Obstructive uropathy contributes significantly to the burden of chronic kidney disease (CKD). Obstruction may occur anywhere along the urinary tract, and the causes vary depending on the site of obstruction.

Causes of obstruction

• Obstruction within the kidney may cause dilatation of individual calyces

• Obstruction at or distal to the renal pelvis causes diffuse caliectasis or hydronephrosis

• Ureteric obstruction may result from:

  • Stones

  • Tumours

  • Enlarged lymph nodes

  • Retroperitoneal fibrosis

• Bladder tumours may obstruct one or both ureters or ureteric orifices

Clinical presentation

Patients may present with one or more of the following symptoms:

• Pain

• Change in urine output

• Hypertension

• Haematuria

• Increased serum creatinine

Investigations

• Urinalysis

• Full blood count (FBC)

• Serum creatinine

• Kidney, Ureter, and Bladder (KUB) ultrasound

• Intravenous pyelography (IVP)

• CT Intravenous Urography (CT-IVU)

• Magnetic Resonance Imaging (MRI)

• Examination under anaesthesia

Non-pharmacological treatment

Measures to reduce recurrence risk

• Encourage adequate fluid intake of at least 2 litres per day in patients with renal stones

Pharmacological treatment

Pain management

• Diclofenac (PO) 100 mg as an initial dose, followed by 50 mg every 6–8 hours OR Morphine (IV/SC) 1–4 mg every 1–4 hours

  • Dose may be increased up to 10 mg every 4 hours as needed for acute pain

Referral

Referral to urologist

Patients should be referred to a urologist for definitive treatment of the underlying cause of obstruction.

Long-term follow-up

Patients with impaired renal function may require long-term follow-up and monitoring.