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Chronic bilateral obstructive uropathy
Alternative namesObstructive uropathy - bilateral - chronic; Kidney failure - chronic blockage
DefinitionChronic bilateral obstructive uropathy involves prolonged or progressive blockage of the flow of urine from both kidneys, causing kidney (renal) damage.
Causes, incidence, and risk factors
Obstructive uropathy occurs when the flow of urine from the kidneys is blocked. This causes the kidneys to dilate and become damaged. Obstruction can occur anywhere in the the urinary system. If the obstruction is bilateral (affecting both kidneys), bladder outlet obstruction is the most common cause. The kidneys produce urine in the normal manner but the urine cannot leave the bladder because it is blocked. Urine may back up behind this obstruction and cause damage to the structures of the urinary tract.
SymptomsSymptoms depend on the time course of the obstruction and where in the urinary tract the obstruction occurs. Some of the most common symptoms of chronic obstructive uropathy include:
Signs and testsExamination by touch (palpation) may show enlarged or tender kidneys. The bladder may be large and full. Rectal examination may reveal enlarged prostate. Signs and symptoms of chronic renal failure may be present. The blood pressure may also be elevated.
The initial treatment focuses on relieving urinary obstruction.
If the obstruction is at the level of the ureters, ureteral stents or nephrostomy tubes may temporarily solve the problem. Surgery is usually required for permanent resolution of the obstruction depending on the cause of the obstruction.
Antibiotics may be needed to treat urinary tract infection . Treatment for chronic renal failure such as correction of electrolyte abnormalities and dialysis may be necessary.
If the obstruction is corrected before the development of renal failure , bilateral obstructive uropathy may be reversible.
If chronic renal failure develops, long-term kidney damage is likely. This can be life-threatening.
Patients with chronic obstruction are at a higher risk for post-obstructive diuresis, which occurs after obstruction is relieved (such as with a Foley catheter) and the kidneys have not had chance to adapt to the change and are unable to concentrate the urine. Thus, the patient voids large quantities of urine that hasn't been properly processed. This can also be a life-threatening condition and close monitoring is required.
If the obstruction was caused by a cancer , the ultimate outcome is determined by the extent of disease and its response to therapy.
Calling your health care provider
Call your health care provider if decreased urine output or other symptoms of chronic bilateral obstructive uropathy develop.
This condition may be prevented or prevented from causing serious damage by routine screening by primary care physician for signs and symptoms of lower urinary tract disorders, including a rectal examination in men.
Update Date: 5/25/2002Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT