HYDRONEPFROSISDefinition Chronic aseptic dilatation of the pelvi-calyceal system

due to partial or complete intermittent obstruction.

Etiology A- Unilateral Stone Stricture External compression B- Bilateral 1- Causes in both ureters: ex. Stones, stricture,

reflux 2- Causes in the bladder / or bladder neck ex.

Bladder tumor, BPH 3- Causes in the urethra ex. stricture

HYDRONEPFROSISPathophysiology:Nature of obstruction A- Functional for example increased collagen

deposition at the UPJ leads to reduced distensilbility B- Organic - Partial or complete - Acute or chronic

Impedance to flow of urine higher than normal pressure above the site of obstruction Chronic progressive dilation of pelvi-collecting system Vascular compression ischemic atrophy loss of kidney function.

HYDRONEPFROSIS

Causes of low intra-pelvic pressure are: 1-Protective arterial vasoconstriction 2-Backflow reflux of the intrapelvic

contents into the renal tubules (pyelotubular)rena , the renal veins (pyelovenous) or the iterstitium of the kidney (-pyelointerstitial) .

 The first renal function to be affected is urine

concentrating power increasd urine output.

HYDRONEPFROSIS

Clinical pictureSymptoms:

Pain colicky or heaviness in the flankSwelling Hematuria usually mild

 Signs:

Abdominal swellingS&S of the cause of hydronephrosis eg; bladder mass, BPH,etc

HYDRONEPFROSISInvestigations:1-Laboratory:

-Urine analysis-Renal function tests

2-Radiologic:-Plain X-ray film: Soft tissue shadow of the kidney ? Stone-IVP: Loss of waist flattening clubbing ballooning Thin parenchyma -Ultrasound Dilated system- Thickness of the remaining parenchyma

HYDRONEPFROSIS

HYDRONEPFROSIS

TREATMENTA- If the kidney function is good treat the cause

B- If the kidney function is bad preliminary diversion (Nephrostomy) treat the cause

C- Non-functioning kidney (<10% by isotope) Nephrectomy

HYDRONEPFROSIS

RENAL FAILURE

The role of urologist: 1- To rule out a correctable obstruction2- Urologic surgery FOR chronic renal failure

of obstructive cause

ACUTE RENAL FAILURE

Definition: Sudden renal deterioration over a period of hours to days

 Daily increase of serum creatinine of

>0.5mg/dl Oliguria : ( Urine output </= 400ml/24

hours ) Anuria : ( Total cessation of urine output ) 

ACUTE RENAL FAILUREClassification and CausesI-  Prerenal : A. Volume depletion - Heamorrhage/ Burns/ Third space losses e.g

peritonitis B. Circulatory - CHF, Sepsis, Shock, Cirrhosis with ascitis  C. Local renal ischeamia - Renal artery occlusion/ Renal vein occlusion   II- Renal Acute tubular necrosis/ Acute glomerulonephritis

III- Postrenal - Bilateral ureteric obstruction - Unilateral obstruction of a solitary kidney 

ACUTE RENAL FAILUREDrugs Associated with ARF Aminoglucosides Penicillin Sulpha Cyclosporin Certain anaesthetics Iodinated contrast media Non-Steroidal anti-inflammatory

drugs Furosemide and Thiazide Captopril Cimetidine

ACUTE RENAL FAILURE

Diagnosis of Anuria & acute Retention

*Anuria = Empty bladder * Acute Urine Retention = Full bladder

  Differentiation by: 1. Physical examination 2. Abdominal Ultrasound 3. Urethral catheterization

ACUTE RENAL FAILURETreatment Should be focused on:

1. Reversing the underlying cause 2. Preventing further renal injury 3. Correcting fluid and electrolyte imbalance 4. Providing supportive measures

 If ARF is severe and prolonged, it is best

treated with peritoneal dialysis or haemodialysis.

 

CHRONIC RENAL FAILUREDefinition: (Slowly progressive decrease in the GFR and

tubular function) When the patient requires renal replacement

therapy End stage renal disease. Causes:

-DM - Hypertension- Glomerulonephritis - Congenital diseases- Obstructive uropathy -Interstitial nephritis - Chronic pyelonephritis.

 

CHRONIC RENAL FAILUREClinical Picture of CRF

1. Constitutional symptoms 2. GIT symptoms 3. Cardiovascular symptoms

4. Hematological symptoms 5. Neurological symptoms 6. Endocrinal symptoms 7. Renal osteodystrophy 8. Acquired cystic kidney disease 9. Erectile dysfunction

CHRONIC RENAL FAILURETreatment of CRFIs the responsibility of the Nephrologist1-Treatment of Anaemia2- Correction of Coagulopathy3- Protein restriction4- Potassium restriction5- Sodium restriction6- Fluid intake7- Treatment of Ascitis8-Treatment of Renal osteodystrophy

CHRONIC RENAL FAILUREDialysis “Nephrologist “

Definition: (Is any process that changes the

concentration of solutes in the plasma by exposure to a second solution across a semi- permeable membrane)

 Indications: * Urea nitrogen > 100 mg / DL * Creatinine Clearance < 0.1 ml / min/ Kg Types:

A. Peritoneal dialysis B. Haemodialysis

RENAL TRANSPLANTATION

Requirements: 1. Donor

- Living related kidney donor - Cadaveric renal donor

2. Recipient (ESRD) 3. Pretransplantation work up 4. Immunologic work up 5. Surgical technique 6. Postoperative management

RENAL TRANSPLANTATION

Complications: 1. Graft rejection 2. Vascular complications 3. Urologic complications 4. Complications of drugs (Cyclosporin)

 Usually, the graft works for about 10

years