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Obstructive nephropathy
Introduction
Introduction to obstructive nephropathy Obstructive nephropathy refers to urinary tract circulation disorder, which produces backward pressure and affects renal pathology caused by normal physiology of renal parenchyma. The degree of obstruction is complete and partial; the range is bilateral and unilateral; the time has acute sudden and slow progressive; the upper urinary tract and lower urinary tract are located; the upper urinary tract is above the ureter-bladder junction (ureter, pelvis, ureter-kidney junction); lower urinary tract is located below the ureter-bladder junction (urethral, bladder neck, bladder-ureter junction). The influence of the kidney is related to the degree of obstruction and time. Early removal of the obstruction can cause the lesion to disappear, and in the advanced stage, the renal function is permanently lost and cannot be reversed. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: bacteremia, hydronephrosis, hypertension
Cause
Causes of obstructive nephropathy
Stones (30%):
Stones are the most common cause of endoluminal obstruction and can occur anywhere in the ureter but at most in three natural transitions or stenosis, or in the small lumen of the kidney. Intrarenal stones are caused by many metabolic disorders, such as uric acid crystals or the use of less soluble sulfa drugs. In some cases of multiple myeloma, a large amount of pre-week protein can be deposited in the renal tubules to cause obstruction. Some necrotic tissue in cases of renal papillary necrosis can fall off and cause obstruction. In addition, the formation of blood clots in the urinary system may also block the urinary tract, and the latter two cases are mostly outside the kidney.Bladder dysfunction (15%):
Most of the causes of urinary tract obstruction caused by bladder dysfunction are neuropathy, which may be caused by congenital muscle dysplasia or spinal cord dysfunction. Acquired is common in diabetes, cerebrovascular disease, multiple sclerosis or Parkinson's disease.Obstruction outside the urinary tract (15%):
Obstruction caused by urinary tract is often caused by the reproductive system, the rib system, and other diseases of the blood vessels or the posterior peritoneum. Prostatic hypertrophy or tumors are often the cause of male morbidity. Women are caused by many factors such as palace and ovary. Crohn's disease or other gastrointestinal tumors can compress the ureter and cause obstruction. Retroperitoneal lesions can be caused by inflammation, tumors (primary or metastatic, etc.). Pathogenesis of urinary tract obstruction is many reasons, according to the nature of obstruction, can be divided into mechanical obstruction and dynamic obstruction, mechanical obstruction is the majority, but also complete and incomplete, acute and chronic, intermittent and persistent points, The lesions in the urinary system can be the cause of obstruction, and a few lesions outside the urinary system can also cause urinary obstruction. Urinary system obstruction can sometimes be iatrogenic, such as surgery and instrumentation damage, after pelvic tumor radiotherapy The response, etc., in infants, congenital lesions caused by more obstruction, such as stenosis of the foreskin, posterior urethral valve, etc., young adults with urinary calculi, infection or traumatic stenosis caused by obstruction is common. In women, attention should be paid to the lesions in the pelvic cavity, while in the elderly, prostate hyperplasia and tumors are common causes. The common causes are shown in Table 1. 1. There is deposition of uric acid, sulfonamide crystals, multiple myeloma light chain in the small lumen. 2. There are stones in the urinary tract, necrotic papilla tissue and blood clots. 3. Urinary wall (1) ureter: dysfunction of ureter-renal junction, dysfunction of ureter-bladder junction. (2) bladder (neurological): 1 congenital spinal dysplasia. 2 Acquired for spinal cord spasm, diabetes, multiple sclerosis of the brain, spinal cord trauma, Parkinson's disease and cerebrovascular accident. (3) bladder neck dysfunction: substantial lesions have tumors, granuloma after infection, posterior and anterior urethral valve, ureteral fistula, foreskin is too long, urethral stricture, abscess around the urethra. 