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9 hn,rf,transplant 2003


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  • 1. 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
  • 2. 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.
  • 3. 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.
  • 4. HYDRONEPFROSISClinical pictureSymptoms:Pain colicky or heaviness in the flankSwellingHematuria usually mildSigns:Abdominal swellingS&S of the cause of hydronephrosis eg; bladder mass,BPH,etc
  • 5. 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
  • 7. 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
  • 9. RENAL FAILUREThe role of urologist:1- To rule out a correctable obstruction2- Urologic surgery FOR chronic renal failure ofobstructive cause
  • 10. 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 )
  • 11. 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
  • 12. 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
  • 13. ACUTE RENAL FAILUREDiagnosis of Anuria & acute Retention*Anuria = Empty bladder* Acute Urine Retention = Full bladderDifferentiation by:1. Physical examination2. Abdominal Ultrasound3. Urethral catheterization
  • 14. 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.
  • 15. 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.
  • 16. CHRONIC RENAL FAILUREClinical Picture of CRF1. Constitutional symptoms2. GIT symptoms3. Cardiovascular symptoms4. Hematological symptoms5. Neurological symptoms6. Endocrinal symptoms7. Renal osteodystrophy8. Acquired cystic kidney disease9. Erectile dysfunction
  • 17. 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
  • 18. 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
  • 19. RENAL TRANSPLANTATIONRequirements:1. Donor- Living related kidney donor- Cadaveric renal donor2. Recipient (ESRD)3. Pretransplantation work up4. Immunologic work up5. Surgical technique6. Postoperative management
  • 20. RENAL TRANSPLANTATIONComplications:1. Graft rejection2. Vascular complications3. Urologic complications4. Complications of drugs (Cyclosporin)Usually, the graft works for about 10 years