URINARY OBSTRUCTION IN TRANSPLANTED KIDNEYS
- PROGNOSIS AND RECOVERY OF RENAL FUNCTION
- Predicting recovery
- INFORMATION FOR PATIENTS