ERA’S JOURNAL OF MEDICAL RESEARCH

VOL.4 NO.2

Original Article

DOI:10.24041/ejmr2017.44

A CLINICO- EPIDEMIOLOGICAL STUDY OF HYDRONEPHROSIS AT ERA’S

LUCKNOW MEDICAL COLLEGE , LUCKNOW

Rahul Bhushan, Pankaj Kumar, Sanjay Bhat

Department of Surgery

Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, U. P., India-226003

ABSTRACT

Received on : 26-08-2017

Hydronephrosis is defined as aseptic distension of the renal calyces and pelvis

 

Accepted on : 15-12-2017

 

 

with urine as a result of partial obstruction of the outflow of urine. It is a

 

Address for correspondence

clinical condition which is caused by dilatation of the renal collecting system

 

Dr. Pankaj Kumar

most frequently caused by incomplete or complete obstruction. Although this

 

Professor

condition is quite common yet its incidence and prevalence, aetiology,

 

Department of Surgery

diagnosis and management is less commonly reported in literature especially

 

Era's Lucknow Medical College

in context with adults and non-pregnant women. This prospective study was

 

& Hospital, Lucknow

conducted to evaluate the etiology, classify causes of hydronephrosis and to

 

Email: pkumar6661@gmail.com

study common clinical presentation of Hydronephrosis. hydronephrosis was

 

 

Contact no: +91-9839181447

seen as a highly male dominant disease with renal calculi as the major

 

aetiology and BPH and VUR being age-associated risk factors. Aetiology

 

 

 

 

based management of hydronephrosis yielded good outcome. The present

 

 

study is perhaps the first detailed clinco-pathological profile of hydronephrosis.

 

KEYWORD: Hydronephrosis, Renal lump, Renal swellings

 

INTRODUCTION

Hydronephrosis is a condition where urine overfills, or backs up, into the kidney, which causes the kidney to stretch (dilate), much like a balloon when it is filled with water (1). Hydronephrosis is defined as aseptic distension of the renal calyces and pelvis with urine as a result of partial obstruction of the outflow of urine (2). It is a clinical condition which is caused by dilatation of the renal collecting system most frequently caused by incomplete or complete obstruction. There could be a number of underlying causes of hydronephrosis including congenital blockage (present at birth, scarring of tissue (from injuries or previous surgery), calculus, tumours or cancer, vesical mass, urinary tract infection (UTI) and benign prostatic hypertension (BPH) and pregnancy (3- 4). Hypertrophy Secondary to ureteropelvic junction obstruction may present as acute severe flank pain radiating to the inguinal and genital area (5). Hydronephrosis was first studied in 1824 by Fiorep. Since that time, several investigators have studied this association and the prevalence of hydronephrosis with uterine prolapse has varied from 0% to 100%(6-7). This variation can probably be accounted for by differences in the severity of prolapse and by small patient numbers (8). Although this condition is quite common yet its incidence and prevalence, aetiology, diagnosis and management is less commonly reported in literature especially in context with adults and non-pregnant women (9). Most of the literature available is related with hydronephrosis in foetuses, neonates and children and pregnant women (10). Most of the studies in adults are case-reports or

concerned only with diagnostic aspect and as such there is no comprehensive study highlighting the clinical profile, aetiology and management of hydronephrosis in adults only (11-12). In view of this void in literature, the present study was planned in which in order to maintain the exclusiveness, paediatric age group and pregnant women were excluded. It was also kept in mind that hydronephrosis in severely ill patients there might be multiple underlying aetiologies which may confound in exact evaluation of aetiologies and their diagnosis as proposed in present study; hence it was decided to exclude very sick patients with renal failure and patients with associated severe co morbid diseases (13). Patients were selected consecutively as and when they present during the study period considering the inclusion and exclusion criteria. Data for the study was collected from patients attending the Emergency/Surgery OPD in the Department of General Surgery at Era's Lucknow Medical College and Hospital, Lucknow. The outcome of results was assessed upon cases of Hydronephrosis diagnosed by USG findings. Careful history taking was done to determine any etiological factors.

Complete physical examination

Blood Investigations (CBC, RFT), LFT if required.

Urine Investigations (Urine R/M and C/S).

Radiological investigations including X-ray abdomen/KUB, IVP, Ultrasound KUB, RGU and MCU if needed.

Procedures performed on each admitted patient were noted.

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A CLINICO- EPIDEMIOLOGICAL STUDY OF HYDRONEPHROSIS AT ERA`S LUCKNOW MEDICAL COLLEGE , LUCKNOW

Patients were followed up for upto 3 months after discharge and any complications noted were carefully followed.The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. The values were represented in Number (%) and Mean ±SD.(14).

MATERIALSAND METHODS

Study Design

Prospective Study

Place of Study

Department of General Surgery, ERA'S

Lucknow Medical College & Hospital,

Lucknow.

Duration of Study

18 months.

Inclusion Criteria

Patients were included on following basis:

All patients admitted in General Surgery with Ultrasonographical evidence suggestive of Hydronephrosis.

Age more than >12 yrs.

Exclusion Criteria

Patients less than 12 years of age

Pregnant women

Very sick patients with renal failure, patients with associated severe co morbid diseases, patients not willing to participate in study.

RESULTS

The present study was conducted in the Department of Surgery, Era's Lucknow Medical College & Hospitals, Lucknow to evaluate the etiology, classify causes of hydronephrosis and to study common clinical presentation of hydronephrosis. A total of 105 patients of hydronephrosis attending the Emergency, OPD of Department of Surgery during the study period, fulfilling the inclusion criteria were included in the study. The outcome of results was assessed upon cases of Hydronephrosis diagnosed by USG findings.

Age Group

Number

Percentage

(years)

 

 

 

 

 

12-25

25

23.81

26-50

50

47.62

>50

30

28.57

Table 1: Distribution of Cases according to Age (N=105)

Min-Max: 12-79 years (Median: 41.00 years);

Mean±SD: 42.17+18.10

>50

12-25

28.57%

23.81%

 

26-50

 

47.62%

Minimum age of patients enrolled in the study was 12 years while maximum age was 79 years, median age in the study population was 41 years. Mean age of the patients was 42.17+18.10 years. Most common age group in 105 patients of hydronephrosis in our study was 26-50 years (47.62%) followed by >50 years (28.57%). Approximately three-fourth of the patients were aged >25 years. Only 23.81% patients were aged <25 years.

Gender

Number

Percentage

 

 

 

Male

100

95.24

 

 

 

Female

5

4.76

 

 

 

Total

105

100.00

 

 

 

Table 2: Distribution of Cases according to Gender (N=105)

Female 4.76%

Male 95.24%

Majority of the patients in our study were males

(95.24%) only 5 (4.76%) were females.

S.No.

Chief Complaints

No. of

Percentage

at presentation

patients

1.

Follow up cases of Acute retention

6

5.71

2.

Burning micturition with fever

16

15.24

3.

Difculty in micturition

17

16.19

4.

Diminished ow

10

9.52

5.

Dribbling of urine

6

5.71

6.

Flank Pain (Intermittent)

39

37.14

7.

Hesitancy

2

1.90

8.

Iliac fossa pain

6

5.71

9.

Nocturia

3

2.86

Table 3: Distribution of Study Population according

' to Chief Complaints at presentation

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VOL.4 NO.2

 

 

 

Follow up cases of Acute retention

 

Buming micturation with fever

 

 

 

 

 

 

 

 

 

 

 

Difculty in Micturation

 

 

Diminished ow

 

 

 

 

 

 

 

 

 

 

 

 

 

Dribbling of urine

 

 

Flank Pain (Intermittent)

 

 

 

 

 

 

 

 

 

 

 

 

 

Hesitency

 

 

lliac fossa pain

 

 

 

 

 

 

 

 

 

 

 

 

 

Nocturia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.71%

2.86%

5.71%

1.90%

 

 

 

15.24%

included in the study was tobacco chewer/consumer or

habitual of drug intake.

S.No. Clinical History/

Number

Percentage

 

Personal History

of patients

 

1.

Trauma

8

7.62

2.

Tuberculosis

11

10.48

3.

Diabetes mellitus

3

2.86

4.

Hypertension

5

4.76

5.

Bronchial asthma

4

3.81

]

16.19%

37.14%

09.52%

05.71%

Chief complaint of most of the patients was intermittent flank pain (37.14%), followed by difficulty in micturition (16.19%), burning micturition with fever (15.24%). Diminished flow was observed in 9.52%, 5.71% each for follow up cases of acute retention, dribbling of urine and iliac fossa pain. Hesitancy was the least common chief complaint (1.9

0%) followed by Nocturia (2.86%).

S.No.

Personal History

Number

 

Percentage

 

 

 

 

of patients

 

 

 

1.

Smoking

 

13

 

12.38

 

 

 

 

 

 

 

 

 

2.

Alcohol

 

18

 

17.14

 

 

 

 

 

 

 

 

3.

Tobacco chewing/

0

 

0.00

 

 

consumption

 

 

 

 

4.

Drug intake

0

 

0.00

 

 

 

 

 

 

 

Table 4: Incidence of Personal Habits in Study Population

18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

12

 

 

 

 

 

 

 

Percentage

 

 

 

 

 

 

 

10

 

 

 

 

 

 

 

8

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

Smoking

Alcohol

Tobacco

Drug intake

 

chewing/

consumption

Only 12.38% of patients had habit of smoking and

17.14%were habitual of alcohol. None of the patients

6.

Previous Surgery

4

3.81

Table 5: Incidence of Clinical/Personal History in

Study Population

 

12

 

10

Percentage

8

6

 

 

4

 

2

 

0

Trauma

Tuberculosis Diabetes Hypertension

Bronchial

Previous

 

mellitus

asthma

Surgery

Only 10.48% were suffering from tuberculosis, 7.62% had experienced a traumatic event, 2.86% had diabetes, 4.76% were suffering from hypertension, 3.81% had bronchial asthma and 3.81% had undergone surgery previously.

S.No.

Clinical Signs

Number

Percentage

 

 

of patients

 

1.

pallor

16

15.24

 

 

 

 

2.

icterus

0

0.0

 

 

 

 

3.

cyanosis

0

0.0

4.

clubbing

0

0.0

5.

lymph node

0

0.0

6.

oedema

3

2.86

 

 

 

 

7.

fever

9

8.57

 

 

 

 

Table 6: Incidence of Clinical Signs in Study Population

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A CLINICO- EPIDEMIOLOGICAL STUDY OF HYDRONEPHROSIS AT ERA`S LUCKNOW MEDICAL COLLEGE , LUCKNOW

 

16

 

14

 

12

Percentage

10

8

 

 

6

4

2

0

Pollor

Lcterus

Cyanosis Clubbing Lymph node Edema

Fever

Most common clinical signs was Pallor (15.24%), followed by Fever (8.57%), Oedema (2.86%). In none of the patient icterus, cyanosis, clubbing, lymphadenopathy was found.

 

Variable

 

No. of

Min.

Max.

Median

Mean

 

SD

 

 

 

 

 

 

patients

 

 

 

 

 

 

 

 

 

 

 

 

Pulse rate

 

105

 

60

 

110

88

87.66

11.49

 

 

 

(per min)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SBP

 

 

105

 

110

 

150

120

122.55

9.33

 

 

 

(mm Hg)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DBP

 

 

105

 

70

 

90

 

80

81.31

6.26

 

 

 

(mm Hg)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RR

 

 

105

 

16

 

80

 

20

22.48

10.29

 

 

 

(beats/min)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 7: Hemodynamic Variables in Study Population

 

 

 

 

 

 

 

 

 

 

 

 

Variable

 

No.of

Min.

Max.

Median

Mean

 

SD

 

 

patients

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Haemo-

 

96

 

 

7

 

16

 

10.70

10.73

 

2.12

 

 

 

globin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TLC

 

100

 

3000

14000

 

7000

7031.0

2492.4

 

 

DLC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Neutro-

 

100

 

 

55

 

84

 

76

74.67

 

6.13

 

 

 

phils)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DLC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Lymph-

 

100

 

15

 

38

 

25

24.95

 

6.25

 

 

 

ocytes)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DLC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Eosino-

 

96

 

 

0

 

15

 

0

2.06

 

3.57

 

 

phils)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S. Urea

 

100

 

 

1

 

102

 

35

47.55

27.25

 

 

S. Creati

 

100

 

 

0.60

 

6.10

 

1.50

1.57

 

1.06

 

 

 

nine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RBS

 

105

 

 

109

 

141

 

125

126.34

10.73

 

 

S. Na+

 

105

 

 

135

 

144

 

138

139.01

2.65

 

 

 

S. K+

 

105

 

 

3.2

 

5.1

 

4.2

4.34

 

0.62

 

 

Table 8: Haematological/Biochemical Variables in the Study

Hemodynamic variables and haematological variables

of the study population have been tabulated in Table 7

and Table 8.

S.No.

Urine Culture

Number

Percentage

 

 

 

of patients

 

 

 

 

 

 

1.

 

Contaminated

8

7.62

 

 

 

 

 

2.

 

E. coli

21

20.00

 

 

 

 

 

3.

 

Klebsiella

8

7.62

 

 

 

 

 

4.

 

Sterile

68

64.76

 

 

 

 

Table 9: Urine Culture Findings of Study Population

 

 

 

Contaminated

 

 

 

 

7.62%

E.coli

 

 

 

 

 

 

 

 

20.00%

Sterile

 

 

Kleibsella

64.7%

 

 

7.62%

Out of 105 Urine culture specimens, 68 (64.76%) were found to be sterile, 8 (7.62%) specimens contaminated.

E. coli and Klebsiella were isolated from 20.0% and 7.62% urine culture specimens respectively.

 

Total

Normal Temp.

Fever

 

 

(n=34)

(n=3)

 

 

No.

%

No.

%

Contaminated

8

8

23.53

0

0.00

E. coli

21

18

52.94

3

100.00

Klebsiella

8

8

23.53

0

0.00

 

 

 

 

 

 

 

 

χ²=2.487 (df=2); p=0.288

 

 

 

 

 

 

Table 10: Association of Positive Urine Culture with Fever

Normal body temp. Fever

100

90

80

70

60

50

40

30

20

10

0

Contaminated

E. coli

Kleibsella

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VOL.4 NO.2

Of 37 patients with positive Urine Culture, only 3 (8.11%) were found to be suffering of fever and rest 34 had normal body temperature. All the patients suffering from fever were isolated for E. coli. Proportion of patients with normal body temperature was higher as compared to suffering from fever, with contaminated urine culture (23.53% vs. 0.0%) and isolated for Klebsiella (23.53% vs. 0.0%) while proportion of patients suffering from fever was higher as compared to normal body temperature in whom E. coli was isolated from urine specimens. Association of isolate of Urine culture with fever was not found to be statistically significant.

S.No.

X-ray

Number

Percentage

 

Findings

of patients

 

 

Anterior/

 

 

1.

Middle/

13

12.38

Post. urethral

 

stricture

 

 

2.

B/L renal

18

17.14

calculi

 

 

 

3.

Dil ureters

1

0.95

with VUR

 

 

 

4.

Dilated calyx

1

0.95

with VUR

 

 

 

5.

Left renal

17

16.19

calculus

 

 

 

6.

Lt multiple

2

1.90

renal cal

 

 

 

7.

Lt PUJ/ureteric

10

9.52

obstruction

 

 

 

8.

Rt PUJ

4

3.81

obstruction

 

 

 

9.

Rt renal cal

15

14.29

10.

rt ureteric

1

0.95

calculi

 

 

 

11.

urethral

1

0.95

calculus

 

 

 

 

Vesicle

 

 

12.

calculus

2

1.90

 

positive

 

 

 

 

 

 

13.

Ureteric

2

1.90

strictures

 

 

 

14.

