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Kidney Failure due to Obstruction
Kidney Failure due to Obstruction OVERVIEW
Obstructive uropathy is a condition in which the flow of urine is blocked. This causes the urine to back up and injure one or both kidneys. Obstruction of the urinary tract is a frequent cause of transient renal dysfunction, which, in the majority of cases, is reversible. Urinary obstruction can occasionally cause chronic renal failure, in spite of successful relief of the obstruction. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur.
Causes
Different types of ureteral obstruction have different causes, some of them present at birth (congenital). They include:
A second (duplicated) ureter
This common condition, which is congenital, causes two ureters to form on the same kidney. The second ureter can be fully or only partially developed. If either ureter doesn’t work properly, urine can back up into the kidney and cause damage.
A blockage (obstruction) where the ureter connects to the kidney or bladder.
This prevents urine flow. A blockage where the ureter and kidney meet (ureteropelvic junction) may cause the kidney to swell and eventually stop working. This condition can be congenital or can develop with typical childhood growth, resulting from an injury or scarring, or in rare cases, develop from a tumor. A blockage where the ureter and bladder meet may cause urine to back up into the kidneys.
Ureterocele
If a ureter is too narrow and doesn’t allow urine to flow completely, a tiny bulge in the ureter (ureterocele) may develop. When a ureterocele develops, it’s usually in the section of the ureter closest to the bladder. This can block urine flow and cause urine to back up into the kidney, possibly leading to kidney damage.
Retroperitoneal fibrosis
This rare disorder occurs when fibrous tissue grows in the area behind the abdomen. The fibres may grow as a result of cancer tumours or from taking certain medicines used to treat migraines. The fibres encircle and block the ureters, causing urine to back up into the kidneys.
Other possible causes
- Kidney stones
- Cancerous and noncancerous tumors
- Blood clots
- Enlarged lymph nodes
- Internal tissue growth, such as endometriosis in females
- Long-term swelling of the ureter wall, usually due to diseases such as tuberculosis or a parasite infection called schistosomiasis
Diagnosis of Obstructive uropathy
Often, Doctors diagnose ureteral obstruction disorders before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters, and bladder. Also, another ultrasound is performed after birth to reevaluate the kidneys.
If your doctor suspects you have an obstructed ureter, some of these tests and scans might be used to reach a diagnosis:
Blood and Urine tests
Your provider checks samples of your blood and urine for signs of infection and the presence of creatinine, which signals that your kidneys aren't working properly.
Ultrasound
An ultrasound of the area behind your abdominal organs (retroperitoneal ultrasound) allows your provider to view the kidneys and ureters.
Bladder Catheterization
To test for incomplete or blocked urine flow, your provider inserts a small tube (catheter) through the urethra, injects dye into your bladder, and takes X-rays of your kidneys, ureters, bladder and urethra before and during urination.
Renal Nuclear Scan
Your provider or a technician injects a tracer that contains a small amount of radioactive material into your arm. A special camera detects the radioactivity and produces images that your provider uses to evaluate the urinary system.
Cystoscopy
A small tube with a camera and light is inserted into your urethra or through a small incision. The optical system allows the provider to see inside the urethra and bladder.
Computerized Tomography (CT) Scan
A CT scan combines a series of X-ray views taken from many different angles and computer processing to create cross-sectional images of your kidneys, ureter and bladder.
Magnetic Resonance Imaging (MRI)
An abdominal MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues that make up your urinary system.
How common is Ureteral Obstruction?
Ureteral obstructions are fairly common. They are more common in men over 60 because the prostate (a gland that only men have, located around the outflow of the bladder) becomes enlarged as men age. The enlarged prostate can block the flow of urine and result in buildup of urine in the bladder. It can also push up against the ureter and cause a blockage. Another form of bladder outflow blockage is by buildup of pressure in the urinary bladder because of an injury to the nerves or weak muscles—which makes it more difficult for the ureters to empty
Signs and Symptoms of Obstructive Uropathy
The onset of obstructive uropathy can be very quick and acute, or slow and progressive. You’ll feel pain in your midsection on one or both sides of your body. The level and location of pain varies from person to person and depends on whether one or both kidneys are involved.
Fever, nausea, and vomiting are also common symptoms of obstructive uropathy. You may experience swelling or tenderness in the kidneys as urine flows backward into your organs.
A change in your urinary habits can indicate a blockage in your ureters. Symptoms to look for include:
- difficulty passing urine
- a slowed stream, sometimes described as a “dribble”
- a frequent urge to urinate, especially at night (nocturia)
- the feeling that your bladder isn’t empty
- decreased urine output
- blood in your urine
You may have a decrease in the amount of urine you expel if just one of your kidneys is blocked. Usually, both kidneys need to be blocked to impact urine output.
