Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

Renal fibrosis progression following partial unilateral ureteral obstruction: mechanisms and therapeutic insights

Ureteral obstruction, a common clinical condition, is associated with various renal disorders affecting all age groups and can lead to permanent renal damage. In Partial unilateral ureteral obstruction (PUUO), increased ureteral pressure, and decreased glomerular filtration rate (GFR) in the affected kidney cause cellular and molecular abnormalities, which ultimately lead to renal fibrosis if untreated. While removing the obstruction (RUUO) is essential to prevent long-term damage, additional therapeutic approaches may be necessary to fully restore kidney function. The PUUO model is used to induce renal fibrosis, primarily characterized by tubular injury resulting from obstructed urine flow. PUUO in rodents can simulate human chronic obstructive nephropathy at an accelerated rate. Although alleviating the obstruction can reduce immediate symptoms, it is often insufficient to reverse established fibrosis, emphasizing the need for adjunctive therapies. The renal response to RUUO depends on factors like the obstruction's duration and severity, as well as the contralateral kidney's functional state.

Link between obstructive uropathy and acute kidney injury

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.

History of Renal Stone Surgery: A Narrative Review

Untreated obstruction of the urinary tract can result in urinary stasis, hydronephrosis, and infection, which in turn lead to tissue damage, chronic renal failure, and potentially death. Renal stones have afflicted humanity throughout history, with surgical approaches evolving significantly over time. This review explores the origins and major developments in surgical techniques for renal stones, enhancing our understanding of how modern procedures have evolved. These techniques were refined over time, driven by improved anatomical knowledge and surgical experimentation. The ancient perineal lithotomy remained a standard treatment until the late 19th century, when advancements in anesthesia and antisepsis emerged. These innovations allowed surgeons to attempt more ambitious procedures, aided by early methods for visualizing internal organs. In the 20th century, innovations in radiology, imaging technologies, and surgical instruments ushered in the era of minimally invasive surgery.