4. Extra-urinary factors (1) Male reproductive system has benign prostatic hyperplasia, prostate cancer. (2) Female patients have pregnancy, uterine tumor, cervical cancer, uterine ptosis, endometrial displacement, ovarian tumor and ovarian abscess. (3) Digestive system includes Crohn's disease, diverticulitis, pancreatitis, appendix abscess, malignant tumor. (4) vascular system has ureter-renal junction ectopic blood vessels, abdominal aorta and radial artery hemangioma, ovarian vein thrombosis, ureter after vena cava. (5) post-peritoneal inflammation, fibrosis, postoperative complications, tumors (lymphoma, sarcoma), tumor metastasis (cervix, large intestine, bladder), pelvic lipoma, bleeding, etc. Neurogenic bladder originates from central nervous system lesions, causing involuntary urination or spinal cord lesions to cause tension-free bladder, bladder-ureteral reflux, ureteral dilatation, and increased posterior pressure affecting renal parenchyma, a common cause of spinal cord malformation in children. Ureteral stenosis is a complication after posterior peritoneal surgery or cervical cancer radiotherapy, occasionally caused by painkillers caused by kidney disease, granulomatous lesions involving the ureter, ureteral cancer can occur obstruction, often combined with double replication ureter, urethral stricture occurs more Sub-device applications, post-surgical or gonorrhea, pelvic, ureter, bladder benign and malignant tumors can cause urinary tract obstruction, and pyelonephroma is a common malignant lesion. During pregnancy, ureteral peristalsis is weakened and urine is stagnant. It is not true obstruction. It is caused by luteal effect. Cervical cancer can be compressed into the ureter due to its proximity to the ureter and distant tumors. The male benign prostatic hypertrophy is the common cause of obstruction. Prostate cancer is the main cause of urinary tract obstruction in the elderly. Crohn's disease spreads through the inflammation to the posterior peritoneum, mainly involving the right ureter, chronic pancreatitis, especially in the case of pseudocysts can cause left ureteral obstruction, appendicitis and large intestine diverticulitis can produce posterior peritoneal scar tissue, causing obstruction. Vascular lesions in the abdominal aortic aneurysm is a rare cause of obstruction, ectopic blood vessels can cause obstruction at the ureter-kidney junction, and the ureter after the vena cava is the right ureter after the vena cava causes different degrees of obstruction, mostly male (the ratio of male to female is 3) : 1), manifested as intermittent abdominal pain, often similar to renal colic, and urinary tract infection, female ovarian varicose veins, close to the right ureter is the cause of uncommon obstruction, especially in postpartum pelvic vein thrombosis, venous valve loss , vein expansion. Post-peritoneal tumor metastasis, primary lesions from the cervix, prostate, bladder, ovary, large intestine are common causes; rare causes of post-peritoneal fibrosis, involving 1/3 of the ureter, pulling in the middle, long-term use of Methysergide and Ergoline derivative, caused by lysine vinylamine, other diseases that may be associated with peritoneal fibrosis include lower extremity lymphangitis, multiple abdominal surgery, allergic purpura, hemorrhage, biliary tract disease, chronic urinary tract infection, tuberculosis, Sarcoidosis. (B) the pathogenesis 1. Hemodynamic changes in the urine from the kidneys to the bladder must pass liquid hydrostatic pressure, renal pelvic ureteral peristalsis, urine flow rate and other factors, urinary tract collection from the epithelial wall layer and ring, vertical two smooth muscle Composition, activity from the contraction wave of the smooth muscle cells of the renal pelvis to the renal pelvis and ureter caused contraction, contraction makes the urine from the renal pelvis into the ureter, in the ureter, the annular smooth muscle contraction of the ureter wall, closing the lumen so that the pressure of the posterior renal tissue does not occur The so-called joint; then the longitudinal smooth muscle contraction will push the urinary tract urine down the ureter, when the urinary tract is obstructed, the pressure in the urinary tract is increased, and the jointing effect is lost, and the posterior pressure is transmitted to the renal pelvis and the renal nipple. The pressure and urine volume of the posterior conduction, the obstruction site above the bladder, unilateral or bilateral, incomplete or complete. In the first 1 to 2 hours after ureteral obstruction, renal blood flow increased significantly. Due to the decrease of renal vascular resistance, renal blood flow gradually decreased after obstruction, and decreased to 40% to 50% of normal blood flow by 24h. Decreased filtration rate resulted in a significant decrease in filtration fraction. The GFR was only 20% to 30% of normal at 24 hours. After the obstruction was removed, the intra-tubular pressure returned to normal, but the glomerular filtration rate was still low and renal vascular resistance increased. It gradually returned to normal after about 1 week. Renal blood flow occurs during the onset of obstruction, and vasopressin thromboxane A2 and angiotensin II play a major role, both of which cause mesangial cells to contract, reducing glomerular filtration area, which occurs after obstruction The role of hemodynamic changes is also confirmed by animal experiments. Angiotensin-converting enzyme inhibitor and thromboxane synthase inhibitor can prevent renal dysfunction after obstruction and renal interstitial mononuclear obstruction. Cell infiltration is associated with the production and release of prostaglandins. In the irradiated animals, the infiltration