WNL/NAD

18

17.14

 

 

 

 

Table 11a: X-ray Findings of Study Population

X-ray of 17.14% patients were found to be within- normal limits or without any abnormality. Bilateral renal calculi (17.14%) was found to be the most common X-ray finding, followed by Left renal

calculus (16.19%), Right renal calculi (14.29%).

S.No.

Urine Culture

Number

Percentage

 

 

of patients

 

1.

Bilateral

19

18.1

hydronephrosis

 

 

 

 

Bilateral renal

 

 

2.

calculi with

18

17.1

 

hydronephrosis

 

 

 

Unilateral renal

 

 

3.

calculi with

34

32.4

 

hydronephrosis

 

 

4.

BPH

9

8..6

5.

Dilated calyx

12

11.4

with PUJ

 

obstruction

 

 

6.

Dilated calyx

1

0.95

with VUR

 

 

 

 

Unilateral ureteric

 

 

7.

calculus with

9

8.6

 

hydronephrosis

 

 

8.

Genitourinary

1

0.95

Tuberculosis

 

 

 

9.

Severe UTI

1

0.95

with BOO

 

 

 

10.

Vesicureteric

1

0.95

reux with

 

dilated ureters

 

 

Table 11b USG Findings of Study Population

Unilateral renal calculi with hydronephrosis was the most common USG findings (n=34; 32.38%). Bilateral hydronephrosis was reported in 19 (18.1%) while bilateral renal calculi with hydronephrosis were

S.No.

Diagnosis

Number

Percentage

 

 

of patients

 

 

 

 

 

1.

Calculus

64

61.90

 

 

 

 

2.

VUR

2

1.90

 

 

 

 

3.

Stricture

14

13.33

Urethra

 

 

 

4.

PUJ

12

11.43

 

 

 

 

5.

Chronic UTI

1

0.95

 

 

 

 

6.

BPH

11

10.48

 

 

 

 

7.

Ureteric

1

0.95

stricture

 

 

 

Table 12: Final Findings of Study Population

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A CLINICO- EPIDEMIOLOGICAL STUDY OF HYDRONEPHROSIS AT ERA`S LUCKNOW MEDICAL COLLEGE , LUCKNOW

reported in 18 (17.14%) cases. Dilated calyx with PUJ obstruction, BPH, unilateral ureteric calculi with hydronephrosis were seen in 11.4%, 8.6% and 8.6% patients respectively. There was 1 case each with USG findings suggestive of dilated calyx with VUR, Genitourinary Tuberculosis, Severe UTI with BOO and Vesicureteric reflux with dilated ureters respectively.

years for VUR (8.00% vs. 0.0% & 0.0%), PUJ (32.00% vs. 8.0% & 0.0%). Proportion of patients aged 26-50 years was higher as compared to 12-25 years and >50 years for Calculus (70.00% vs. 52.00%

& 56.67%). Proportion of patients aged >50 years was

higher as compared to 12-25 years and 26-50 years for

Stricture urethra (20.0% Vs. 8.0% and 12.0%) and

BPH (23.33% vs. 0.0% & 8.0%). Difference in Final

Chronic UTI

BPH

diagnosis in different age groups was found to be

0.95%

PUJ 11.43%

10.48%

statistically significant (p<0.001).

 

Total

Males

Females

 

(n=100)

(n=5)

 

 

 

 

No.

%

No.

%

Calculus

65

60

60.00

5

100.00

Structure

 

 

Urethra

VUR

 

13.33%

 

1.90%

Calculus

 

 

61.90%

Most common diagnosis was Calculus (61.90%) followed by Stricture (13.33%), PUJ (11.43%), BPH (10.48%), VUR (1.90%), and Chronic UTI (0.95%).

 

T

12-25 yrs

26-50 yrs

>50 yrs

 

O

(n=25)

(n=50)

(n=30)

 

T

 

A

 

 

 

 

 

 

 

No.

%

No.

%

No.

