A 48-year-old woman is evaluated for vaginal discharge and postcoital bleeding. A friable mass at the cervix that bleeds easily on touch is discovered during a pelvic examination. A cervical biopsy reveals invasive squamous cell cancer of the cervix and uterus. There are no lymph node metastases. During a radical hysterectomy, the right ureter is accidentally injured but then repaired. Following surgery, imaging studies reveal a partial obstruction of the right ureter with mild dilation of the proximal collecting system. Which of the following changes in the right kidney is most likely?

Question

Quizplus · Accepted Answer

Eductional Objective: GFR is determined by the interaction of hydrostatic and oncotic pressures in the glomerular capillaries and Bowman's space. GFR increases as glomerular hydrostatic pressure increases and decreases as Bowman's capsule hydrostatic pressure or glomerular capillary oncotic pressure increases. Acute ureteral obstruction raises the hydrostatic pressure near the constriction. This increase in pressure is transmitted back to the Bowman's space, resulting in a decrease in GFR.
The filtration fraction (FF) is the portion of the renal plasma flow (RPF) that is filtered into Bowman's space from the glomerular capillaries (ie, the GFR:RPF ratio). RPF may increase transiently during acute ureteral obstruction (first 12 hours); however, efferent arteriolar constriction (in response to decreased GFR) will decrease RPF over time. Even at later stages, though, the GFR remains depressed to a greater extent than the RPF, resulting in reduced FF.

A 48-Year-Old Woman Is Evaluated for Vaginal Discharge and Postcoital