VA AM Report Pearls Bastille Day Extravaganza!

A Few Learning Points on Obstructive Nephropathy

-Urethral obstruction and bilateral ureteral obstruction are common causes of renal failure and can happen because of prostatic enlargement or even as a result of compression from retroperitoneal masses. Obstructive nephropathy can lead to dramatic electrolyte abnormalities and very high elevations in BUN and Cr.

-According to UpToDate, the mechanism of glomerular injury is not completely understood, though a proposed mechanism is decreased renal perfusion from afferent renal vasoconstriction as a response to increased intraglomerular pressures.

-Urethral obstructions are most often relieved via foley catheterization, though a suprapubic catheter can also be placed in severe obstruction. Nephrostomy tubes need to be placed, most often by IR, in patients who have ureteral obstruction.

-If the obstruction is relieved soon after it develops, rapid total recovery can occur. Furthermore, most of the improvements in GFR that are seen after the obstruction is relieved will occur in the first 7-10 days. Some patients will need hemodialysis as they await renal recovery for weeks and some of those patients will require indefinite HD.

-A presentation not attributable to BPH should prompt a search for other causes of obstruction such as a retroperitoneal or intra-abdominal mass.

Thanks everyone for another great report!!

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