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Published on: February 2, 2021
Acute Kidney Injury Caused by Obstructive Nephropathy
Jonathan S Chávez-Iñiguez1,2, Goretty J Navarro-Gallardo1,2, Ramón Medina-González1,2
1Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
Abstract:
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. 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. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
Insights
Acute kidney injury from obstructive nephropathy impacts kidney function via ischemia and inflammation. Prompt diagnosis and treatment, including urinary tract drainage, are crucial for recovery and preventing long-term kidney damage.
Area of Science:
- Nephrology
- Urology
Background:
- Obstructive nephropathy causes 5-10% of acute kidney injury cases, significantly impacting patient morbidity and mortality.
- Urinary tract obstruction leads to kidney damage through ischemia, inflammation, and fibrosis, affecting fluid, electrolyte, and acid-base balance.
- Clinical manifestations include metabolic acidosis, hyperkalemia, uremia, anuria, and potentially polyuria post-drainage, with acute urine retention as a common presentation.
Purpose of the Study:
- To review the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
- To highlight the underappreciated long-term kidney sequelae despite seemingly favorable recovery after urinary tract decompression.
Main Methods:
- Comprehensive review of existing literature on obstructive nephropathy and acute kidney injury.
- Analysis of diagnostic approaches including medical history, voiding changes, and imaging studies like CT and ultrasound.
- Evaluation of management strategies encompassing urinary tract drainage, supportive care, metabolic correction, and renal replacement therapy.
Main Results:
- Diagnosis relies on detailed patient history and characteristic imaging findings such as hydronephrosis.
- Management involves prompt urinary tract decompression, supportive measures, and correction of metabolic derangements.
- While recovery is often favorable, significant kidney sequelae can occur, indicating the condition is undervalued.
Conclusions:
- Acute kidney injury secondary to obstructive nephropathy is a common yet underestimated condition with potentially serious long-term consequences.
- Early recognition, accurate diagnosis, and timely, comprehensive management are essential to mitigate kidney damage and improve patient outcomes.
- Further research and clinical attention are warranted to address the underappreciation of this nephrological and urological entity.
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