Chronic unilateral obstructive uropathy

Kidney anatomy — The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

Also known as: Ureteral obstruction - chronic and Obstructive uropathy - unilateral - chronic

Definition

Chronic unilateral obstructive uropathy is a condition in which there is long-term blockage of one of the tubes (ureters) that drains urine from the kidneys.

Causes, incidence, and risk factors

Unilateral obstructive uropathy usually occurs when ureteral or kidney stones block the flow of urine. Urine backs up and causes kidney swelling (hydronephrosis).

Other causes include:

Narrowing of the ureter that is present at birth (congenital), most commonly right below the kidney, a condition called ureteropelvic junction obstruction
Injury to the ureter from prior abdominal or pelvic surgery

Risk factors for unilateral obstructive uropathy include:

Kidney stones
Tumors in surrounding structures such as uterus, cervix, or lymph nodes
Ureteral stones and tumors

Chronic unilateral obstructive uropathy occurs in approximately 5 out of every 1,000 people.

Symptoms

Abdominal pain, right or left lower belly area
Back pain, may be on only one side
Blood in the urine
Increased urinary frequency/urgency
Frequent need to urinate at night
Painful urination
Severe flank pain that may occur on one side, but may also be felt in the groin, thigh, and genitals
Urinary tract infection

Signs and tests

Your health care provider will perform a physical exam, which includes feeling your abdomen. The exam may reveal a swollen kidney.

A blood pressure measure may reveal high blood pressure. A urinalysis may show blood in the urine. A urine culture can determine if you have an infection.

Kidney swelling or blockage of the ureter may appear on these tests:

Treatment

The goal of treatment is to reduce or remove the blockage.

Stents or drains placed in the ureter or in the renal pelvis may provide short-term relief of symptoms.

A nephrostomy tube, which drains urine from the kidney through the back, may be used to relieve the blockage.

Surgery to repair the underlying cause will usually correct the blockage.

Expectations (prognosis)

This condition damages the structures of the urinary tract. It may result in permanent damage to the kidney. If only one kidney is involved, the other kidney usually continues to work, and kidney failure or insufficiency does not occur.

Complications

Chronic or recurrent urinary tract infection
High blood pressure
Permanent failure of the affected kidney (chronic kidney failure)

Calling your health care provider

Call your doctor if you have flank pain or other symptoms of chronic unilateral obstructive uropathy.

If you have already been diagnosed with this condition, call your health care provider if symptoms worsen or persist despite treatment, or if new symptoms develop.

Prevention

If you are prone to kidney stones, drink plenty of water (6 to 8 glasses per day) to reduce the chances of their formation.

A diet low in sodium and oxalates and high in citrate may reduce your risk of calcium-based kidney stone formation. Talk to a nutritionist for more information on such diets.

Urinary tract infections should be treated promptly and thoroughly.

References

Wein AJ, et al. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007.

Goldman L, Ausiello D, et al. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:741-742.

Review date:: March 22, 2010
Reviewed by:: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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