%

 

L

Calculus

65

13

52.00

35

70.00

17

56.67

VUR

2

2

8.00

0

0.00

0

0.00

Stricture

14

2

8.00

6

12.00

6

20.00

Urethra

 

 

 

 

 

 

 

PUJ

12

8

32.00

4

8.00

0

0.00

Chronic

1

0

0.00

1

2.00

0

0.00

UTI

 

 

 

 

 

 

 

BPH

11

0

0.00

4

8.00

7

23.33

 

 

 

 

 

 

 

 

Table 13: Association of Age with Final Diagnosis

Upto 25 26-50 yrs >50 yrs

70

60

50

40

30

20

10

0

Calculus

VUR

Stricture

PUJ

Chronic

BPH

 

 

Urethra

 

UTI

 

Calculus was diagnosed in majority of the patients of each age group., Proportion of patients aged 12-25 years was higher as compared to 26-50 years and >50

VUR

2

2

2.00

0

0.00

StrictureUrethra

14

14

14.00

0

0.00

PUJ

12

12

12.00

0

0.00

Chronic UTI

1

1

1.00

0

0.00

BPH

11

11

11.00

0

0.00

 

 

 

 

 

χ²=3.231 (df=5); p=0.664

Table 14: Association of Gender with Final Diagnosis

100

90

80

70

Percentage 60

50

40

30

20

10

0

Calculus VUR Stricture PUJ Chronic BPH

UrethraUTI

Only 5 patients were female and all were diagnosed as

Calculus. No statistically significant association in

gender and Final diagnosis was found.

 

T

2-25 yrs

26-50 yrs

>50 yrs

 

O

 

T

(n=9)

(n=18)

(n=18)

 

A

 

L

 

 

 

 

 

 

 

 

No.

%

No.

%

No.

%

BLRenal

18

5

55.56

8

44.44

5

27.78

calculi

 

 

 

 

 

 

 

BPH

11

0

0.00

4

22.22

7

38.89

Stricture

14

2

22.22

6

33.33

6

33.33

 

 

 

 

 

 

 

 

VUR

2

2

22.22

0

0.00

0

0.00

 

 

 

 

 

 

 

 

 

 

 

χ

²=13.364(df=6);

p=0.038

Table 13: Association of Bilateral Hydronephrosis

(n=45) with Age

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Upto 25 26-50 yrs >50 yrs

 

60

 

50

Percentage

40

30

20

10

0

BL Renal Calculi

BPH

Stricture

VUR

Only 45 patients were found to be suffering from Bilateral hydronephrosis. For of patients aged 12-25 was found to be higher as compared to 26-50 years and >50 years for Bilateral renal calculi (55.56% vs. 44.44% & 27.78%) and VUR (22.22% vs. 0.0% & 0.0%) while proportion of patients aged >50 years and 26-50 years was higher for BPH (38.89% & 22.22% vs. 0.0%) and Stricture (33.33% & 33.33% vs. 22.22%).

CONCLUSIONS

From our study, we concluded that age of patients ranged from 12 to 79 years with a mean age of 42.12 years. Out of them, majority of patients were males (95.24%). There were only 4 (4.76%) females. Intermittent flank pain was the most common complaint at presentation (37.14%) followed by difficulty in micturition and burning micturition with fever (16.19% and 15.24% respectively). Diminished flow (9.52%), iliac fossa pain, h/o acute retention, dribbling of urine (5.71%), nocturia (2.86%) and hesitancy (1.9%) were some of the less common presenting complaints. History of smoking (12.38%) and alcohol use (17.14%) were reported as the personal habits with health risk. None of the patients reported of drug use / tobacco chewing habit. Evaluation of medical history revealed history of tuberculosis (10.48%) as the most common finding followed by trauma (7.62%), hypertension (4.76%), bronchial asthma and previous surgery (3.81% each) and diabetes mellitus respectively (2.86%). Most of the patients did not present with any particular clinical sign. Pallor (15.24%) and fever (8.57%) were the most common clinical signs. A total of 3 (2.86%) reported

