Extrarenal obstruction

Introduction Obstruction includes intrarenal obstruction and extrarenal obstruction: the former mainly has uric acid crystals and a large amount of peri-peripherin precipitation to block renal tubules. In addition, in recent years, severe nephrotic syndrome causes renal tubulointerstitial edema to compress renal tubules, which is particularly important for nephropathy. One of the important reasons for the syndrome combined with ARF; extrarestrial obstruction mainly urinary calculi, prostatic hypertrophy or hyperplasia, diabetic patients often cause urinary tract obstruction due to renal papillary necrosis.

Cause

Obstructive nephropathy is a disease that causes renal function and substantial damage due to urinary flow disorders. The disease can occur acutely or chronically. The lesion is often unilateral, but in many cases it can be bilateral. Urinary tract obstruction is usually an important cause of obstructive nephropathy, but if the obstruction does not affect the renal parenchyma, it is not called obstructive nephropathy, but is called obstructive uropathy. Hydronephrosis is usually a clinical finding in obstructive nephropathy, but many obstructive nephropathy (such as intrarenal obstruction) does not necessarily have hydronephrosis. At the same time, many cases, especially congenital ureteral malformations, can have pyelectasis during the examination, but not necessarily hydronephrosis.

The main causes of urinary tract obstruction are the ureter itself and the two major categories of ureters. The ureter itself is divided into two categories: intraluminal obstruction and ureteral wall obstruction. 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.

The ureteral wall itself has two major categories of functional and anatomical abnormalities. The former is often caused by the normal operation of the running muscles in the tube, and the muscles can be prevented from running normally due to the ureteral longitudinal muscle or the ring running muscle disorder. There are many junctions in the pelvic pelvic cavity. Most of the children are bilateral, and the left kidney is often severe, so the performance is often prominent. The other group is mainly ureteral bladder junction barrier, also male, mostly unilateral. In both cases, most of the longitudinal muscle fibers are lacking and the ring muscles are relatively normal. Some people think that the mechanism is similar to that of the giant intestine, and most people think that the mechanisms are different.

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.

The ureteral wall lesions caused by anatomical lesions include stenosis caused by inflammation, tumors, and the like.

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.).

an examination

Related inspection

Renal angiography

Urine routine, ultrasound, and X-ray examination often not only establish a diagnosis, but also identify the cause.

The amount of urine in the urine test has been described above. Conventional differences may also vary depending on the cause. Most cases have proteinuria, but the amount is generally small. Red and white blood cells are often observed. Caused by stone tumors, etc., there are many cells, sometimes there are gross hematuria, combined infection can have more white blood cells. Caused by necrosis of the kidney, not only can there be more red blood cells in the urine, but also more white blood cells. At this time, the typical urine color is "washing water", and the necrotic tissue can be seen after the red gauze is filtered. Tube type examination often indicates the cause, such as caused by sulfa paste, uric acid, etc., and its special crystal can be attached to the tube type. In cases of co-infected patients, their urinary pH is often elevated. If the regular value is above 7.5, most of them have long-term obstruction, and the lesions are chronic.

In addition to the size of the kidney, the B-ultrasound can also detect the hydronephrosis, and many stones can be found. If the examination reveals that there is still a lot of urine in the bladder after urination, it suggests prostatic hypertrophy, tumor, or neurogenicity.

Abdominal plain film can detect positive urinary calculi, and those caused by Mycobacterium tuberculosis can see calcification in the abdominal cavity and kidney area, and the size of the kidney can be roughly observed. In addition to measuring the size of the kidney, CT can also detect whether there is expansion of the collecting duct system. It is characterized by the fact that if it is caused by a tumor (intrarenal or extrarenal), retroperitoneal lesions, etc., it is more important to confirm the diagnosis. A small number of special cases require retrograde ureteral contrast and contrast. Some cases of acute obstruction can help clear the cause after intravenous pyelography.

Obstructive nephropathy can occur at any age, young child, child, adult, and elderly. It should always be thought of in the differential diagnosis of kidney disease. Because the damage and recovery of renal function is related to the degree, location, etiology and obstruction of obstruction, early diagnosis is difficult, but early diagnosis and treatment are crucial, which is related to the treatment results and recovery.

At the time of diagnosis, it is first determined whether there is obstructive nephropathy, and then the cause, location, extent, presence or absence of infection, and renal dysfunction of the obstruction are ascertained.

History should be known in the history of surgery, medication history, gynecological and intestinal disease history, bladder symptoms and changes in urine output. Physical examination should pay attention to the abdominal mass, lower abdominal bladder, parallel rectal examination and pelvic gynecological examination. In order to clarify the location and extent of obstruction, it is necessary to use the above various laboratory tests and imaging, ultrasound, and radionuclide renal examination. The diagnosis can be confirmed if there is a corresponding change.

Differential diagnosis

Need to be identified with the following symptoms:

Embolization nephritis: Embolization nephritis is one of the manifestations of kidney in infective endocarditis with renal damage.

Chronic Kidney Damage: Chronic Renal Failure (CRF) is not an independent disease. It is the end-stage manifestation of deterioration of renal damage caused by various causes. A series of syndromes occur when the renal function is close to 10% of normal people. Generally, there is a relatively long course of disease, according to the degree of renal dysfunction, the degree of renal insufficiency is compensated; the decompensation period of renal insufficiency is also called azotemia; the stage of renal failure; the end stage is also called uremic stage.

Renal artery occlusion: Renal angiography of renal pelvic tumors and ureteral tumors may reveal thinning or obstruction of the intrarenal artery, often indicating infiltration.

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