Etiology
Upper urinary tract (nonglomerular)
Upper urinary tract nonglomerular causes of NVH include infection (pyelonephritis); stone formation (nephrolithiasis); and three broader groups: mass lesions, and abnormalities of vascular inflow and urine outflow.
Mass lesions range from benign simple renal cysts to malignancy (renal cell carcinoma and calyceal or upper tract urothelial cancer [previously termed transitional cell carcinoma]). Renal artery infarction, renal vein thrombosis, arteriovenous malformations, and papillary necrosis (or sickle cell disease) are vascular inflow examples. Hydronephrosis, vesicoureteral reflux, calyceal diverticula, and ureteropelvic junction obstruction relate to urine outflow.
Other renal pathologies, such as polycystic kidney disease, atrophic kidney, and medullary sponge kidney, can present with NVH.
Upper urinary tract (glomerular)
Kidney disorders involving the glomerulus (acute glomerulonephritis, lupus nephritis, thin glomerular basement membrane disease, and IgA nephropathy) and producing NVH can be identified early in the diagnostic evaluation by red blood cell morphology and the presence of proteinuria.[4][8][19][20] Early recognition of these allows for a more focused workup and prompts nephrology consultation.
Lower urinary tract
The lower urinary tract includes the bladder and urethra, as well as the prostate and penis. As with the upper urinary tract, infection (cystitis, urethritis, prostatitis), stone formation, tumors (e.g., bladder papilloma), and diverticula contribute to NVH originating from the lower urinary tract. Most often a malignant lesion causing NVH occurs within the lower urinary tract, specifically urothelial cancer.[7][14][15][16][17]
Noninfectious causes of cystitis (radiation-induced, interstitial, and eosinophilic cystitis) and disorders occurring only in men (benign prostatic hyperplasia, prostate cancer, phimosis, penis cancer) need to be considered as possible causes of NVH.
Other lower urinary tract causes include bladder neck contracture and urethral stricture.
Nonurinary tract origin
Some readily identifiable causes belong in this group and should be inquired about early in the history. Examples include menstruation and trauma (sexual activity, contusion, exercise). Other miscellaneous causes include HIV, lymphoma, multiple myeloma, and urinary tract tuberculosis.[21]
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