Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

1484 Upper Urinary Tract Obstruction

UPPER URINARY TRACT OBSTRUCTION

MARGARET S. PEARLE, MD

history & physical

History

■Acute obstruction

➣Severe flank pain with or without radiation to lower abdomen,

nausea, vomiting

➣Oliguria/anuria if bilateral process

➣Fever if associated with infection

■Chronic obstruction

➣Unilateral or bilateral flank discomfort

➣Vague feeling of fullness

➣Anorexia

➣Flank pain with forced diuresis

Signs & Symptoms

■Elevated pulse and blood pressure secondary to pain in acute

obstruction

■Low-grade fever not uncommon with acute obstruction; high fever

suggests pyelonephritis

■Signs of volume overload such as pedal edema

■Tenderness over flank or anterior abdomen

■Palpable abdominal mass in some cases of extrinsic obstruction Ele-

vated creatinine if bilateral, or unilateral with renal dysfunction

tests

Basic Blood Tests

■CBC: mild leukocytosis (10,000–15,000/mm2) common in acute

obstruction

■Creatinine and blood urea nitrogen: to assess renal functional

impairment

■Serum electrolytes

■Glucose

Basic Urine Tests

■Urinalysis: pH, microhematuria, pyuria, crystalluria, proteinuria,

bacteria, hyphae

■Urine electrolytes: elevated urinary sodium and decreased urine

osmolality in chronic obstruction

■Urine culture (bacterial and fungal)