What is included in the inpatient care of hydronephrosis and hydroureter?

Updated: Dec 16, 2020
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Monitor patients for postobstructive diuresis. This is a marked polyuria observed after relief of an obstructed system.

Patients who are most likely to experience postobstructive diuresis present with chronic obstruction, edema, congestive heart failure, hypertension, weight gain, and azotemia. Clinically significant postobstructive diuresis is usually seen only in the setting of prior bilateral obstruction or, similarly, a unilateral obstruction of a solitary functioning kidney.

This postobstructive diureses can lead to a marked diuresis with the wasting of sodium, potassium, phosphate, and the divalent cations. Management involves avoiding severe volume depletion, hypokalemia, hyponatremia, hypernatremia, and hypomagnesemia.

Volume or free-water replacement is appropriate only when the salt and water losses result in volume depletion or a disturbance of osmolality. In many cases, excessive volume or fluid replacement prolongs the diuresis and natriuresis. An appropriate starting fluid for replacement is 0.45% saline. During this period, vital signs, volume status, urine output, and serum and urine chemistry and osmolality should be monitored.

Postobstructive diuresis is usually self-limited. It usually lasts for several days to a week but may, in rare cases, persist for months.

In fetuses with severe oligohydramnios and documented lung maturation, early delivery has been suggested. Although no data document improved renal outcome with early delivery, early delivery may be indicated to reduce the risk of other adverse outcomes from oligohydramnios, such as umbilical cord compression.


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