This document defines and describes hydronephrosis, which is the chronic dilatation of the pelvi-calyceal system due to partial or complete intermittent obstruction of urine flow. It discusses the etiology, pathophysiology, clinical presentation, investigations, and treatment of hydronephrosis. Treatment involves treating the underlying cause if kidney function is good or performing nephrostomy or nephrectomy if function is impaired. The role of the urologist is to rule out correctable obstructions and perform surgery for obstructive causes of chronic renal failure.

2. HYDRONEPFROSIS
Definition
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

3. HYDRONEPFROSIS
Pathophysiology:
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.

4. 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.

5. HYDRONEPFROSIS
Clinical picture
Symptoms:
Pain colicky or heaviness in the flank
Swelling
Hematuria usually mild
Signs:
Abdominal swelling
S&S of the cause of hydronephrosis eg; bladder mass,
BPH,etc

6. HYDRONEPFROSIS
Investigations:
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

7. HYDRONEPFROSIS

8. HYDRONEPFROSIS
TREATMENT
A- 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

9. HYDRONEPFROSIS

10. RENAL FAILURE
The role of urologist:
1- To rule out a correctable obstruction
2- Urologic surgery FOR chronic renal failure of
obstructive cause

11. 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 )

12. ACUTE RENAL FAILURE
Classification and Causes
I- 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

13. ACUTE RENAL FAILURE
Drugs Associated with ARF
 Aminoglucosides
 Penicillin
 Sulpha
 Cyclosporin
 Certain anaesthetics
 Iodinated contrast media
 Non-Steroidal anti-inflammatory drugs
 Furosemide and Thiazide
 Captopril
 Cimetidine

14. 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

15. ACUTE RENAL FAILURE
Treatment
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.


16. CHRONIC RENAL FAILURE
Definition:
 (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.

17. CHRONIC RENAL FAILURE
Clinical 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

18. CHRONIC RENAL FAILURE
Treatment of CRF
Is the responsibility of the Nephrologist
1-Treatment of Anaemia
2- Correction of Coagulopathy
3- Protein restriction
4- Potassium restriction
5- Sodium restriction
6- Fluid intake
7- Treatment of Ascitis
8-Treatment of Renal osteodystrophy

19. CHRONIC RENAL FAILURE
Dialysis “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

20. 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

21. 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