Hydronephrosis pathophysiology On the Web
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Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine. This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. The rise in ureteral pressure leads to marked changes in glomerular filtration, tubular function, and renal blood flow. The glomerular filtration rate (GFR) declines significantly within hours following acute obstruction. This significant decline of GFR can persist for weeks after relief of obstruction. In addition, renal tubular ability to transport sodium, potassium, and protons and concentrate and to dilute the urine is severely impaired.
- Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine.
- This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. The rise in ureteral pressure leads to marked changes in glomerular filtration, tubular function, and renal blood flow.
- The glomerular filtration rate (GFR) declines significantly within hours following acute obstruction. This significant decline of GFR can persist for weeks after relief of obstruction. In addition, renal tubular ability to transport sodium, potassium, and protons and concentrate and to dilute the urine is severely impaired.
- The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis.
- The obstruction may arise from either inside or outside the urinary tract or may come from the wall of the urinary tract itself.
- Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder. Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurological deficits.
- Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urinary tract.
- Hydronephrosis is transmitted in autosomal dominant pattern.
- Evidence for genetic heterogeneity in hereditary hydronephrosis caused by pelvic-ureteric junction obstruction with one locus assigned to chromosome 6p has been found.
- Urinary tract infection
- Congenital malformation
- Scarring of tissues( From injury or previous surgery)
- On gross pathology, the following features may be see in hydronephrosis.
- Renal papillary compression
On microscopic histopathological analysis,findings of hydronephrosis include:
- Degenerative changes in the glomeruli and tubules of the renal cortex.
- Dilated lumen of distal tubules and collecting ducts
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