Abstract
Renal obstruction can be caused by intrinsic or extrinsic factors that affect the ureters, bladder, or urethra. Most of the literature concerning the pathophysiology of renal obstruction has focused on unilateral ureteral obstruction (UUO) or bilateral ureteral obstruction (BUO). Table 15.1 lists possible causes of renal obstruction.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dhillon HK. Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol. 1998;81 (suppl 2):39-44
Chung S et al. Diuretic renography in the evaluation of neonatal hydronephrosis: is it reliable? J Urol. 1993;150(2 pt 2):765-768
Hafez AT et al. Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis. J Urol. 2002; 168(4 pt 1):1518-1521
Lee RS et al. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006; 118(2):586-593
Huang WY et al. Renal biopsy in congenital ureteropelvic junction obstruction: evidence for parenchymal maldevelopment. Kidney Int. 2006;69(1):137-143
Elder JS et al. Renal histological changes secondary to ureteropelvic junction obstruction. J Urol. 1995;154(2 pt 2): 719-722
Rosen S et al. The kidney in congenital ureteropelvic junction obstruction: a spectrum from normal to nephrectomy. J Urol. 2008;179(4):1257-1263
Airik R, Kispert A. Down the tube of obstructive nephropathies: the importance of tissue interactions during ureter development. Kidney Int. 2007;72(12):1459-1467
Airik R et al. Tbx18 regulates the development of the ureteral mesenchyme. J Clin Invest. 2006;116(3):663-674
Brenner-Anantharam A et al. Tailbud-derived mesenchyme promotes urinary tract segmentation via BMP4 signaling. Development. 2007;134(10):1967-1975
Miyazaki Y et al. Bone morphogenetic protein 4 regulates the budding site and elongation of the mouse ureter. J Clin Invest. 2000;105(7):863-873
Miyazaki Y et al. Evidence that bone morphogenetic protein 4 has multiple biological functions during kidney and urinary tract development. Kidney Int. 2003; 63(3):835-844
Chevalier RL. Perinatal obstructive nephropathy. Semin Perinatol. 2004;28(2):124-131
Oshima K et al. Angiotensin type II receptor expression and ureteral budding. J Urol. 2001;166(5):1848-1852
Dunn NR et al. Haploinsufficient phenotypes in Bmp4 heterozygous null mice and modification by mutations in Gli3 and Alx4. Dev Biol. 1997;188(2):235-247
Hinman F. Renal counterbalance. Cal West Med. 1926;24(3):333-335
Taki M, Goldsmith DI, Spitzer A. Impact of age on effects of ureteral obstruction on renal function. Kidney Int. 1983;24(5):602-609
Chevalier RL et al. Unilateral ureteral obstruction in early development alters renal growth: dependence on the duration of obstruction. J Urol. 1999;161(1):309-313
Mandell J et al. Human fetal compensatory renal growth. J Urol. 1993;150(2 pt 2):790-792
Koff SA et al. The assessment of obstruction in the newborn with unilateral hydronephrosis by measuring the size of the opposite kidney. J Urol. 1994;152(2 pt 2): 596-599
Gruskin AB, Edelmann CM Jr, Yuan S. Maturational changes in renal blood flow in piglets. Pediatr Res. 1970; 4(1):7-13
Chevalier RL, Gomez RA. Response of the renin-angiotensin system to relief of neonatal ureteral obstruction. Am J Physiol. 1988;255(6 pt 2):F1070-7
Chevalier RL, Thornhill BA. Ureteral obstruction in the neonatal rat: renal nerves modulate hemodynamic effects. Pediatr Nephrol. 1995;9(4):447-450
Chevalier RL, Kaiser DL. Chronic partial ureteral obstruction in the neonatal guinea pig I. Influence of uninephrectomy on growth and hemodynamics. Pediatr Res. 1984;18(12):1266-1271
Chevalier RL, Thornhill BA, Gomez RA. EDRF modulates renal hemodynamics during unilateral ureteral obstruction in the rat. Kidney Int. 1992;42(2): 400-406
Greger R. Physiology of renal sodium transport. Am J Med Sci. 2000;319(1):51-62
Alexander RT, Grinstein S. Na+/H + exchangers and the regulation of volume. Acta Physiol (Oxf). 2006;187(1–2):159-167
Wen JG et al. Obstructive nephropathy: an update of the experimental research. Urol Res. 1999;27(1):29-39
