Pérez-Aizpurua Xabier, Cabello Benavente Ramiro, Bueno Serrano Gonzalo, Alcázar Peral José María, Gómez-Jordana Mañas Blanca, Tufet I Jaumot Jaime, Ruiz de Castroviejo Blanco Joaquín, Osorio Ospina Felipe, Gonzalez-Enguita Carmen
Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain.
World J Nephrol. 2024 Jun 25;13(2):93322. doi: 10.5527/wjn.v13.i2.93322.
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%-10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
梗阻性尿路病被定义为尿路任何水平的尿流结构或功能中断。它被认为是急性肾损伤（AKI）最常见的病因之一，占病例的5%-10%。尿路急性严重梗阻对肾脏是一种潜在威胁的情况，因此需要迅速识别和处理以解除梗阻。本文的目的是回顾和综合关于梗阻性尿路病的现有证据，为临床医生提供临床指南。对AKI背景下的梗阻性尿路病进行了文献综述，重点关注诊断和处理方面最不清楚的问题。以英文进行了近期文献检索，并优先选择包括系统评价、荟萃分析和大型系列研究在内的顶级证据文章。尿路急性梗阻是一个诊断和治疗挑战，可能导致重要的临床并发症以及对肾脏的直接结构和血流动力学损害。早期识别主要病因及其确切位置对于确保及时引流尿液以及选择最合适的引流技术至关重要。多学科方法，包括泌尿科医生、肾病科医生和其他医学专科，最适合正确处理伴随的血流动力学变化、液体和电解质失衡以及其他相关问题。梗阻性尿路病是AKI的主要病因之一。识别适合早期分流的患者以及可行或适当选择指示技术有时具有挑战性。深入了解尿路梗阻发生发展背后的病理生理学对于正确诊断和处理至关重要。