w i t h o e d e m a . M e a n h e m o d y n a m i c a n d haematological parameters of patients were within normal range. Mean serum urea level was 47.55±27.55 mg/dl, thus indicating a high degree of derangement. Urine culture was sensitive in 29 (27.6%) cases. E. coli was isolated in 21 and Klebsiella in 8 cases. No significant association of microbial positivity with body temperature was observed. X-ray

findings did not show any abnormality in 18 (17.14%) cases. Most common X-ray abnormality was presence of renal calculi (18; 17.14% bilateral and 32; 30.5% unilateral; 2; 1.9% multiple). Urethral stricture in 13 (12.38%) cases and Unilateral obstruction in 14 (13.3%) cases. Ureteric calculi were seen in 3 (2.9%) cases. Vesicular calculi were seen in 2 (1.9%) cases. There was 1 (0.95%) case each with dilated uterers with VUR, dilated calyx with VUR; Urethral calculi were seen in 1 case each. USG findings were positive in all the cases. Unilateral renal calculi with hydronephrosis was the most common USG findings (n=34; 32.38%). Bilateral hydronephrosis was reported in 19 (18.1%) while bilateral renal calculi with hydronephrosis was reported in 18 (17.14%) cases were the most common findings. Dilated calyx with PUJ obstruction, BPH, unilateral ureteric calculi with hydronephrosis were seen in 11.4%, 8.6% and 8.6% patients respectively. There was 1 case each with USG findings suggestive of dilated calyx with VUR, Genitourinary Tuberculosis, Severe UTI with BOO and Vesicureteric reflux with dilated ureters respectively.

The aetiology of hydronephrosis was established as calculus in 64 (61.9%) cases followed by stricture urethra (13.33%), PUJ (11.43%), BPH (10.48%), VUR (1.9%), Chronic UTI (0.95%) and ureteric stricture (0.95%) respectively. Calculus was most common diagnosis in all age groups, however, in younger age group (12-25 yrs) PUJ was the second most common diagnosis whereas in age group >50 years, BPH was the second most common diagnosis. Statistically, a significant association was seen between age and aetiology of hydronephrosis. All the 5 females were diagnosed to have calculus as the aetiology of hydronephrosis as compared to 60% of males presenting with calculus as the aetiology. In cases with bilateral hydronephrosis, in younger age group (12-25 years) calculi were the most common aetiology (55.56%) followed by stricture and VUR (22.22% each), in age group 26-50 years renal calculi were the most common aetiology (44.44%) followed by stricture (33.33%) and BPH (22.22%) whereas in older age group >50 years, BPH was the most common aetiology (38.89%) followed by stricture (33.33%) and renal calculi (27.78%) respectively. Statistically, there was a significant difference in aetiology of hydronephrosis in different age groups. Management based on aetiology was successful in all the case with a significant reduction in renal size from the first month follow up itself. By third month follow up resolution of hydronephrosis was seen in all the cases. None of the cases showed recurrence.

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A CLINICO- EPIDEMIOLOGICAL STUDY OF HYDRONEPHROSIS AT ERA`S LUCKNOW MEDICAL COLLEGE , LUCKNOW

DISCUSSION

The findings of present study suggested that the clinical signs and symptoms of hydronephrosis were non-specific to the aetiology which was dependent mainly on age and gender. After ruling out paediatric age group and pregnant women, hydronephrosis was seen as a highly male dominant disease with renal calculi as the major aetiology and BPH and VUR being age-associated risk factors. Aetiology based management of hydronephrosis yielded good outcome. The present study is perhaps the first detailed clinic pathological profile of hydronephrosis. In fact, there is tremendous life of large case series on hydronephrosis – though the present study has made to fill this gap, yet further studies on this entity are recommended to build a proper data base regarding epidemiology, pathogenesis, clinical presentation and management.

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How to cite this article : Bhushan R., Kumar P., Bhat S., A Clinico- Epidemiological Study of Hydronephrosis At Era`s Lucknow

Medical College , Lucknow, EJMR2017;4(2):112-119.

ERA’S JOURNAL OF MEDICAL RESEARCH, VOL.4 NO.2

Page: 119