Postoperative problems and treatment of hydronephrosis

Postoperative problems and treatment of hydronephrosis

Generally speaking, hydronephrosis caused by urinary tract obstruction is a long-term pathological process. The operation relieves the obstruction and solves the problem only in morphology, which creates the condition for the recovery of renal function. After the obstruction is relieved, there will be a series of problems in the recovery of renal function, which must be paid great attention by the urological surgeons. Otherwise, the improper handling of these problems can also have serious consequences. These issues include:
Obstruction after diuresis: upper urinary tract obstruction within 1~3 days after the relief, the patient may appear diuretic phenomenon. The amount of 24h urine can be 3000 ~ 8000ml. Continuous discharge of large amounts of urine in a short period of time, will inevitably lead to water, electrolyte, acid-base imbalance, serious cases will threaten the lives of patients. The cause of the obstruction after diuresis has two main aspects: A. obstruction after blood urea nitrogen accumulation and excretion of sodium hormone, the renal tubular reabsorption function to reduce water, sodium and chloride; B. renal tubular epithelial flattening and absorption area decrease, alkaline phosphatase and Na -K -ATP were significantly reduced. With the progression of the disease, the function of the renal tubule gradually recovered and urine volume gradually returned to normal.
Against the balance problem: the recovery of renal function depends on the stimulation of metabolic load in the body, depending on the balance of the problem in the course of the recovery of the renal function. Therefore, one side of hydronephrosis and renal function is severely impaired, such as contralateral renal function is completely normal, then the renal obstruction even be lifted, but it is not a metabolite of stimulation, the recovery of renal function will be very slow. And if the side of the kidney also has some damage, kidney obstruction in relief, the recovery will be faster. Therefore, if both sides have kidney obstruction, which in patients with systemic conditions permit, the first release of renal function better side kidney obstruction, then the other side as soon as possible to relieve the obstruction of the kidney.
The influence of obstruction on the kidney: the increase of systemic blood volume due to the retention of water and sodium after obstruction, and the increase of renin activity can lead to hypertension. When the obstruction is removed or the kidney is removed, blood pressure drops in some patients. Hydronephrosis is caused by increased production of erythropoietin, which can lead to polycythemia and can be restored to normal after nephrectomy.

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