This document discusses the etiopathogenesis, clinical features, and diagnosis of ureteropelvic junction (UPJ) obstruction. It begins by defining UPJ obstruction as a restriction of urine flow from the renal pelvis to the ureter. UPJ obstruction can be caused by intrinsic factors like anatomical abnormalities or extrinsic factors like crossing vessels. Clinically, it can present at any age as flank pain, hematuria, or hypertension. Diagnosis involves imaging like renal ultrasound, CT urogram, diuretic renogram, and voiding cystourethrogram to evaluate obstruction and identify associated issues like vesicoureteral reflux. Surgical correction may be needed to repair the obstruction and preserve
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
this presentation covers anatomy of the testis, embryological development, causes, clinical features, complications, differences between various types, investigations, and management of undescended testis.
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
this presentation covers anatomy of the testis, embryological development, causes, clinical features, complications, differences between various types, investigations, and management of undescended testis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. • A ureteropelvic junction (UPJ) obstruction can
be thought of as a restriction to flow of urine,
from the renal pelvis to the ureter, which, if
left uncorrected, leads to progressive renal
deterioration
3
Dept of Urology, GRH and KMC, Chennai.
4. PUJ Obstruction
• Accounts for 64% of infants with unresolved post-natal
hydronephrosis
• Males > Females (2:1 in newborns)
• Left >Right (2:1)
• 10% bilateral
Synchronous or asynchronous
May be inheritable
4
Dept of Urology, GRH and KMC, Chennai.
5. ETIOLOGY
• The precise cause of UPJ obstruction remains
elusive despite investigation along a number
of lines:
• ? embryologic
• ? anatomic
5
Dept of Urology, GRH and KMC, Chennai.
6. ETIOLOGY
• Intrinsic
– Aperistaltic segment
– Intrinsic narrowing/ Kink
found more frequently in the presence of renal ectopia
or fusion anomalies
– Ostling’s folds
• Present in 92% newborns
• Result from differential growth of ureter vs body
• Usually resolves in childhood
Ureteral polyps
Persistent fetal convolutions
6
Dept of Urology, GRH and KMC, Chennai.
7. • Transforming growth factor-β, Epidermal
growth factor expression, and Neuropeptide Y
increased UPJ stenosis
• Abnormalities of ureteral musculature have
been implicated as electron microscopy has
demonstrated excessive collagen deposition at
the site of the pujo
7
Dept of Urology, GRH and KMC, Chennai.
8. Intrinsic Cause of UPJO: Intrinsic
Narrowing
Renal Pelvis
Proximal Ureter
Intrinsic
Narrowing
8
Dept of Urology, GRH and KMC, Chennai.
10. ETIOLOGY
• Extrinsic
– High insertion
– Kinking secondary to fibrosis
– Crossing vessel ?
• 15-63%
• Anterior to UPJ supplying lower pole of kidney
• Majority in adults or older children
10
Dept of Urology, GRH and KMC, Chennai.
11. • When an aberrant or accessory renal artery to the lower
pole of the kidney is present and the ureter courses behind
it, the ureter may angulate at both the UPJ and the point at
which it traverses over the vessel as the pelvis fills and
bulges anteriorly.
• Further angulation of the ureter occurs as it becomes
adherent to the PUJ secondary to an inflammatory process
• A two-point obstruction ensues, with kinking of the ureter
at the PUJ and at the point where the ureter drapes over
the vessel.
• Over time, these areas may become ischemic, fibrotic, and
finally stenotic
• Secondary UPJ obstruction due to severe VUR
11
Dept of Urology, GRH and KMC, Chennai.
12. Lower Pole Vessel
UPJ Anterior
High Insertion Kinking
Crossing Vessels 12
Dept of Urology, GRH and KMC, Chennai.
13. EXTRINSIC CAUSE
• Fibroepithelial polyps
• Urothelial malignancy,
• Stone disease
• Postinflammatory or postoperative scarring or
ischemia
13
Dept of Urology, GRH and KMC, Chennai.