of interstitial mononuclear cells is eliminated, the production of thromboxane is prevented, and renal function is improved after obstruction. Atrial natriuretic peptide also participates in hemodynamic changes after obstruction. Plasma levels of atrial natriuretic peptide are different in unilateral and bilateral ureteral obstruction, bilateral is higher than unilateral, and atrial natriuretic peptide causes dilatation of the arteriole The balllet arteries contract, increase the glomerular filtration fraction, and increase the glomerular filtration rate in patients with obstruction. In addition, when the ureteral pressure increases, renal nerve activity increases; the removal of nerves increases renal blood flow and glomerular filtration rate. 2. Sodium ion excretion and diuresis after obstruction In acute partial unilateral ureteral obstruction, urinary sodium and potassium excretion are significantly reduced, urinary sodium concentration is reduced, urine osmotic pressure is increased, and when ureteral pressure is increased, renal tubules Reabsorption of sodium and water increased significantly, in the case of chronic partial obstruction, the glomerular filtration rate gradually decreased, increased filtration of sodium and excretion fraction, indicating renal tubular reabsorption decreased, after the complete bilateral obstruction Significant diuretic phenomenon occurs, a large amount of water, sodium and other solute discharge, can lead to water, electrolyte loss, the occurrence of this diuretic phenomenon of physiological and pathological three kinds of physiological, the total extracellular volume after the complete obstruction, activation Natriuretic factor; renal dysfunction after bilateral complete obstruction, urea nitrogen retention, glomerular filtrate containing urea nitrogen and other solutes, causing osmotic diuresis; due to obvious diuretic after the obstruction is relieved and replenishing a large amount of fluid, The pathological factor is that the glomerular filtration rate recovers to a considerable extent so that the retained water and solute reach the renal tubule, while the latter has a reabsorption function; End and a distal tubule sodium reabsorption reduced; antidiuretic hormone sensitive manifold not recovered. 3. Urine concentrating dysfunction Urine concentrating dysfunction is a characteristic of obstructive nephropathy. Patients with obvious dysfunction have renal diabetes insipidus, polyuria, and low urine. If the water intake is insufficient, it can cause severe dehydration and hypernatremia. The function recovery after the obstruction is relieved often takes several months, and the mechanism of urinary concentrating dysfunction is as follows: (1) The hypertonic state cannot be established in the renal medulla interstitial: the defect of chloride and sodium transport in the medullary sputum, medulla The hypertonic state cannot be established in the interstitium, and the osmotic suction tension of water from the collecting duct to the renal interstitial is reduced, and the decrease of the extrarenal pulp Na-K-ATPase activity may participate in this defect. (2) renal tubular antidiuretic sensitivity reduction: direct and indirect effects of obstruction on renal tubular epithelium, so that the role of vasopressin is not sensitive, the injection of antidiuretic hormone can not reduce urine output and increase urinary tension, can not increase the urinary ring Adenosine phosphate, an increase in prostaglandin E2 production in the renal medulla of obstructed kidneys, also reduces the sensitivity of the collecting tube to antidiuretic action. (3) increase of osmotic load: due to the decrease of glomerular filtration rate, the solute content per milliliter of glomerular filtrate is relatively increased, and the concentration of urinary concentration and urine dilution in each nephron is increased. Part of the urinary concentrating dysfunction involved in obstructing the kidney.Prevention
Obstructive kidney disease prevention
The disease has a variety of causes, prevention should first clear the cause of obstruction, and give special treatment, try to relieve urinary tract obstruction to improve the urinary tract smooth condition, for diseases that can not remove obstruction, can transfer urine flow through ureteral ileal anastomosis If necessary, obstructive nephrectomy should be considered. Only the cause of obstruction and active treatment should be used to protect renal function and prolong the survival of patients.
Complication
Obstructive nephropathy complications Complications bacteremia hydronephrosis hypertension
1. Infection: The most dangerous thing about urinary tract obstruction is that bacteria with urine can enter the blood through the fissures of the renal pelvis, or enter the blood through the epithelial layer of the urinary system that becomes extremely thin when highly inflated. Therefore, when the obstruction is combined with infection, not only The infection is difficult to control and is prone to develop bacteremia.
