II. Epidemiology

  1. Accounts for 1-10% of Acute Renal Failure cases
  2. More common in elderly

III. Pathophysiology

  1. Urinary Tract Obstruction
  2. Results in renal Pelvis dilatation
  3. Progressive decrease in Renal Function
    1. Increased intratubular pressure
    2. Decreased capillary filtration pressure

V. Symptoms

  1. Abdomen or Groin Pain (colic-type attacks)

VI. Signs

  1. Mass at flank, suprapubic, or central Abdomen
  2. Abdominal exam
  3. Pelvic exam
  4. Rectal exam
  5. Anuria (Indicates obstruction in 90% cases)

VII. Labs

  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hematuria
    3. Pyuria
    4. Crystals

VIII. Diagnostic Testing

  1. Post-void residual >100 ml
    1. Indicates Bladder outlet obstruction
  2. Ultrasound or Intravenous Pyelogram
    1. Dilated ureters or renal Pelvis
  3. Abdominal CT or Abdominal MRI
  4. Percutaneous Nephrostomy drainage trial

IX. Management

  1. See Acute Kidney Injury Management
  2. Exclude reversible causes rapidly
  3. Renal Function recovery reflects obstruction duration

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Related Studies

Ontology: Hydronephrosis (C0020295)

Definition (CHV) water retention in the kidney
Definition (CHV) water retention in the kidney
Definition (NCI) Collection of urine in the renal pelvis that results in dilatation of the renal pelvis and calyces. It is caused by obstruction of urine flow, nephrolithiasis, or vesicoureteral reflux. Signs and symptoms include flank pain, nausea, vomiting, fever, and dysuria.
Definition (NCI_NCI-GLOSS) Abnormal enlargement of a kidney, which may be caused by blockage of the ureter (such as by a kidney stone) or chronic kidney disease that prevents urine from draining into the bladder.
Definition (CSP) distention of the pelvis and calices of the kidney with urine, as a result of obstruction of the ureter, with accompanying atrophy of the parenchyma of the organ.
Definition (MSH) Abnormal enlargement or swelling of a KIDNEY due to dilation of the KIDNEY CALICES and the KIDNEY PELVIS. It is often associated with obstruction of the URETER or chronic kidney diseases that prevents normal drainage of urine into the URINARY BLADDER.
Concepts Disease or Syndrome (T047)
MSH D006869
ICD9 591
ICD10 N13.30
SnomedCT 197791000, 155866001, 43064006
English Hydronephroses, Hydronephrosis, HYDRONEPHROSIS, Hydronephrosis NOS, hydronephrosis, hydronephrosis (diagnosis), Unspecified hydronephrosis, Hydronephrosis [Disease/Finding], hydronephroses, Hydronephrosis NOS (disorder), Hydronephrosis (disorder)
French HYDRONEPHROSE, Hydronéphrose, Syndrome de la jonction pyélo-urétérale
Portuguese HIDRONEFROSE, Hidronefrose
Spanish HIDRONEFROSIS, hidronefrosis, SAI (trastorno), hidronefrosis, SAI, hidronefrosis (trastorno), hidronefrosis, Hidronefrosis
German HYDRONEPHROSE, Harnstauungsniere, Hydronephrose, Wassersackniere
Japanese 水腎症, スイジンショウ
Swedish Hydronefros
Czech hydronefróza, Hydronefróza
Finnish Hydronefroosi
Polish Wodonercze
Hungarian hydronephrosis
Norwegian Hydronefrose
Dutch hydronefrose, Hydronefrose, Nefrose, hydro-
Italian Idronefrosi

Ontology: Urinary tract obstruction (C0178879)