14. PATHOLOGIC CHANGES OF
OBSTRUCTION
GROSS
• kidneys - enlarged, cystic
appearance
• Dilation of the pelvis and
ureter and blunting of the
papillary tips
• Cortex edematous & slightly
enlarged
• diffuse thinning of cortex
and medullary tissue
MICROSCOPIC
• Widespread glomerular
collapse and tubular
atrophy, interstitial fibrosis,
and proliferation of
connective tissue in the
collecting system --- 5 to 6
weeks after obstruction
14
Dept of Urology, GRH and KMC, Chennai.
15. SCLEROSIS & HYALINOSIS OF
GLOMERULUS TUBULES DEMONSTRATE
THYROIDIZATION-TYPE ATROPHY
15
Dept of Urology, GRH and KMC, Chennai.
16. Patterns of Effect
• 1. regulation of growth,
• 2.tissue differentiation,
• 3.fibrosis
• 4.altering the functional integration of the
kidney
16
Dept of Urology, GRH and KMC, Chennai.
18. Differentiation
Differentiation is the process of cells attaining specific
functional traits to permit specialized functions and
organization into tissues.
It is the basis for renal function,
Obstruction affects these finely tuned patterns, as can
be seen histologically in a severely obstructed kidney
with dysplasia.
Abnormal epithelial mesenchymal transformation (EMT) is one
alteration in differentiation that does occur in the adult and can
be reversible 18
Dept of Urology, GRH and KMC, Chennai.
19. FIBROSIS
A universal characteristic of obstructive nephropathy
appears to be renal fibrosis
It is seen as infiltration of the interstitium with abnormal
amounts of ECM, including collagens, fibronectin, and
other connective tissue proteins.
Their presence disrupts the normal interconnections
between cells that permit functional integration of the
renal tissues.
19
Dept of Urology, GRH and KMC, Chennai.
21. • Modulation of renal fibrosis may be a significant potential
target for managing obstructive nephropathy,
• but the delicate balance of these factors needs to be
understood to a greater degree than at present
• Nitric oxide has also been shown to regulate the development
of obstructive fibrosis postnatally and may play a similar role
prenatally
• Increased nitric oxide generation reduces the degree of
interstitial fibrosis
21
Dept of Urology, GRH and KMC, Chennai.
22. FUNCTIONAL INTEGRATION
Renal function is regulated at numerous levels, including vascular,
neural, and hormonal factors, this may be significantly affected by
inflammatory processes(absent in congenital obstruction)
Although inflammatory changes do not appear to be a major
factor in early postnatal congenital urinary obstruction but it is likely
that they begin to play a greater role with age
Congenital obstruction alters both the ongoing functional integration
of the kidney as well as the development of the mechanisms
that are intrinsic to this regulation.
22
Dept of Urology, GRH and KMC, Chennai.
23. CLINICAL FEATURE
• Can present clinically at any time of life.
• Asymptomatic
• The most common presentation in neonates and
infants palpable flank mass
• During evaluation of azotemia, which may result
from bilateral obstruction in a functionally or
anatomically solitary kidney.
• UPJ obstruction may also be incidentally found
during studies performed to evaluate unrelated
anomalies such as congenital heart disease
23
Dept of Urology, GRH and KMC, Chennai.
24. • In older children or adults, intermittent abdominal
or flank pain, at times associated with nausea or
vomiting,
• Hematuria, either spontaneous or associated with
otherwise relatively minor trauma,
• Laboratory findings of microhematuria, pyuria, or
frank urinary tract infection
• Hypertension
24
Dept of Urology, GRH and KMC, Chennai.
25. UPJ Obstruction-Workup
• Renal Ultrasound
• CT UROGRAPHY
• Diueretic Renogram
– Differential function
– Drainage curve
• VCUG to evaluate for VUR
– Is it needed in all children?
– Are prophylactic antibiotics needed?
• Retrograde Pyelogram
– Evaluation for distal obstruction
• If no dilated ureters on US
• On table antegrade nephrostogram
25
Dept of Urology, GRH and KMC, Chennai.
