Hydronephrosis

Introduction Hydronephrosis is caused by obstruction of the urinary tract and enlargement of the renal pelvis and renal tissue with renal tissue atrophy. Urinary tract obstruction can occur anywhere in the urinary tract, either unilaterally or bilaterally. The degree of obstruction can be complete or incomplete, and can cause hydronephrosis after a certain period of time. Stenosis or obstruction of any part of the urinary tract and normal function of the neuromuscular can cause obstacles in the passage of urine, causing obstruction of the urine flow. The upper part of the obstruction is gradually increased due to poor urine discharge, and the lumen is enlarged, eventually leading to Kidney water, expansion, thinning of the renal parenchyma, renal dysfunction, if bilateral obstruction, the consequences of uremia are serious.

Cause

The enlargement of the renal pelvis and renal pelvis caused by urinary tract obstruction is accompanied by renal atrophy. Urinary tract obstruction can occur anywhere in the urinary tract, either unilaterally or bilaterally. The degree of obstruction can be complete or incomplete, and can cause hydronephrosis after a certain period of time. Stenosis or obstruction of any part of the urinary tract and normal function of the neuromuscular can cause obstacles in the passage of urine, causing obstruction of the urine flow. The upper part of the obstruction is gradually increased due to poor urine discharge, and the lumen is enlarged, eventually leading to Water in the kidneys.

an examination

Related inspection

Urine routine urea nitrogen urea urine inclusion body examination

Clinical manifestations of hydronephrosis:

1. Symptoms of the primary disease, such as pain in the stones, hematuria in the tumor, urinary tract stenosis and dysuria.

2. The back side of the water is sore.

3. Concurrent infections include chills, fever, and pyuria.

4. The cystic mass of the affected side of the waist.

5. Chronic renal insufficiency, uremia, bilateral obstruction.

Auxiliary inspection:

1. Low back pain, cystic mass in the waist.

2. B-ultrasound: the kidney volume increases, the cortex becomes thinner, and the size of the substance is not equal to the liquid dark area.

3. X-ray intravenous urography showed hydronephrosis.

4. Isotope kidney map, obstructive kidney map.

5. Transurethral retrograde intubation angiography showed hydronephrosis.

Differential diagnosis

Differential diagnosis of hydronephrosis in the kidney:

1. Polycystic kidney disease: The age of onset is 40 to 60 years old, and more than half of the patients have hypertension. A cystic mass can be reached on one or both sides of the upper abdomen. However, the surface of the mass showed multiple cystic nodules and no fluctuations. IVU shows that the renal pelvis is stretched or deformed without expansion. Ultrasonography and radionuclide kidney scan showed an increase in bilateral kidney volume and multiple round cyst images in the kidney. CT examination showed an increase in both kidneys, and most cystic masses with smooth edges and different sizes were seen in the renal parenchyma.

2. Simple renal cyst: cystic mass can often be touched when the volume is increased. Ultrasound examination revealed a single rounded, transparent, dark area in the kidney area. IVU showed that the renal pelvis and renal pelvis were compressed, deformed, and displaced without water accumulation. CT examination showed a low-density mass with a thin circular wall and clear boundaries. After enhancement, the density of renal parenchyma increased and the mass did not increase.

3. Peripheral cysts: cystic masses with unclear borders may appear at the waist. The mobility of the mass is poor and the sense of fluctuation is not obvious; however, there is often a history of trauma. IVU showed that the kidney was shrunk and displaced, but the renal pelvis and renal pelvis were normal and no expansion. Ultrasound examination revealed a darkened area around the kidney.

4. Adrenal cysts: large cystic masses can be found in the waist. X-ray plain film can be seen in circular calcification; IVU shows that the kidney moves down and the renal axis is under pressure, and the renal pelvis and renal pelvis have no deformation and expansion. Retroperitoneal angiography, ultrasonography, and CT examination showed images of cystic masses in the adrenal region.

5. Mesenteric cyst: The abdomen can reach a cystic mass with a clear edge. However, the mass is shallower and moves to the left and right; there is a symptom of intestinal obstruction; there is a sign of compression on the X-ray of the gastrointestinal tract.

6. Pancreatic cyst: The left upper abdomen can reach a cystic mass with unclear margin. But often accompanied by abdominal trauma or history of acute pancreatitis; more common in adults; no urinary system performance; urine sugar test positive; gastrointestinal tract barium meal X-ray examination has signs of compression.

7. Liver cyst: cystic mass can be reached under the right upper abdomen or under the xiphoid process. However, the location of the cyst is superficial, easy to reach, tenderness is obvious; no urinary system symptoms are included; ultrasonography and radionuclide liver scan show signs of cyst.

8. Horseshoe Kidney: The umbilical area of the abdomen touches a uniform and substantial mass. When accompanied by water accumulation, irregular cystic mass can be touched, but IVU shows that the kidney axis is inverted, and the shadow of the isthmus connecting the two kidneys is visible in the middle. The renal pelvis on both sides is lower and close to the midline. The inside stretches.

9. During normal pregnancy, there is often mild renal and ureteral water in addition to the uterus compression of the ureter, which is caused by the relaxation of renal ureter muscle during the secretion of progesterone during pregnancy. This is a physiological change that occurs almost on the right side due to the anatomical relationship.

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