Gembillo Guido, Spadaro Giuseppe, Santoro Domenico
Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina 98125, Italy.
World J Nephrol. 2025 Mar 25;14(1):99120. doi: 10.5527/wjn.v14.i1.99120.
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.
梗阻性肾病是急性肾损伤的主要风险因素。从流行病学角度来看，它导致了5%至10%的急性肾衰竭病例以及4%的终末期肾病病例。尽管梗阻性肾病是一种公认的疾病，但从肾脏病学和泌尿外科学角度对该主题进行的详细研究仍严重不足。大多数已发表的研究集中在该主题的病理生理学上，而忽视了对当前数据支持的诊断和治疗方法的全面分析。在这种情况下，评估整体血流动力学状态至关重要，尤其是在存在尿脓毒症的情况下。一旦确保临床稳定，关注症状管理就很重要，通常是通过控制疼痛来实现。最终，立即决定患者是否应接受及时的尿液改道至关重要。尿液改道是梗阻性肾病治疗的重要组成部分，一旦确诊，应立即且毫不拖延地启动。尿路减压后梗阻肾脏的功能恢复取决于梗阻程度、梗阻持续时间以及是否存在合并的尿路感染。这种情况的治疗时机和恰当处理决定了梗阻后肾功能的恢复，并可预防慢性肾脏病的发展。在这篇社论中，我们强调了梗阻性肾病在急性肾损伤背景下的病理生理作用和临床意义。
