Anatomy-Kidney. Congenital Anomalies:. Agenesis Fusion Dysplasia Simple cysts Polycystic kidney disease. Urolithiasis – Stones:. Urolithiasis – stones:. Infection. Calcium Stone-Formation. Infected Stone-Formation. Urinary NH 4 +. CaP supersaturation. Urinary pH.
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Polycystic kidney disease
Sex (M > F)
Uric acid stone
Uric acid supersaturation
I)For acute attack: analgesics and
( fluid ,antispasmodics, change urine PH, antibiotics & follow up )
B)Active (ESWL-Percutanousenephro- lithotomy, nephro- lithotomy ,Pyelo-lithotomy,Retrograde endoscopy, uretrolithotomy )
III)Treatment of complication( calculasanuria, hydronephrosis and pyonephrosis)
IV)Prevention of recurrence etiology
Multiple : urethral –ureter-kidney-bladder
Most common renal tumor of childhood. Peak age - 2.5 - 3.5 years.
Embryonic renal tissue (metanephric blastema). Genetic abnormalities.
Palpable abdominal mass. Abdominal pain, fever, anorexia, nausea/vomiting.
No specific clinical laboratory findings. Diagnosis by radiographic techniques.
Gross: Solitary/multiple cystic mass, sharply delineated. Soft, bulging, gray-white with focal hemorrhage and necrosis.
5-yr. Survival 80%.
Metastases to lung, liver, bone, brain.
Resection with chemotherapy ± radiotherapy.
Hypernephroma, clear cell carcinoma.
5th and 6th decades, most common primary renal malignancy.
Cells of proximal convoluted tubule.
Risk factors are smoking, obesity, analgesic abuse
Hematuria*, flank pain, palpable mass. Frequently metastasize (lungs, bone, skin, liver, brain).
Gross or microscopic hematuria.
5-yr. survival 40%.
Poor prognosis with metastases.
Chemotherapy, surgery, immunotherapy.
Suprapubic catheters. Surgical approach / Endoscopy Delayed repair usually
Cushoned by perinephric fat and Gerota’s fascia
Along T10 - L4
Fixed only through pedicle.
within the lumen
in the wall
• Recognition of obstruction is important since it increase the chance of infection and stone formation. In addition unresolved obstruction almost always lead to permanent renal atrophy fortunately many causes of obstruction are surgically correctable or medically treatable.
• It can be sudden or insidious, partial or complete,
unilateral or bilateral. It may occur at any level of the urinary treat from the urethra to the renal pelvis.
• It can be caused by lesion that are intrinsic to urinary tract or extrinsic lesion that compress the ureter.
Women: Presence of at least 100,000 colony-
forming units (cfu)/mLin a pure
culture of voided clean-catch urine
Men: Presence of just 1,000 cfu/mLin a pure
culture of voided clean-catch urine
indicates urinary tract infection
Asymptomatic Bacteriuria (ASB)
signs and Symptoms
Used in primary care & LTC settings. But for institutionalized adults, urinalysis is preferable.
preliminary/quick determinations of:
ketones *leukocyte esterase
urobilinogen specific gravity
Routine Urinalysis—Key Indicators of Infection
Foul-smelling—often presence of bacteria which splits urea to form ammonia
Traditional gold standard for significant bacteriuria >100,000 cfu/mL of urine.
Foley catheterization should be avoided if at all possible
BPH / Cancer.
Median lobe (3rd lobe)
Ball valve mechanism
Press upon the prostatic urethra.
Obstruction - difficulty on urination
Dysuria, retention, dribbling, nocturia
Infections, hydronephrosis, renal failure.
Weak urine stream
Night time urination
Frequent or urgent urination
Starting and stopping of urination
Hesitancy of stream
Sensation of incomplete bladder emptying
Painful or burning urination
Surgery(TURP), OPEN PROSTATECTOMY
Minimally invasive treatments Transurethral microwave (TUMT) Transurethral needle ablation (TUNA) Interstitial laser coagulation (ILC)
Annual prostate exams after age 50
See your doctor immediately if you
have any symptoms
Renal PainUreteric pain Prostatic Pain Penile Pain
• Trauma: mild to moderate trauma commonly causes renal bleeding, severe injuries may not bleed (avulsed kidney complete disruption).
• Tumours: may be profuse or intermittent.
Renal cell carcinoma: associated mass, loin pain, clot colic or fever, occasional polycythaemia, hypercalcaemia and hypertension.
TCC: characteristically painless, intermittent haematuria.
• Calculus: severe loin/groin pain, gross or microscopic, associated infection.
• Glomerulonephritis: usually microscopic, associated systemic disease (e.g. SLE).
• Pyelonephritis .
• Renal tuberculosis: sterile pyuria, weight loss, anorexia, PUO, increased frequency of micturition day and night.
• Polycystic disease : palpable kidneys, hypertension, chronic renal failure.
• Renal arteriovenous malformation or simple cyst: painless, no other symptoms.
• Renal infarction: may be caused by an arterial embolus, painful tender kidney.
• Calculus: severe loin/groin pain, gross or microscopic, associated
• Calculus: sudden cessation of micturition, pain in perineum and tip of penis.
• TCC: characteristically painless, intermittent haematuria, history of work in rubber or dye industries.
• Acute cystitis: suprapubic pain, dysuria, frequency and bacteriuria.
• Interstitial cystitis : may be autoimmune, drug or radiation induced, frequency and dysuria common.
• Schistosomiasis : history of foreign travel, especially North Africa.
• BPH: painless haematuria, associated obstructive symptoms, recurrent UTI.
• Carcinoma .
• Trauma: blood at meatus, history of direct blow to perineum, acute retention.
• Calculus .
• Urethritis .