Tag Archives: Kidney Specialist in Noida

Obstructive Nephropathy

Obstructive Nephropathy: Diagnosis and Treatment


What is it and what are the reasons?

Obstructive nephropathy is an abnormality in the structure and function of the kidneys, which is caused by obstruction of the outflow of urine due to partial or complete obstruction of the urinary tract (most commonly ureters or urethra), explains the best nephrologist in Delhi.

The most common causes are prostatic hyperplasia and cancer, tumors (uterus, ovary, large intestine), uterine prolapse, retroperitoneal fibrosis, narrowing of the ureter or its opening to the renal pelvis or bladder (may be acquired or congenital), posterior urethral valve (usually congenital in boys).

The cause of obstructive nephropathy may also be impaired urinary tract function, most often the bladder after a spinal cord injury or as a result of a malformation of the spinal cord (e.g. cerebrospinal hernia) or so-called neurogenic bladder (bladder neck spasm).

A variant of obstructive nephropathy is drainage nephropathy caused by long-term backward reflux (reflux) of urine from the bladder to the ureter and kidney.

How common is obstructive nephropathy?

Obstructive nephropathy is a fairly rare kidney injury in adults, while it is the most common cause of chronic renal failure in children (due to urinary congenital malformations), says the nephrologist in Delhi.

How is it revealed?

An obstacle to the outflow of urine from the kidney leads to the development of hydronephrosis, i.e. the widening of the pelvis and the renal calyces. If the urine outflow from the kidney suddenly almost completely closes, renal colic appears.

When hydronephrosis develops slowly, it may not have any symptoms, but if it reaches a large size, it manifests itself like a tumor in the abdomen – a large kidney can be felt by touch examination or press on other organs in the abdomen. Sometimes urinary tract obstruction is partial or changes over time, and then large (polyuria) and small (oliguria) urine volumes may alternate. Symptoms of a urinary outflow obstruction may be urinary tract infection or haematuria. When permanent, severe damage occurs to both kidneys, symptoms of chronic renal failure occur, says the nephrologist in Noida.

What to do if symptoms occur

Always seek medical attention if you experience symptoms suggestive of a urinary tract disease, i.e.

  • urination disorders
  • pain in the lumbar region or lower abdomen
  • haematuria
  • palpable tumor in the stomach
  • symptoms of urinary tract infection.

How does the doctor make a diagnosis?

Reported symptoms (as above) indicate a disease of the urinary tract which may lead to obstruction of urine outflow (and development of obstructive nephropathy). The most important are imaging of the urinary system, first of all USG, then usually urography or CT They show unilateral or bilateral hydronephrosis, and when the obstacle is located low – widening of one or both ureters or bladder distension. These tests also help to identify the cause, i.e. the type of obstacle to the proper outflow of urine, explains the nephrologist in Gurgaon.

What are the treatments?

The goal of treating obstructive nephropathy is to restore effective drainage of urine from the kidneys, which involves removing or bypassing an obstacle that obstructs urine outflow. Usually urological treatment is needed. If the obstacle cannot be removed and the urine outflow is restored, urological procedures are carried out by the urologist in Noida to avoid the obstacle. This can be the introduction of a catheter into the bladder, ureter or directly into the renal pelvis through body shells in the lumbar region (so-called transcutaneous nephrostomy). Usually these are urgent interventions that ensure urine outflow until the patient is ready for elective surgery for the final treatment of the obstacle (e.g. prostate surgery, bladder tumor or urinary reconstruction).

Is it possible to cure completely?

Complete cure for obstructive nephropathy is possible provided the obstruction has been permanently cured before irreversible kidney changes have occurred. Removing an obstacle if chronic kidney damage has already occurred does not lead to cure because chronic kidney disease is progressive, states the kidney specialist in Delhi.

What do you need to do after treatment?

In obstructive nephropathy, urological supervision and periodic monitoring of urinary tract function are usually necessary. When there is permanent kidney damage (chronic obstructive nephropathy), periodic nephrological monitoring is required, says the kidney specialist in Noida.

What to do to avoid getting sick?

To avoid obstructive nephropathy, obstacles to urine outflow should be detected and treated early. Particular attention should be paid to any urination disorders, suggests the nephrologist in Delhi.


Complications Associated with Immunosuppression


In order for the renal transplant to function and not be rejected by our body for the work of the immune system, we need to reduce or block the action of certain components of the immune response.

We do this by administering drugs aimed at certain metabolic pathways as specific as possible that allow us to reduce the adaptive immune response without affecting the innate measure to a greater extent, but they entail another series of factors, entities or risks that we will detail in this post.

The risk of infections

Infections are the first cause of death after a kidney transplant in Delhi. Logically, by decreasing the body’s defenses the main risk is represented by infections. Both the usual and those called generated by the so-called opportunistic pathogens (those microorganisms that usually would not cause infection in a healthy patient, are able to infect and make an immunosuppressed patient sick). The greatest risk of infection occurs in the first 3 months after transplantation, since at the beginning higher doses of immunosuppressants are administered to avoid acute graft rejection, says nephrologist in Delhi.

The most common infections are respiratory infections and urinary infections, secondly gastrointestinal infections; There is usually a history of an infected relative who may have been the cause of the infection, explains nephrologist in Noida.

With respect to opportunistic pathogens, the most frequent are viruses starting with cytomegalovirus (CMV) and polyomaviruses (BK and JC viruses), hepatitis viruses, herpes, chickenpox, to name a few. Then we find bacteria such as Nocardia, listeria, pneumocystis, among others.

In some cases, we can reduce the risk of infection by getting vaccinated. All transplanted patients should receive a series of vaccines to reduce the risk of infection by these microorganisms; however, it should be noted that vaccines with live or live-attenuated microorganisms should NOT be administered, only those with inactivated, dead microorganisms or bacterial/viral proteins should be administered, says doctor for kidney transplant in Delhi.

Vaccination and prophylaxis

Another way to reduce the risk of infection is through prophylaxis (that is, preventive treatment). Depending on the epidemiological environment of the center where the transplants are performed, more or less prophylactic medications are administered and usually maintained only during the first 3 to 6 months.

However, if in spite of all this, a transplanted patient contracts an infectious disease, it is important that he notify his nearest health professional, and in the case of fever, go to the hospital emergency department as soon as possible, suggests kidney Specialist in Noida.

Immunosuppressive toxicity

Immunosuppressive medications can generate negative effects not only by their direct action, but also by indirect actions or adverse reactions of each family of medications.

On the one hand, we have the anticalcineurinics (cyclosporine and tacrolimus) almost indispensable in most immunosuppression regimens in some patients can general gum growth, hair loss, neurological disorders, insomnia and even direct kidney damage (in very high concentrations).

On the other, mycophenolate (purine nucleotide synthesis blocker) is characterized by generating gastrointestinal disturbances, commonly diarrhea. Another similar medication, azathioprine can cause anemia or leukopenia (decrease in white blood cells below adequate values).

Finally, another group of medications known as mTOR inhibitors, sirolimus and everolimus can cause anemia, hypertension, slow healing or generate joint pain.

As we can see, the effects that these drugs can generate are varied, but their usefulness and benefit outweigh these risks, so it is important that if you notice any alteration or change in normality related to the effects mentioned above, contact your kidney transplant doctor in Delhi.