Stecker JF Jr, Gillenwater JY. Experimental partial ureteral obstruction. I. Alteration in renal function. Invest Urol. 1971;8(4):377-385
Wilson DR. Micropuncture study of chronic obstructive nephropathy before and after release of obstruction. Kidney Int. 1972;2(3):119-130
Tanagho EA. Surgically induced partial urinary obstruction in the fetal lamb. 3. Ureteral obstruction. Invest Urol. 1972;10(1):35-52
Olsen L. Renal function in experimental chronic hydronephrosis. III. Glomerular and tubular functions in relation to renal pelvic volume. Scand J Urol Nephrol. 1976;(suppl 32):5-13
Josephson S. Experimental obstructive hydronephrosis in newborn rats III. Long-term effects on renal function. J Urol. 1983;129(2):396-400
Boron WF. Acid-base transport by the renal proximal tubule. J Am Soc Nephrol. 2006;17(9):2368-2382
Misseri R et al. Inflammatory mediators and growth factors in obstructive renal injury. J Surg Res. 2004;119(2): 149-159
Sean Eardley K, Cockwell P. Macrophages and progressive tubulointerstitial disease. Kidney Int. 2005;68(2): 437-455
Wada T et al. Gene therapy via blockade of monocyte chemoattractant protein-1 for renal fibrosis. J Am Soc Nephrol. 2004;15(4):940-948
Pittock ST et al. MCP-1 is up-regulated in unstressed and stressed HO-1 knockout mice: pathophysiologic correlates. Kidney Int. 2005;68(2):611-622
Esteban V et al. Angiotensin II, via AT1 and AT2 receptors and NF-kappaB pathway, regulates the inflammatory response in unilateral ureteral obstruction. J Am Soc Nephrol. 2004;15(6):1514-1529
Inazaki K et al. Smad3 deficiency attenuates renal fibrosis, inflammation, and apoptosis after unilateral ureteral obstruction. Kidney Int. 2004;66(2):597-604
Chevalier RL. Molecular and cellular pathophysiology of obstructive nephropathy. Pediatr Nephrol. 1999;13(7):612-619
McVary KT, Maizels M. Urinary obstruction reduces glomerulogenesis in the developing kidney: a model in the rabbit. J Urol. 1989;142(2 pt 2):646-651. discussion 667-8
Peters CA et al. The response of the fetal kidney to obstruction. J Urol. 1992;148(2 pt 2):503-509
Chevalier RL et al. Recovery following relief of unilateral ureteral obstruction in the neonatal rat. Kidney Int. 1999;55(3):793-807
Okuda S et al. Influence of age on deterioration of the remnant kidney in uninephrectomized rats. Clin Sci Lond. 1987;72(5):571-576
O’Donnell MP et al. Age is a determinant of the glomerular morphologic and functional responses to chronic nephron loss. J Lab Clin Med. 1985;106(3):308-313
Quinlan MR et al. Exploring mechanisms involved in renal tubular sensing of mechanical stretch following ureteric obstruction. Am J Physiol Ren Physiol. 2008; 295(1):F1-F11
Alenghat FJ, Ingber DE. Mechanotransduction: all signals point to cytoskeleton, matrix, and integrins. Sci STKE. 2002;2002(119):PE6
Wang N, Butler JP, Ingber DE. Mechanotransduction across the cell surface and through the cytoskeleton. Science. 1993;260(5111):1124-1127
Klahr S, Ishidoya S, Morrissey J. Role of angiotensin II in the tubulointerstitial fibrosis of obstructive nephropathy. Am J Kidney Dis. 1995;26(1):141-146
Chertin B et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 2006;49(4):734-738
Rosen S, Heyman SN. Difficulties in understanding human “acute tubular necrosis”: limited data and flawed animal models. Kidney Int. 2001;60(4):1220-1224
Lieberthal W, Nigam SK. Acute renal failure II. Experimental models of acute renal failure: imperfect but indispensable. Am J Physiol Ren Physiol. 2000;278 (1):F1-F12
Mizuguchi Y et al. A novel cell-permeable antioxidant peptide decreases renal tubular apoptosis and damage in unilateral ureteral obstruction. Am J Physiol Ren Physiol. 2008;295(5):F1545-F1553
Lee RS et al. Temporal variations of the postnatal rat urinary proteome as a reflection of systemic maturation. Proteomics. 2008;8(5):1097-112
Decramer S et al. Predicting the clinical outcome of congenital unilateral ureteropelvic junction obstruction in newborn by urinary proteome analysis. Nat Med. 2006;12(4):398-400
Mostbeck GH, Zontsich T, Turetschek K. Ultrasound of the kidney: obstruction and medical diseases. Eur Radiol. 2001;11(10):1878-1889
