Link between obstructive uropathy and acute kidney injury

Abstract

Obstructive uropathy represents a major risk of acute kidney injury. From an epidemiological point of view, it is responsible for 5% to 10% of cases of acute renal failure and 4% of cases of end-stage kidney disease. Although obstructive uropathy is a recognized disease, there is a significant lack of detailed research on this topic from both a nephrological and urological perspective. The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data. In this context, it is crucial to assess the overall hemodynamic status, especially in the presence of urosepsis. Once clinical stability is assured, it is important to focus on symptom management, usually by controlling pain. Ultimately, it is crucial to decide immediately whether the patient should receive a prompt urinary diversion. Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnecessary delay once the diagnosis has been confirmed. Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction, the duration of the obstruction and the presence of a concomitant urinary tract infection. The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease. In this editorial, we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.

Keywords: Obstructive uropathy; Acute kidney injury; Chronic kidney disease; Kidney stones; Hydronephrosis

Core Tip: Obstructive uropathy is a common cause of acute kidney injury. An accurate initial assessment is crucial to identify patients who may benefit from early urinary diversion and to avoid potential complications. The initial evaluation must include a physical examination, a thorough medical history, laboratory tests, and imaging studies. The treatment includes surgical and pharmacological approaches, depending on the underlying causes of the acute kidney injury, which can be multifactorial. Further research is needed to develop targeted interventions to improve patient outcomes based on multidisciplinary evaluation.