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Presentation 1
Presentation 1
UROPATHY
Dr. Bassem W. Yani ,MD
Diploma, FEBU, FCS urology
CONSULTANT UROLOGIST
UTH LUSAKA ZAMBIA
Definitions
• Hydronephrosis- Dilation of the renal
pelvis or calyces
• Obstructive uropathy- functional or
anatomic obstruction of urine flow at
any level of the urinary tract
• Obstructive nephropathy- when
obstruction causes function or
anatomic renal damage
Prevalence
• 3.1% in autopsy series
• 2-2.5% of children at autopsy
• No gender differences until THE AGE
OF 20 years
– Females are more common 20-60 years
– Males are more common older than 60
years
ssifications
1/onset :acute or chronic
2/ site: unilateral or bilateral
3/degree : partial or complete
4/aetiology :
mechanical or functional
congenital or acquired
Causes of Obstructive Nephropathy
• Renal:
– Congenital, Polycystic
kidney, ureteropelvic junction
obstruction
– Neoplastic- Wilms' tumor,
Renal cell carcinoma,
Transitional cell carcinoma of
the renal pelvis, Multiple
myeloma
– Inflammatory-
Tuberculosis,
– Metabolic- Calculi
– Miscellaneous- Sloughed
papillae, Trauma, Renal artery
aneurysm
Causes of Obstructive Nephropathy
• Ureter:
Congenital- Stricture,
Ureterocele, Ureterovesical
reflux, , Retrocaval ureter
Neoplastic- Primary
carcinoma of ureter,
Metastatic carcinoma
Inflammatory-
Tuberculosis ,post radiation
Metabolic stone ureter
Traumatic mostly iatrogenic
External compression
Retroperitoneal fibrosis,
Aortic aneurysm, Pregnancy
Causes of Obstructive Nephropathy
• Bladder and Urethra
Congenital- Posterior
urethral valve,
Neoplastic- Bladder
carcinoma, Prostate
carcinoma, Carcinoma of
urethra, Carcinoma of
penis
Inflammatory- Para
urethral abscess, phimosis
Miscellaneous-Benign
prostatic hypertrophy
Functional Neurogenic
bladder
Metabolic stone bladder or
urethra
Traumatic stricture urethra
Global Renal Functional Changes
• Obstruction can affect hemodynamic variables and GFR
– Degree of affect depends on extent and severity of
obstruction, whether UUO or BUO, and whether it has
been relieved or not
• GFR= Kf(PGC-PT-PGC)
– Need to understand in order to comprehend the
relationships between changes in renal hemodynamics and
alterations in GFR during and after obstruction
– Kf glomerular ultrafiltration coeffecient related to the surface
area and permeability of the capillary membrane
– PGC glomerular capillary pressure. Influenced by renal plasma
flow and the resistance of the afferent and efferent arterioles
– PT Hydraulic pressure of fluid in the tubule
-P the oncotic pressure of the proteins in the glomerular capillary
and efferent arteriolar blood
Global Renal Functional Changes
• uroflow meter
Helpful in diagnosis of infra vesicle
obstruction
Diagnosis: Radiological
• Nuclear Renography
– Provides functional assessment without contrast
• Obstruction is measured by the clearance
curves
– Tc 99m DTPA- glomerular agent
– Tc 99m MAG3 – tubular agent
• Whitaker Test
– “True pressure” within the pelvis =
Collecting system pressure – intravesicle presure
• Saline or contrast though a percutaneous
needle or nephrostomy tube at a rate of 10mL/
min
• Catheter in bladder to monitor intravesicle
pressure
Normal < 15 cm H2O Indeterminate = 15-22 cm H2O Obstruction > 22 cm H2O