Senile obstructive nephropathy

　　Any etiology of senile obstructive nephropathy can lead to structural and functional changes in the obstructed kidney. Within one week of obstruction, the changes within the kidney are all reversible. When the obstruction is relieved, the glomerular filtration rate (GRF) can recover to two-thirds of the pre-obstruction level; if the obstruction is relieved after 4 weeks, the GRF can only recover to 20% to 25% of the original level; if complete obstruction exceeds 4-6 weeks, it will cause irreversible damage to the structure and function of the kidney.

　　The complications of this disease are common, including infection, urinary retention, hematuria, and renal insufficiency. The specific introduction is as follows:

　　1. The accumulation of a large amount of urine in the bladder that cannot be excreted is called urinary retention. There are many causes of urinary retention, which can generally be divided into obstructive and non-obstructive categories.

　　2. Normal urine contains a very small amount of red blood cells. In the absence of centrifugation, under a microscope, there may be 0 to 2 red blood cells per high-power field. If the number exceeds this, it is considered hematuria.

　　3. Renal insufficiency is caused by various reasons, severe damage to the glomeruli, leading to a clinical syndrome characterized by disorders in the body's excretion of metabolic waste and regulation of water and electrolyte balance, as well as acid-base balance.

　　Due to the differences in etiology, nature, location, duration, and presence of complications of obstructive nephropathy, its clinical manifestations are relatively complex.

　　I. Symptoms

　　1. Lower urinary tract symptoms: Those caused by urethral stricture, prostatic lesions, bladder neck obstruction, neurogenic bladder, and other conditions often manifest as difficulty in urination, thinning of the urinary stream, and incomplete urination after urination. In cases with concurrent infection, symptoms of lower urinary tract irritation and hematuria or pyuria may occur.

　　2. Upper urinary tract symptoms: Patients with obstructive nephropathy due to ureteral stenosis, calculi, blood clots blocking, or accidental ligation of the ureter, etc., may experience renal colic, hematuria, and in cases of concurrent infection, in addition to urinary tract irritation symptoms, chills, high fever, and gastrointestinal symptoms may occur.

　　3. General symptoms: Alternate increase or decrease in urine output may occur, and in cases of renal insufficiency, symptoms such as anorexia, nausea, vomiting, lack of spirit, fatigue, and drowsiness may occur.

　　Second, signs

　　1. Lower urinary tract obstruction: The narrowing of the anterior urethra, the hardening or scar area of the urethra can be palpated locally; when there is a prostate lesion, digital rectal examination can palpate an enlarged prostate; in patients with neurogenic bladder, the disappearance of perineal sensation and relaxation of the anal sphincter muscles may occur, and in severe obstruction, the bladder with excessive retained urine can be palpated.

　　2. Upper urinary tract obstruction: The affected side's enlarged kidney can be palpated, there is tenderness in the renal area; in cases of concurrent infection, abdominal tenderness may occur; and in cases where abdominal swelling or inflammatory masses compress, palpable masses in the corresponding area may be felt.

　　3. General symptoms: Hypertension, signs of ascites may occur, and in a few cases, cherry lips (erythrocytosis) may occur.

　　Any senile obstructive nephropathy caused by any cause can lead to structural and functional changes in the obstructed kidney, therefore, the prevention of this disease mainly focuses on the prevention of senile obstructive nephropathy. It is recommended that the elderly should undergo physical examinations regularly, do early detection, and early treatment.

　　The following examinations can serve as objective indicators for the diagnosis of obstructive nephropathy and its degree of disease, to help confirm the diagnosis of this disease.

　　1. Urine

　　Proteins or casts may appear in the urine, the early urine osmolality increases, the late urine specific gravity is low and fixed, and in cases of concurrent infection, red and white blood cells can be seen. Urine culture can detect pathogenic bacteria.

　　2. Blood

　　In cases of concurrent infection, blood counts can increase, and in cases of bilateral obstruction and renal insufficiency, there can be varying degrees of anemia, increased blood urea nitrogen and creatinine, decreased carbon dioxide binding power and blood calcium, and increased blood phosphorus.

