Obstructive Nephropathy: Diagnosis and Treatment

What is it and what are the reasons?

Obstructive nephropathy is an abnormality in the structure and function of the kidneys, which is caused by obstruction of the outflow of urine due to partial or complete obstruction of the urinary tract (most commonly ureters or urethra), explains the best nephrologist in Delhi.

The most common causes are prostatic hyperplasia and cancer, tumors (uterus, ovary, large intestine), uterine prolapse, retroperitoneal fibrosis, narrowing of the ureter or its opening to the renal pelvis or bladder (may be acquired or congenital), posterior urethral valve (usually congenital in boys).

The cause of obstructive nephropathy may also be impaired urinary tract function, most often the bladder after a spinal cord injury or as a result of a malformation of the spinal cord (e.g. cerebrospinal hernia) or so-called neurogenic bladder (bladder neck spasm).

A variant of obstructive nephropathy is drainage nephropathy caused by long-term backward reflux (reflux) of urine from the bladder to the ureter and kidney.

How common is obstructive nephropathy?

Obstructive nephropathy is a fairly rare kidney injury in adults, while it is the most common cause of chronic renal failure in children (due to urinary congenital malformations), says the nephrologist in Delhi.

How is it revealed?

An obstacle to the outflow of urine from the kidney leads to the development of hydronephrosis, i.e. the widening of the pelvis and the renal calyces. If the urine outflow from the kidney suddenly almost completely closes, renal colic appears.

When hydronephrosis develops slowly, it may not have any symptoms, but if it reaches a large size, it manifests itself like a tumor in the abdomen – a large kidney can be felt by touch examination or press on other organs in the abdomen. Sometimes urinary tract obstruction is partial or changes over time, and then large (polyuria) and small (oliguria) urine volumes may alternate. Symptoms of a urinary outflow obstruction may be urinary tract infection or haematuria. When permanent, severe damage occurs to both kidneys, symptoms of chronic renal failure occur, says the nephrologist in Noida.

What to do if symptoms occur

Always seek medical attention if you experience symptoms suggestive of a urinary tract disease, i.e.

• urination disorders
• pain in the lumbar region or lower abdomen
• haematuria
• palpable tumor in the stomach
• symptoms of urinary tract infection.

How does the doctor make a diagnosis?

Reported symptoms (as above) indicate a disease of the urinary tract which may lead to obstruction of urine outflow (and development of obstructive nephropathy). The most important are imaging of the urinary system, first of all USG, then usually urography or CT They show unilateral or bilateral hydronephrosis, and when the obstacle is located low – widening of one or both ureters or bladder distension. These tests also help to identify the cause, i.e. the type of obstacle to the proper outflow of urine, explains the nephrologist in Gurgaon.

What are the treatments?

The goal of treating obstructive nephropathy is to restore effective drainage of urine from the kidneys, which involves removing or bypassing an obstacle that obstructs urine outflow. Usually urological treatment is needed. If the obstacle cannot be removed and the urine outflow is restored, urological procedures are carried out by the urologist in Noida to avoid the obstacle. This can be the introduction of a catheter into the bladder, ureter or directly into the renal pelvis through body shells in the lumbar region (so-called transcutaneous nephrostomy). Usually these are urgent interventions that ensure urine outflow until the patient is ready for elective surgery for the final treatment of the obstacle (e.g. prostate surgery, bladder tumor or urinary reconstruction).

Is it possible to cure completely?

Complete cure for obstructive nephropathy is possible provided the obstruction has been permanently cured before irreversible kidney changes have occurred. Removing an obstacle if chronic kidney damage has already occurred does not lead to cure because chronic kidney disease is progressive, states the kidney specialist in Delhi.

What do you need to do after treatment?

In obstructive nephropathy, urological supervision and periodic monitoring of urinary tract function are usually necessary. When there is permanent kidney damage (chronic obstructive nephropathy), periodic nephrological monitoring is required, says the kidney specialist in Noida.

What to do to avoid getting sick?

To avoid obstructive nephropathy, obstacles to urine outflow should be detected and treated early. Particular attention should be paid to any urination disorders, suggests the nephrologist in Delhi.