Hydronephrosis - diagnosis

( A ) medical history because of its clinical manifestations and obstruction , time, speed occurrence , nature and the presence or absence of secondary infection related to the primary lesion , for which the diagnosis should be noted :
① may be asymptomatic in the early or latent chronic obstructive ;
② the sensitivity of the patient is closely related with the symptoms found . For abdominal mass , chronic low back soreness, refractory refractory urinary tract infections, such as patients with unexplained fever should consider the possible existence of upper urinary tract obstruction should be further examination. For children with intermittent abdominal mass in urine were more and more attention should be paid .
( B) The signs may percussion pain from kidney area , signs of further examination mass, abdominal mass determine whether the presence of upper urinary tract obstruction .
(C ) laboratory tests:
① Urinalysis : patients with early mild hydronephrosis may be normal urine , hematuria and proteinuria may occur when the development of calyx expand. A lot of proteinuria and tubular obstruction in the urinary tract are not common.
② renal function test : urinary tract obstruction in patients with hydronephrosis, renal function tests in general due to the compensatory and not appear on the contralateral side abnormalities, phenol red excretion of test and measurement , such as indigo carmine showed bilateral renal damage then the damage . When severe bilateral hydronephrosis , urinary flow slowly through the tubules , there are a lot of urea is reabsorbed , but creatinine is generally not absorbed, which leads to more than the normal ratio of 10:1 urea and creatinine . When renal parenchymal damage seriously affect renal function, serum creatinine and creatinine clearance rate will rise.
③ anemia : hydronephrosis occurs when kidney dysfunction .
(Iv ) X-ray examination:
① KUB : Display an enlarged kidney shadow, such as urinary tract calcification prompt appears ureteral stones causing obstruction.
② IVP : In addition to kidney function has been seriously damaged in general can provide more detailed information on where you can find the location and cause of obstruction ; renal pelvis, ureter expansion and the extent of light ; hydronephrosis from the thickness of the renal cortex and its developing density can be roughly estimated kidney function . Such as high-dose intravenous urography and television videos and movies while dynamic observation kidney, ureter peristalsis , to distinguish it as a mechanical or dynamic obstruction . And can be compared to the motility sides .
③ retrograde pyelography : renal dysfunction , intravenous urography may be retrograde display poor contrast for obstruction , the cause and degree of obstruction , but must be wary when retrograde contrast to the kidneys caused by bacteria into water pyonephrosis , or because of the contrast agent to stimulate intubation and obstruction of mucosal edema , increased the degree of obstruction never become completely full .
④ percutaneous renal ureterography : For developing venography is not ideal, retrograde angiography failed or are unsuitable for retrograde contrast , could by the waist in B ultrasound-guided renal biopsy in water antegrade angiography in order to understand the degree of obstruction , proximal to the obstruction of the ureter and renal pelvis circumstances , and with the urine collected for cytology and culture , but also for urinary drainage catheter .
⑤ angiography : All patients with suspected vascular malformations associated with obstructive lesions , according to the need for renal vascular , abdominal aorta , renal vein or inferior vena cava angiography in order to understand the relationship between cause and vascular obstruction . But also to understand the kidney blood supply, renal cortical thickness and other information from angiography .
⑥ cystourethrography : hydroureter patients with bilateral renal angiography can be used for this to see if there vesicoureteral reflux and primary bladder and other neurological diseases .
( Five ) ultrasound. Can understand the kidney, ureter degree of hydrocephalus , renal atrophy , may also be part of the reason for the initial detection of obstruction , and guidance for puncture angiography.
( Six ) radionuclide :
① radionuclide renography : In obstructive renal vascular phase and secretory phase diagram has a certain degree of repression , which is obstruction obstruction severity and time-related , mainly for excretion relative decline slowly. Figure help estimate the difference in renal function and degree of obstruction in the kidneys , but not for quantitative analysis.
② 131 Ⅰ radionuclide uptake scan γ camera reveals the difference : the slow transfer of radionuclides through the renal cortex flashing accumulate in the renal pelvis .
( Seven ) CT can understand the site of obstruction , contribute to the etiology of the obstruction detection, can clearly show the thickness of the kidney , ureter dilatation of renal cortex . And can also compare the structure and function of both sides .
( Eight ) and percutaneous nephrolithotomy and ureteroscopy can be observed cavity obstruction , and after this biopsy and expansion , cut, intubation and other treatment , but also through this for nephrostomy .
( Nine ) cystoscopy can be directly observed collection of urine kidney function tests bilateral ureteral catheterization of the side openings and quantitative analysis of urea , phenolsulfonphthalein or indigo carmine colorimetric test , and speculated pelvis capacity from urine after intubation for retrograde angiography.
( J) the internal pressure of the renal pelvis measuring percutaneous catheterization (> F18) simultaneously inserted inside the urethra from a F12 ~ 14 indwelling catheter in the bladder , remain open to drain the fluid bladder with saline or contrast agent to 10m1 / min flow rate injected pelvis, until the liquid is filled pelvis and upper urinary tract and bladder outflow injection speed ( both 10ml/min) are equal , after taking over pelvis Y- connection piezometric pressure recorded in the pelvis ( pelvis absolute pressure ) . Measured by the same catheter bladder pressure , absolute pressure will be deducted pelvis abdominal pressure ( bladder pressure ) is the relative pressure , normal is 1.18 ~ 1.47kpa (12 ~ 15cm) H2O,> 1.47kpa (15cmH2O) suggestive of mild obstruction :> 2.16kpa (22cmH2O) shows moderate obstruction ,> 3.92kpa (40cmH2O) is a serious obstruction.
If the load while injecting a contrast agent , but also to learn while filming or recording obstruction and causes.