Dr. med. Dirk Manski

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Hydronephrosis and Upper Urinary Tract Obstruction: Differential Diagnosis

Definition of Hydronephrosis

Upper urinary tract obstruction results in urinary stasis and pressure increase in the kidney. It may lead to urinary tract infection and urosepsis and if long-lasting, there is a risk of renal insufficiency.

Grading of Hydronephrosis


Renal ultrasound: hydronephrosis grade II with dilatation of the renal pelvis and calyces. With kind permission, Dr. A. Passon, Augsburg.
figure Renal ultrasound: hydronephrosis grade II

Differential diagnosis of Hydronephrosis

Urinary retention:

Ureter diseases causing hydronephrosis (intrinsic causes):

Iatrogenic Causes of Hydronephrosis:

Hydronephrosis due to Vascular Diseases:

Gynecological Diseases Causing Hydronephrosis:

Hydronephrosis caused by Diseases of the Retroperitoneum:

Diagnostic Workup in Hydronephrosis


Classification of hydronephrosis in grade I–IV (Beetz and others, 2001).
Hydronephrosis grade I: dilatation of the renal pelvis without dilatation of the calyces. Prominent reflex of the renal sinus without signs of parenchymal atrophy.
Hydronephrosis grade II: dilatation of the renal pelvis and calyces. Attenuated sinus reflex. No signs of parenchymal atrophy.
Hydronephrosis grade III: Missing or marginal sinus reflex. Minor signs of organ atrophy present (flat papillae and blunt fornices).
Hydronephrosis grade IV: massive dilatation of the renal pelvis and calyces. Borders between renal pelvis and calyces are missing. Significant signs of renal atrophy (thin parenchyma).
figure classification and grading of hydronephrosis






Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

Gleason, P. E.; Kelalis, P. P.; Husmann, D. A. & Kramer, S. A. Hydronephrosis in renal ectopia: incidence, etiology and significance
J Urol, 1994, 151, 1660-1



  Deutsche Version: Differentialdiagnose Harnstau