2. Hydronephrosis: hydronephrosis caused by prolonged obstruction will eventually lead to a gradual decline in renal function, and no urine can occur when bilateral kidney or isolated kidney is completely obstructed, resulting in renal failure.
3. High blood pressure.
Symptom
Obstructive nephropathy symptoms common symptoms dysuria, fatigue, polyuria, high blood pressure, more urinary frequency, abdominal mass, loss of appetite, ascites, nausea
Obstructive nephropathy is a common cause of renal failure, clinical manifestations vary, can be acute, can also be chronic progressive or almost asymptomatic; completely depends on the cause of obstruction, length of obstruction, acute or chronic, partial or complete, Unilateral or bilateral and complication with different manifestations.
1. Changes in urine volume: oliguria, no urine or polyuria, mostly caused by bilateral complete obstruction, lower abdomen and lumbar pain and acute renal failure, partial obstruction can cause polyuria, intermittent obstruction can Repeated oliguria or anuria, followed by obvious polyuria, especially in the past patients with the following history, pelvic surgery misplaced ureter; pelvic malignant tumor spread and invade the ureter, recent ureteral transplantation; long-term bladder neck obstruction, recent Ileum bladder reconstruction; indwelling catheter is not flushed, recent retrograde angiography.
2. Bladder symptoms: hesitating urination, fine urine flow, weak force, terminal drip, frequent urination, nocturia, dysuria, urinary retention, symptoms of lower urinary tract obstruction, occur in urethral stricture, prostatic hypertrophy, neurogenic bladder, prostate Or bladder tumor invades the bladder neck.
3. Pain: Pain can be a prominent symptom of urinary tract obstruction, severe cases of renal colic, severe pain, radiation to the external vaginal and groin, patients with intestinal paralysis, such as acute abdomen, unilateral obstruction in the ureter - The junction of the renal pelvis, or the ureter can be painless, or the dull pain in the waist occurs in the influent and the application of diuretics, the waist appears when urinating, and the pain in the abdomen is bladder-ureteral reflux.
4. Lump: long-term urinary tract obstruction can enlarge the kidney, hydronephrosis, lumps in the flank, especially in children, normal urine and renal pelvis only 5 ~ 10ml, persistent obstruction of the urinary tract, obstruction The upper part is enlarged, the renal pelvis and renal pelvis are significantly enlarged, the renal medulla is destroyed, and the cortex is a hardened thin layer.
5. Chronic renal failure: chronic slow-onset bilateral obstruction can first be treated with chronic renal failure, fatigue, loss of appetite, nausea, vomiting, edema, previous history of no kidney disease, urine test and no abnormalities in uremic patients should be considered Causes of chronic urinary tract obstruction, acute or chronic renal failure, gross hematuria should be considered due to tumor, stone or blood clot caused by urinary tract obstruction.
6. Renal tubular function defects: due to urinary tract obstruction, renal tubular dysfunction, water and sodium in the small tube reabsorption, causing polyuria, loss of water, loss of salt, renal diabetes insipidus performance, thirst, Drink more, due to lack of water, lack of circulating capacity, upright hypotension, renal function gradually reduced, high blood potassium, high blood chloride renal tubular acidosis.
7. Urinary tract infection: For refractory, recurrent urinary tract infection, should consider whether there is urinary tract obstruction or abnormal anatomical structure, more suspicion of urinary tract obstruction in male urinary tract infection, obstruction below the bladder It is most prone to bacteriuria, retention of urine in the bladder is conducive to bacterial reproduction, bladder with urinary retention and dilatation, and immunity to bacterial immunity is weakened.
8. Hypertension: acute or chronic hypertension, unilateral or bilateral hydronephrosis may be associated with hypertension, in bilateral hydronephrosis, sodium retention, hypertension is volume dependent, on one side Urinary tract obstruction, obstructive side renal venous renin level increased, blood pressure decreased after removal of obstruction, renal vein renin level returned to normal, hypertension is renin dependent.
9. Polycythemia: hydronephrosis may be associated with polycythemia, and elevated plasma erythropoietin levels are found in unilateral obstruction.
10. Neonatal ascites: Ascites is found in neonates with bilateral urinary tract obstruction, more common in male newborns with urethral valves.
