HYDRONEPFROSISDefinitionChronic aseptic dilatation of the pelvi-calyceal system due to partialor complete intermittent obstruction.EtiologyA- UnilateralStoneStrictureExternal compressionB- Bilateral1- Causes in both ureters: ex. Stones, stricture, reflux2- Causes in the bladder / or bladder neck ex. Bladder tumor, BPH3- Causes in the urethra ex. stricture
HYDRONEPFROSISPathophysiology:Nature of obstructionA- Functional for example increased collagen depositionat the UPJ leads to reduced distensilbilityB- Organic- Partial or complete- Acute or chronicImpedance to flow of urine higher than normal pressureabove the site of obstruction Chronic progressivedilation of pelvi-collecting system Vascularcompression ischemic atrophy loss of kidneyfunction.
HYDRONEPFROSISCauses of low intra-pelvic pressure are:1-Protective arterial vasoconstriction2-Backflow reflux of the intrapelvic contents into therenal tubules (pyelotubular)rena , the renal veins(pyelovenous) or the iterstitium of the kidney (-pyelointerstitial) .The first renal function to be affected is urineconcentrating power increasd urine output.
HYDRONEPFROSISClinical pictureSymptoms:Pain colicky or heaviness in the flankSwellingHematuria usually mildSigns:Abdominal swellingS&S of the cause of hydronephrosis eg; bladder mass,BPH,etc
HYDRONEPFROSISInvestigations:1-Laboratory:-Urine analysis-Renal function tests2-Radiologic:-Plain X-ray film:Soft tissue shadow of the kidney? Stone-IVP:Loss of waist flattening clubbing ballooningThin parenchyma-UltrasoundDilated system- Thickness of the remaining parenchyma
HYDRONEPFROSISTREATMENTA- If the kidney function is good treat the causeB- If the kidney function is bad preliminary diversion (Nephrostomy) treat the causeC- Non-functioning kidney (<10% by isotope) Nephrectomy
RENAL FAILUREThe role of urologist:1- To rule out a correctable obstruction2- Urologic surgery FOR chronic renal failure ofobstructive cause
ACUTE RENAL FAILUREDefinition: Sudden renal deterioration over aperiod of hours to daysDaily increase of serum creatinine of >0.5mg/dlOliguria : ( 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 peritonitisB. Circulatory- CHF, Sepsis, Shock, Cirrhosis with ascitisC. Local renal ischeamia- Renal artery occlusion/ Renal vein occlusionII- RenalAcute tubular necrosis/ Acute glomerulonephritisIII- 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 FAILURETreatmentShould be focused on:1. Reversing the underlying cause2. Preventing further renal injury3. Correcting fluid and electrolyte imbalance4. Providing supportive measuresIf ARF is severe and prolonged, it is best treatedwith peritoneal dialysis or haemodialysis.
CHRONIC RENAL FAILUREDefinition: (Slowly progressive decrease in the GFR andtubular function) When the patient requires renal replacementtherapy End stage renal disease.Causes:-DM - Hypertension- Glomerulonephritis - Congenital diseases- Obstructive uropathy -Interstitial nephritis- Chronic pyelonephritis.
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 solutesin the plasma by exposure to a second solution across asemi- permeable membrane)Indications:* Urea nitrogen > 100 mg / DL* Creatinine Clearance < 0.1 ml / min/ KgTypes:A. Peritoneal dialysisB. Haemodialysis
RENAL TRANSPLANTATIONRequirements:1. Donor- Living related kidney donor- Cadaveric renal donor2. Recipient (ESRD)3. Pretransplantation work up4. Immunologic work up5. Surgical technique6. Postoperative management
RENAL TRANSPLANTATIONComplications:1. Graft rejection2. Vascular complications3. Urologic complications4. Complications of drugs (Cyclosporin)Usually, the graft works for about 10 years