Obstructive uropathy
| Classification according to ICD-10 | |
|---|---|
| N13.9 | Obstructive uropathy |
| ICD-10 online (WHO version 2019) | |
The obstructive uropathy (including urinary , Harnstase or urinary ) denotes a congestion of urine varying severity due to outflow obstruction in the efferent urinary tract . This can be in the area of the kidneys , the ureters , but also in the area of the urinary bladder or the urethra . The resulting increase in pressure can lead to a loss of parenchymal function , the risk of urosepsis and renal insufficiency .
A distinction must be made between two different forms, depending on whether the flow obstacle is on the one hand in front of the urinary bladder or on the other in or after the urinary bladder. In the case of an intra- or post- vesical urinary obstruction, acute postrenal kidney failure with renal insufficiency or even dialysis is required . In the case of a prevesical obstruction, clinically relevant renal insufficiency occurs only in the case of bilateral urinary stasis.
causes
Causes of obstructive uropathy can be:
- Ureteral stones
- Kidney stones
- Tumors in the kidney, ureter , bladder, urethra , prostate
- malignant lymphomas in the abdominal area
- congenital ureteral and urethral constrictions
- Iatrogenic ureteral lesions
- neurological diseases: paraplegia, neurogenic voiding disorders
- Trauma
- Blood clot
- Retroperitoneal fibrosis (Ormond's disease)
- retroperitoneal masses
- Adhesions after abdominal surgery
- Endometriosis
- pregnancy
Some other rare bilateral causes are described under the heading acute kidney failure in the paragraph on postrenal azotemia.
course
The urinary stasis in chronic obstructive uropathy increases the susceptibility of the urinary tract to infections. The resulting increased interstitial (between the actual functional tissues) nephritis (kidney inflammation) and the increased pressure in the urinary system with dilation (expansion), the so-called hydronephrosis , lead to the loss of functional kidney tissue. Without adequate relief measures, obstructive uropathy ends with increasing scarring and shrinking kidneys.
- The acute form is reversible .
- The chronic form shows increasing atrophy of the kidney parenchyma up to hydronephrosis (sac kidney ).
Diagnosis
- Imaging tests for examining the genitourinary system include:
- Percussion : A full urinary bladder , which you can quickly find out by tapping the bladder, could be a sign of an obstruction below the urinary bladder.
- Urine diagnostics
therapy
Depending on the symptoms and localization, the following therapy options are available:
- Relief by nephrostomy , where urine is drained out through the skin
- ureteral, suprapubic or urethral catheterization e.g. B. Double J catheter (urether stent, pigtail catheter )
- Antibiotic therapy
Graduation
The congestion of urine can be subdivided sonographically into four degrees:
Urinary congestion grade I: Corresponds to a dilatation of the renal pelvis only . To assess the progression, it is recommended to measure the anechoic expansion in the longitudinal axis of the kidney. An ampullary renal pelvis must be considered for differential diagnosis .
Urinary congestion grade II: Here there is a dilatation of both the pyelon and the kidney calyx - the parenchyma is still normal. The goblet and pyelon widths should be measured to assess the progress.
Urinary congestion grade III: In addition to the second-degree congestion, there is also an incipient narrowing of the parenchyma.
Urinary congestion grade IV: The maximum variant of urinary congestion shows itself in a complete loss of the kidney parenchyma - the hydronephrotic sac kidney.
Web links
- Forms of obstructive uropathy at kinderchirurgie.ch