At the time of diagnosis, it is first determined whether there is obstructive nephropathy, and then the cause of the obstruction, the location of the lesion, the degree, the presence or absence of infection, and the impairment of renal function are ascertained.
History should be understood in the history of surgery, medication history, gynecological and intestinal disease history, bladder symptoms and changes in urine volume, physical examination should pay attention to the abdominal mass, lower abdominal bladder, parallel rectal examination and pelvic gynecological examination, in order to clear obstruction The location and scope, need to use the above various laboratory examinations and imaging, ultrasound, radionuclide kidney chart examination, if there is a corresponding change can be clearly diagnosed.
Examine
Examination of obstructive nephropathy
Laboratory inspection
1. Urine examination: In acute and chronic urinary tract obstruction, red blood cells and white blood cells can appear in the urine, generally no proteinuria or mild proteinuria, urine protein <1.5g/24h, urine culture can be found with or without infection Centrifugal sedimentation to find crystals to find various stone components, low urinary sodium concentration, increased osmolality, and urinary characteristics similar to prerenal renal failure in newly obstructed cases; small tube injury caused by chronic obstruction, increased urine sodium concentration, urine The osmotic pressure is reduced, the ratio of urine and plasma creatinine is reduced, and the urine test features similar to acute tubular necrosis can be used as a urine concentration function and a uric acid function test as needed.
2 blood test: blood gas analysis to determine the pH and determination of blood chlorine, potassium, sodium, to determine the four types of renal tubular acidosis that can occur in chronic obstruction, blood and urine urea nitrogen, creatinine measurement can be seen disproportionately elevated (Normally about 10:1), because in the obstructive nephropathy, the flow rate of urine in the small lumen is slowed down, and urea reabsorption increases.
Film degree exam
1. Pathophysiology: No matter what causes urinary tract obstruction, the basic pathological changes are urinary dilatation above obstruction, initial wall muscle thickening, increased contractility, late compensatory capacity, thin wall, muscle Atrophy and hypotonia, when the urinary tract obstruction, the pressure in the renal pelvis increases, if the pressure reaches the equivalent of glomerular filtration pressure, the glomerulus stops filtering, the urine formation also stops, but the blood circulation in the kidney remains normal, this When the "safety valve" in the kidney is open, the urine in the renal pelvis can pass through the renal pelvis vein, the reverse flow of lymph and renal tubules and extravasation around the renal pelvis, so that the pressure in the renal pelvis and renal tubules is slightly decreased to maintain the urinary function of the kidney. However, the obstruction failed to be relieved, the secretion of urine and the reflux were unbalanced, and the increase of internal pressure continued, resulting in the expansion of the renal pelvis, the accumulation of water, the increase of the urinary pressure, and the compression of the renal blood vessels, resulting in ischemia of the renal tissue. , hypoxia, atrophy, renal tubular secretion and reabsorption function, and eventually hydronephrosis, become a loose, non-functional water sac, visible pathological changes of obstructive nephropathy by four factors : increased pressure in the ureter, decreased renal blood flow, macrophage and lymphocyte infiltration and bacterial infection, obstruction caused by hydronephrosis, renal pelvis expansion, nipple flat, external pores, cortex into a thin layer surrounded by capsular bag Renal ureter, histology shows dilatation of the tubule system, mainly the collecting duct and distal tubule, the proximal tubule also sees dilatation, the parietal epithelial cells flatten atrophy and tubule ischemia, the renal small cystic dilatation, the fiber around the glomerulus Renal, renal interstitial fibrosis and mononuclear cell infiltration.
2. X-ray examination: abdominal plain film and X-ray body layer film are routine early examination methods, the difference in kidney size between the two sides > 2cm or calcification shadow, suggesting that obstructive nephropathy may be, patients with chronic renal failure have normal kidney size Prompt for this possibility, the tomographic image can better display the outline of the kidney and its size, and find smaller calcification points.
3. Contrast examination
(1) Intravenous pyelography (IVP): It is often the preferred method of examination for obstructive nephropathy. It can correctly display the kidney, renal pelvis, renal pelvis, ureter and roughly reflect renal function. The contrast agent is hypertonic water-soluble iodized salt, vein. Immediately after injection, it is filtered by glomerulus and reabsorbed without small tube. Water and sodium are reabsorbed and concentrated in the small lumen. It shows a uniform density of kidney shadow. It is developed in the renal pelvis 2 minutes after injection, and the kidney function is developed. Poor, development delay, and gradually develop after a long time.
