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Review
. 2024 Aug 22;17(10):sfae249.
doi: 10.1093/ckj/sfae249. eCollection 2024 Oct.

Non-dilated obstructive nephropathy

Valeria Feliciangeli  1 , Annalisa Noce  2 , Giulia Montalto  3 , Stefano Germani  1 , Roberto Miano  4 , Anastasios D Asimakopoulos  1
Affiliations
Review

Non-dilated obstructive nephropathy

Valeria Feliciangeli et al. Clin Kidney J. .

Abstract

Obstructive nephropathy (ON) is a common and reversible cause of post-renal acute kidney injury (AKI) and may be caused by a variety of conditions. It occurs when both the upper urinary tracts are obstructed, or when one tract is obstructed in patients with a solitary kidney. ON is suspected whenever there is evidence of hydronephrosis at imaging. However, not all patients with obstruction develop hydronephrosis and significant obstruction can be present in the absence of hydronephrosis. This syndrome is called non-dilated obstructive uropathy (NDOU). It accounts for about 5% of cases of urinary obstruction and the diagnosis can be challenging. The current paper provides an overview of the literature aiming to identify the main causes of NDOU and its clinical presentation, in order to clarify when to suspect it among AKI cases. A narrative review was performed due to the overall low quality of the available evidence. Only patients with post-renal AKI and a non-dilated or minimal dilation of the intrarenal collecting system were included. As evidenced by our review, NDOU is most prevalent in the fifth and sixth decades of life and affects mainly the male gender. On hospital admission serum creatinine levels are usually very high. Among the most common clinical presentations are oliguria/anuria, abdominal pain, signs of retention such as oedema or pleural effusion, and nausea/vomiting. About three out of four cases of NDOU are due to an ab-extrinsic compression of the ureters caused by retroperitoneal fibrosis or malignant disease. An effective and minimally invasive urinary diversion is obtained with ureteric stenting or a percutaneous nephrostomy. A correct diagnosis of NDOU may be challenging but it is of paramount importance as it can lead to a prompt management with a potential complete resolution of both obstruction and acute renal failure.

Keywords: NDOU; malignance disease; non-dilated obstructive nephropathy; non-dilated obstructive uropathy; retroperitoneal fibrosis.

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Conflict of interest statement

The authors have stated that they have no conflict of interest.

Figures

Figure 1:
Figure 1:
Flow of information through the different phases of this narrative review according to the PRISMA criteria.
Figure 2:
Figure 2:
Diagnostic and therapeutic algorithm for NDOU.
See this image and copyright information in PMC

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