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Pathophysiology of Urinary Tract Obstruction
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=== Bilateral Ureteral Obstruction (BUO) or Obstruction of a Solitary Kidney === * Complete obstruction of urinary flow results in anuria. # '''First phase''' #* '''Similar to UUO, there is an initial increase in RBF with BUO but this response appears to be less pronounced and of shorter duration (β90 minutes)''' # '''Second phase''' #* '''Large decrease in RBF. As a result, GFR declines''' #** '''The decline in GFR is accompanied by an increase in efferent arteriole resistance''' # '''Third phase''' #* '''The collecting system pressure remains elevated for longer than unilateral obstruction and is often still high at 24 hours''' #** '''It is believed that this persistent increased pressure is secondary to afferent arteriolar vasodilation and efferent arteriolar vasoconstriction, which may be caused by the accumulation of atrial natriuretic peptide or other factors associated with complete obstruction.''' #** '''There is a shift of blood flow to the outer renal cortex with BUO, in contrast to the reversed pattern with UUO.''' #** '''During UUO, preglomerular vasodilation is followed by a more prolonged PREglomerular vasoconstriction''', and this increase in afferent arteriolar resistance causes a reduction in glomerular capillary pressure that in turn results in decreased intratubular pressure. '''In contrast, during BUO preglomerular vasodilation is followed by a prolonged POSTglomerular vasoconstriction'''
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