26. Antenatal Hydronephrosis
Society for Fetal Urology Grading System
Grade 0:no hydronephrosis
Grade 1:slight pelvic dilatation,no calyceal
dilatation
Grade 2: moderate pelvic dilatation,slight
calyceal dilatation(major calyces)
Grade 3: large pelvis, dilated calyces (minor
calyces),normal parenchyma
Grade 4: large pelvis, dilated calyces,thinned
parenchyma
26
Dept of Urology, GRH and KMC, Chennai.
27. Normal Kidney
(SFU Grade 0)
SFU Grade 1
(Pelviectasis)
27
Dept of Urology, GRH and KMC, Chennai.
28. Hydronephrosis Grades 2 and 3
From www.cevlforhealthcare.org
28
Dept of Urology, GRH and KMC, Chennai.
29. SFU Grade 4
(Thin Parenchyma)
29
Dept of Urology, GRH and KMC, Chennai.
32. Imaging: Renograms
• DMSA (Technetium-99m-dimercaptosuccinic acid)
– Tightly bound to renal tubular cells
– Excellent renal cortical imaging agent
– No interference from the collection system
– Good for acute pyelonephritis and cortical scars
– Most accurate to determine differentialrenal function
• DTPA (Technetium-99m-diethylenetriamine pentaacetic acid)
– Clearance exclusively via GF
– No significant tubular secretion or cortical retention
– Good for renal perfusion and GFR determination
• MAG-3 (Technetium-99m-mercaptoacetyltriglycine)
– Clearance by tubular secretion
– Good for renal perfusion and drainage studies
– Higher renal extraction fraction vs DTPA
– Superior image quality versus DTPA
– More accurate in settings of immature renal function 32
Dept of Urology, GRH and KMC, Chennai.
33. Diuretic Renogram
1. Differential renal function (DRF)
– Measured prior to renal excretion (2 min)
• Influenced by timing of diuretic administration
– Measurement of renal uptake subtracting for background
• Sometimes difficult in hydronephrotic kidney
2. t1/2 time
– Defined as the time for the radionucleotide to decrease by half
the peak amount in the pelvis
– Generation of a time drainage curve
• >20 min “obstructed”
• 10-20 min indeterminant
• <10 min unobstructed
33
Dept of Urology, GRH and KMC, Chennai.
35. Diuretic Renograms-Variability
• Hydration State
• Functional status of the kidney
• Renal responsiveness to diuretic
• Bladder fullness
• Operator dependency
– Timing of diuretic administration
– Area of interest
• Postural positioning during imaging
• Collecting system capacity / compliance
35
Dept of Urology, GRH and KMC, Chennai.
36. Magnetic Resonance Urogram
• Newest technology
• Use of Gd-DTPA and Lasix
• T1 and T2 weighted images
• Measurement of GFR and Renal Transit Time (RTT)
• Better anatomical detail and better predictor of UPJ
obstruction
• Expensive and not widely available
• Requires sedation
36
Dept of Urology, GRH and KMC, Chennai.
37. • MRU measurement of contrast excretion is the renal transit
time, which is defined as the time it takes for contrast to pass
from the renal cortex to the proximal ureters
• normal 4 minutes or less
• Equivocal if longer than 4 and less than 8 minutes
• obstructed if 8 minutes or longer
37
Dept of Urology, GRH and KMC, Chennai.
38. Whitaker Test
• 22 gauge angiocaths in
renal pelvis
• Foley catheter
• If opening pressure
normal, infuse based on
wt, ht, and age
38
Dept of Urology, GRH and KMC, Chennai.
39. Whitaker Test
• Infusion rate 10 ml/min
>22 cm H2O Obstructed
15-22 cm H2O Indeterminant
<15 cm H2O Unobstructed
39
Dept of Urology, GRH and KMC, Chennai.
40. Associated Anomalies
• Congenital renal malformations are commonly seen in association
with UPJ obstruction
• UPJ obstruction is the most common anomaly encountered in the
opposite kidney; it occurs in 10% to 40% of cases.
• Renal dysplasia and multicystic dysplastic kidney are the next most
frequently observed contralateral lesions .
• unilateral renal agenesis has been noted in almost 5% of children
• UPJ obstruction may also occur in either the upper or the lower
half (usually the latter) of a duplicated collecting system or of a
horseshoe or ectopic kidney
40
Dept of Urology, GRH and KMC, Chennai.