Definition (NCI_CTCAE) A disorder characterized by blockage of the normal flow of contents of the urinary tract.
Definition (NCI) Blockage of the normal flow of contents of the urinary tract.
Concepts Disease or Syndrome (T047)
ICD9 599.60, 599.6
ICD10 N13.9
SnomedCT 266567006, 266636004, 197936002, 7163005
English Urinary obstruction unspecif., Urinary obstruction unspecified, obstructive uropathy (diagnosis), obstructive uropathy, urinary obstruction (diagnosis), urinary tract obstruction (diagnosis), urinary obstruction, urinary tract obstruction, Urinary tract obstruction NOS, Uropathy obstructive, Urinary Tract Obstruction, Urinary obstruction NOS, obstructive uropathies, obstruction urinary tract, obstruction tract urinary, obstruction urinary, obstructions tract urinary, Urinary obstruction, Urinary obstruction unspecif, Urinary obstruction unspecified (disorder), Obstructive uropathy, unspecified, Obstructive uropathy, Urinary tract obstruction, Urinary tract obstruction (disorder), obstruction; urinary, obstructive; uropathy, urinary; obstruction, uropathy; obstructive, Obstructive uropathy, NOS, Urinary tract obstruction, NOS, Obstructive Uropathy, Urinary obstruction, unspecified, Obstructive uropathy NOS, Urinary (tract) obstruction NOS
Italian Ostruzione delle vie urinarie, Uropatia ostruttiva, Ostruzione urinaria, non specificata, Ostruzione delle vie urinarie NAS
Dutch uropathie obstructief, urinewegobstructie NAO, urine-obstructie niet-gespecificeerd, obstructie; urine, obstructief; uropathie, urine; obstructie, uropathie; obstructief, obstructieve uropathie, urinewegobstructie
French Obstruction urinaire non précisée, Obstruction des voies urinaires SAI, Obstruction des voies urinaires, Uropathie obstructive
German Harnwegsobstruktion NNB, Harnwegsobstruktion unspezifisch, Uropathie obstruktiv, Harnwegsobstruktion, obstruktive Uropathie
Portuguese Obstrução das vias urinárias NE, Obstrução urinária NE, Uropatia obstrutiva, Obstrução das vias urinárias
Spanish Obstrucción urinaria no especificada, Obstrucción del tracto urinario NEOM, obstrucción urinaria no especificada, obstrucción urinaria no especificada (trastorno), obstrucción de las vías urinarias, obstrucción urinaria, uropatía obstructiva (trastorno), uropatía obstructiva, Obstrucción del tracto urinario, Uropatía obstructiva
Japanese 尿路閉塞症、詳細不明, 尿路閉塞NOS, 尿路閉塞, 閉塞性尿路疾患, ニョウロヘイソクNOS, ニョウロヘイソクショウショウサイフメイ, ヘイソクセイニョウロシッカン, ニョウロヘイソク
Czech Blíže neurčená obstrukce močového ústrojí, Obstrukce močového ústrojí NOS, Obstrukční uropatie, Obstrukce močového ústrojí
Hungarian obstructiv uropathia, húgyúti obstructio k.m.n., húgyúti obstructio, Húgyúti obstructio, nem meghatározott, Obstructiv uropathia

Ontology: Urinary outflow obstruction (C0600039)

Concepts Anatomical Abnormality (T190) , Disease or Syndrome (T047)
SnomedCT 252028009
English Urinary outflow obstruction, Urinary outflow obstruction (disorder)
Spanish obstrucción del flujo urinario (trastorno), obstrucción del flujo urinario

Ontology: Postrenal failure (C1167727)

Concepts Disease or Syndrome (T047)
French Défaillance sous-rénale
Italian Insufficienza post-renale
Japanese 腎後性腎不全, ジンゴセイジンフゼン
Czech Postrenální selhání
Hungarian postrenalis veseelégtelenség
English Postrenal failure
Portuguese Insificiência pós-renal
Spanish Fallo postrenal
Dutch postrenaal falen
German postrenales Nierenversagen

Ontology: Postrenal azotemia (C2919641)

Concepts Disease or Syndrome (T047)
SnomedCT 445612002
English Postrenal azotaemia, Azotaemia due to urinary tract obstruction, Postrenal azotemia, Azotemia due to urinary tract obstruction, Postrenal azotemia (disorder)
Spanish azoemia por obstrucción del tracto urinario, azoemia posrenal (trastorno), azoemia posrenal