Symptoms in Unborn Children
Obstructive uropathy can be a problem in an unborn fetus. One of the signs of obstruction in an unborn baby is a level of amniotic fluids in the womb that’s lower than normal. Urine is one of the components of amniotic fluid. A fetus with obstructive uropathy is unable to urinate outside its body. This leads to a drop in amniotic fluid volume, which can lead to fetal or birthing complications..
Who is affected by ureteral obstruction?
People of all ages can have a blocked ureter. Patients with kidney stones, can have a blockage at any age. These blockages can happen in both men and women. Older men with enlarged prostates can also affected. In babies and children who have a ureteral obstruction, the cause is usually a birth defect that affects their urinary tract.
How do I know if I have ureteral obstruction?
If you suspect you have ureteral obstruction, you should see your doctor. Some of the signs of a blocked ureter are similar to symptoms of other conditions that need treatment, such as urinary tract infections (UTI), having pain, or not getting good urine output even when you drink plenty of fluids. It’s important to see your doctor for diagnosis and treatment.
Treatment of
The treatment you receive depends on the reason for the blockage. First, your doctor will perform a procedure to allow the urine to drain from your body. These procedures include
Procedures
- Inserting a ureteral stent: Doctors insert a thin tube in the ureter that holds the ureter open so urine can drain freely.
- Placing a catheter in the kidney: In this procedure, doctors create an opening, called a nephrostomy, in the skin near the kidney. They insert a catheter into the opening and drain urine directly from the kidney.
- Placing a catheter in the urinary bladder: This procedure is used if the blockage is at the outflow of urine from the bladder.
- After draining the urine, your doctor will address the reason for the blockage. Your doctor’s approach will depend on what caused the obstruction and the severity of the blockage.
Common Treatments
Common treatments for ureteral obstruction are:
- Medication: If an enlarged prostate is causing the blockage, doctors may prescribe:
- An alpha-blocker to relax the muscles of the prostate.
- A medicine called finasteride (Proscar®) that causes the prostate to shrink.
- Surgery: If the blockage is due to a birth defect or tumor, doctors can often perform surgery to remove the obstruction.
- Stent: Doctors can insert a stent (a thin, flexible tube) into the ureter to keep it open and allow urine to flow.
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FAQ
How do I know if I have ureteral obstruction?
If you suspect you have ureteral obstruction, you should see your doctor. Some of the signs of a blocked ureter are similar to symptoms of other conditions that need treatment, such as urinary tract infections (UTI), having pain, or not getting good urine output even when you drink plenty of fluids. It’s important to see your doctor for diagnosis and treatment.
What are the side effects of the treatment for ureteral obstruction?
The side effects of alpha-blockers include dizziness, headaches and fainting. Side effects of finasteride the medication used to shrink the prostate, include decreased sexual desire and increased hair growth.
Surgery to remove the obstruction or place a stent can have side effects such as discomfort and increased risk of infection.
What can I do to help relieve symptoms of ureteral obstruction?
If you have symptoms of ureteral obstruction, you should see your doctor right away. Symptoms can get worse if left untreated. Only a doctor can diagnose and treat ureteral obstruction.
How can you prevent ureteral obstruction?
There is no way to prevent ureteral obstruction caused by:
- A genetic condition.
- Tumor.
- Vascular disease.
- GI issues.
- Enlarged prostate.
To avoid developing a ureteral stone, one of the causes of ureteral obstruction, you should drink plenty of water and limit your sodium (salt) intake.
What is the prognosis (outlook) for patients who have ureteral obstruction?
The outlook for ureteral obstruction depends on whether the kidneys were damaged while urine was unable to drain. If doctors fix the blockage before serious kidney damage occurs, ureteral obstruction doesn’t usually have serious long-term effects. In severe cases, kidney failure and death can result from a ureteral obstruction if it is left untreated.
DR. ANAND UTTURE
MCh - Urology/Genito-Urinary Surgery, DNB - Urology/Genito - Urinary Surgery, MBBS, FICS, MS - General Surgery
Dr Anand Utture is a Senior Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology.
Book AppointmentWhen to see a Urologist Doctor
Make an appointment with your doctor if you have any signs and symptoms that worry you.
Seek immediate medical attention if you experience:
- Pain so severe that you can’t sit still or find a comfortable position
- Pain accompanied by nausea and vomiting
- Pain accompanied by fever and chills
- Blood in your urine
- Difficulty passing urine