Shokeir AA. The diagnosis of upper urinary tract obstruction. BJU Int. 1999;83(8):893-900. quiz 900–1
Platt JF, Rubin JM, Ellis JH. Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. Am J Roentgenol. 1989;153(5):997-1000
Shokeir AA et al. Renal doppler ultrasound in children with obstructive uropathy: Effect of intravenous normal saline fluid load and furosemide. J Urol. 1996;156(4):1455-1458
Whitaker RH. Diagnosis of obstruction in dilated ureters. Ann R Coll Surg Engl. 1973;53(3):153-166
Sperling H et al. The Whitaker test, a useful tool in renal grafts? Urology. 2000;56(1):49-52
Dubovsky EV, Russell CD. Advances in radionuclide evaluation of urinary tract obstruction. Abdom Imaging. 1998;23(1):17-26
English PJ et al. Modified method of diuresis renography for the assessment of equivocal pelviureteric junction obstruction. Br J Urol. 1987;59(1):10-14
Upsdell SM, Testa HJ, Lawson RS. The F-15 diuresis renogram in suspected obstruction of the upper urinary tract. Br J Urol. 1992;69(2):126-131
Pais VM, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ et al., eds. Campbell-Walsh Urology. Philadelphia, PA: Saunders; 2006
Smith RC et al. Diagnosis of acute flank pain: value of unenhanced helical CT. Am J Roentgenol. 1996;166(1):97-101
Gentle DL et al. Protease inhibitor-induced urolithiasis. Urology. 1997;50(4):508-511
El-Nahas AR et al. Role of multiphasic helical computed tomography in planning surgical treatment for pelvi-ureteric junction obstruction. BJU Int. 2004;94(4):582-587
Lawler LP et al. Adult ureteropelvic junction obstruction: insights with three-dimensional multi-detector row CT. Radiographics. 2005;25(1):121-134
Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics. 2008;28(1):23-46. discussion 46–7
Karabacakoglu A et al. Diagnostic value of diuretic-enhanced excretory MR urography in patients with obstructive uropathy. Eur J Radiol. 2004;52(3):320-327
Lefort C et al. Dynamic MR urography in urinary tract obstruction: implementation and preliminary results. Abdom Imaging. 2006;31(2):232-240
Farnham SB et al. Pediatric urological causes of hypertension. J Urol. 2005;173(3):697-704
Kinn AC. Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment. J Urol. 2000;164(3 pt 1):652-656
Parkhouse HF et al. Long-term outcome of boys with posterior urethral valves. Br J Urol. 1988;62(1):59-62
Vaughan ED Jr, Gillenwater JY. Diagnosis, characterization and management of post-obstructive diuresis. J Urol. 1973;109(2):286-292
Jones DA, George NJ, O’Reilly PH. Postobstructive renal function. Semin Urol. 1987;5(3):176-190
Nyman MA, Schwenk NM, Silverstein MD. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc. 1997;72(10):951-956
Schlossberg SM, Vaughan ED Jr. The mechanism of unilateral post-obstructive diuresis. J Urol. 1984;131(3): 534-536
Kim SW et al. Diminished renal expression of aquaporin water channels in rats with experimental bilateral ureteral obstruction. J Am Soc Nephrol. 2001;12(10): 2019-2028
Frokiaer J et al. Bilateral ureteral obstruction downregulates expression of vasopressin-sensitive AQP-2 water channel in rat kidney. Am J Physiol. 1996;270(4 pt 2): F657-F668
Kim SW et al. Diminished expression of sodium transporters in the ureteral obstructed kidney in rats. Nephron Exp Nephrol. 2004;96(3):e67-76
Norregaard R et al. COX-2 activity transiently contributes to increased water and NaCl excretion in the polyuric phase after release of ureteral obstruction. Am J Physiol Ren Physiol. 2007;292(5):F1322-1333
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer London
About this chapter
Cite this chapter
Cannon, G.M., Lee, R.S. (2011). Pathophysiology of Renal Obstruction. In: Chapple, C., Steers, W. (eds) Practical Urology: Essential Principles and Practice. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-034-0_15
Download citation
DOI: https://doi.org/10.1007/978-1-84882-034-0_15
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-84882-033-3
Online ISBN: 978-1-84882-034-0
eBook Packages: MedicineMedicine (R0)