　　3. B-ultrasound

　　Ultrasound can understand the degree, location, and kidney size of urinary tract dilation and hydronephrosis, whether there is residual urine in the bladder, and whether there are tumors compressing around the urinary tract, and can indirectly infer the residual renal function.

　　4. X-ray film

　　An abdominal X-ray film can help detect positive renal and ureteral calculi, understand the size of the kidneys, the shadow of malignant tumors, and whether there is bone metastasis, and detect spinal bifida, suggesting the possibility of neurogenic bladder.

　　Patients with senile obstructive nephropathy should pay attention to a light diet, eat more vegetables and fruits, reasonably match the diet, and ensure adequate nutrition. At the same time, they must stay away from spicy and刺激性 foods and avoid the intake of greasy foods. If the condition requires it, consult a doctor to formulate a corresponding dietary plan.

　　After the diagnosis of the disease is established, it should be treated promptly against the cause, relieve the obstruction as soon as possible, prevent infection, correct the balance of water and electrolytes, and protect renal function.

　　First, relieve the obstruction

　　For different causes, locations, and degrees of urinary tract obstruction, different methods should be adopted to relieve the obstruction.

　　1. Urinary Tract Stones: Any stones, if the diameter is 5mm and/or ineffective with the aforementioned methods of treatment, or severe renal积水, it is advisable to resolutely perform extracorporeal shock wave lithotripsy or surgical stone removal.

　　2. Benign Prostatic Hyperplasia: Benign prostatic hyperplasia is a common cause of lower urinary tract obstruction in elderly men. If it causes incomplete obstruction, conservative treatment can be tried first. Western medicine for the treatment of benign prostatic hyperplasia includes α-adrenergic receptor blockers, 5α-reductase inhibitors, hormones (anti-androgens), etc. In addition, terazosin (Gouteling Tablets) has a significant oral effect. Physical techniques include inserting a titanium-nickel alloy stent into the posterior urethra through a cystoscope, which has a supporting and expanding effect to relieve obstruction. If the above methods are ineffective or obstruction progresses, timely transurethral resection of the prostate should be performed to completely relieve obstruction.

　　3. Periureteral Adhesions: Chronic recurrent urinary tract infections, abdominal tuberculosis, nonspecific colitis and/or intestinal inflammation, appendiceal perforation, and abdominal radiotherapy, etc., can lead to posterior membrane fibrosis, ureteral adhesions, which are common causes of ureteral obstruction. Early treatment with corticosteroids can alleviate obstruction caused by adhesions. Traditional Chinese medicine treatment focuses on promoting blood circulation and removing blood stasis, supplemented by clearing heat and promoting diuresis. If adhesions cannot be relieved and renal积水 becomes severe, ureterolysis can be performed, or ureteral stents can be placed during surgery.

　　Second, Prevention and Treatment of Urinary Tract Infection

　　Patients with urinary tract obstruction are prone to concurrent urinary tract infection, so obstruction should be relieved as soon as possible. Various examinations should be carried out with strict aseptic operation. For those with concurrent urinary tract infection, clean midstream urine or bladder puncture urine should be taken for bacterial culture and drug sensitivity test, and appropriate non-nephrotoxic antibiotics should be chosen for treatment.

　　Third, Treatment after Obstruction

　　After the obstruction of the urinary tract is relieved, polyuria begins within a few hours to 1 day, usually resolves spontaneously within 4 days, and severe cases may last for 1 to 2 weeks. The daily urine volume can reach 3000 to 4000 ml, and some cases may exceed 10,000 ml, which is very prone to dehydration, electrolyte imbalance, and hypotension. If not treated in time, accidents may occur. If there is still no obvious polyuria after 3 to 4 months after the obstruction is relieved, it indicates that irreversible renal failure has occurred, and it should be treated as chronic renal insufficiency. If complete urinary tract obstruction leads to acute post-renal renal failure in a short period of time, it is advisable to promptly perform nephrostomy or temporary hemodialysis treatment to protect renal function and win time for the definitive treatment of obstructive nephropathy.