Early acute obstruction can be seen in the expansion of the collecting system. Chronic obstruction can be seen in hydronephrosis. IVP may indicate obstruction in the renal pelvis, ureter, ureter-bladder junction or bladder outlet. Careful observation can be seen that the bladder wall is thickened, trabecular formation, prostate enlargement, lower Urinary tract such as bladder neck obstruction can be injected into the bladder through the catheter, and bladder urethra photography when urinating. This method is also used to find bladder-ureteral reflux, and venous pyelography can find urinary X-ray transparent stones.
Diuretic tract dilatation or no hydronephrosis can not prove the presence or absence of urinary tract obstruction, congenital ureter and bladder dysfunction, bladder-ureteral reflux, chronic massive urination such as renal diabetes insipidus can cause urinary tract dilatation, intermittent Sexual obstruction or partial obstruction may not be accompanied by urinary tract dilatation and hydronephrosis, urinary tract obstruction without urinary dilatation may have staghorn calculi in the renal pelvis, posterior peritoneal fibrosis causes ureteral constriction, acute obstruction accompanied by extracellular fluid volume reduction However, the flow rate of urine is reduced.
(2) radionuclide angiography: for the diagnosis of upper urinary tract obstruction, intravenous radionuclide and scanning photography, intravenous tracer marker radionuclide 99mTc-DPTA or 131I mark hippuric acid, continuous photography showing urinary dynamics, Intravenous furosemide 0.3 ~ 0.5mg / kg, can help determine mechanical obstruction, diuretics rapidly increase the excretion of urinary tract tracer nuclides, so that the urinary tract expansion, degree of expansion > 20% suggest ureter and pelvis junction obstruction .
(3) ureteral pyelography: after IVP, ultrasound or radionuclide angiography to find the location and cause of urinary tract obstruction, retrograde or anterior pyelography can provide more detailed evidence, especially in other methods of poor renal development, the need For more detailed anatomical organization, this check is helpful.
For bladder and posterior urethral obstruction, cystoscopy is superior to other angiographic examinations. The ureteral retrograde catheter can be used for one or both sides of the urine for examination. The contrast can be used to clear the obstruction in the ureter. The treatment can relieve the ureter or ureter-pyelone. Obstruction of the joint.
The pyelography is performed by percutaneous puncture into the dilated renal pelvis, the pressure in the renal pelvis is measured, urine is taken for culture and cell examination, and the ureter can be clearly displayed after the injection of the contrast agent, and the obstruction can be removed by resection if necessary.
4. CT and MRI examination: CT and MRI are not used as the initial examination method. Because of the large amount of radiation received, the price is relatively expensive. However, because it can display different densities of tissues, it can provide anatomical structure in detail, especially after diagnosis of peritoneal obstruction. The reason is a helpful method of examination. CT is easy to find radioactive uric acid stones. CT can better define the location and nature of obstruction. It is replacing traumatic retrograde and anterior pyelography. MRI is also like CT. The density of each tissue is shown to determine the cause of obstruction.
5. Ultrasound examination: Ultrasound examination is very effective in diagnosing renal pelvis and renal pelvis enlargement. It is the first method for diagnosing hydronephrosis. Because it is a non-invasive examination, it is the most indication for the diagnosis of hydronephrosis with renal failure. It is also suitable for the diagnosis of fetal hydronephrosis during pregnancy. Due to the high sensitivity of the increase in renal pelvis volume, sometimes false positives may occur. Another defect is that it does not provide obstruction sites and causes.
6. Nucleoside renal examination: can understand the degree of obstruction and obstruction on both sides of the kidney, as well as the function of the kidney, which is helpful for the choice of treatment options, but can not determine the cause and location of the obstruction.
Diagnosis
Diagnosis and diagnosis of obstructive nephropathy
Obstructive nephropathy can occur at any age, young children, children, adults, and the elderly. It should be thought of in the differential diagnosis of kidney disease, because the damage and recovery of renal function is related to the degree of obstruction, location, etiology and obstruction. Therefore, early diagnosis is difficult, but early diagnosis and timely treatment are crucial, which is related to the treatment results and recovery of the disease.
Obstructive nephropathy should be differentiated from kidney diseases caused by other causes, such as lupus nephropathy. In addition, various urinary tract obstructive nephropathy should be differentially diagnosed with each other.
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