RENAL CALICULI.pptx

KIDNEYS

1. RENAL CALICULI HYDRONEPHROSIS CHRONIC PYELONEPHRITIS DR.N.MANJULA

2. URINARY TRACT OBSTRUCTION Blockage to the flow of urine through its normal path. Obstruction may be at any level. This can lead to infection, kidney stones, hydronephrosis , kidney damage.

3. RENAL CALCULI Formed at any level. M/C arise in kidney. M : F = 4:1. Age: 30 – 50. C/F: pain – severe and sudden onset, hematuria .

4. PATHOGENESIS Increased urinary concentration of stone constituents that exceed their solubility in urine – supersaturation . Low urine volume also favours supersaturation .

5. Calcium phosphate stones Alkaline urine Renal tubular acidosis and hyperparathyroidism. Large in size. Smooth surface.

6. Calcium oxalate stone Acidic urine. Hypercalcemia and hypercalciuria . Associated with increased uric acid secretion. Has spiky surface. Cause acute pain and hematuria

7. Triple phosphate stone Associated with infection of urea splitting organism (Proteus, staphylococci) converts urea to ammonia. Alkaline urine. Precipitates Magnesium, Ammonium, Phosphate salts. Staghorn calculi Big in size. Damages kidney.

8. Uric acid stones Acisic urine. Hyperuricemia – Gout and diseases with rapid turn over like leukemia . Radiolucent.(transparent to x ray)

9. Cystine stones Acidic urine. Genetic defect in absorption of cystine . Cystinuria . Flat hexagons.

10. HYDRONEPHROSIS Dilatation of renal pelvis and calyces with atrophy of renal parenchyma. Obstruction to outflow of urine sudden or insidious.

11. CAUSES Congenital: Urethral atresia Posterior urethral valves Pyelourethral junction stenosis Ureteral valves Aberrant renal artery compressing ureter Kinking of ureter.

12. Acquired: Foreign bodies – calculi Tumors – prostatic carcinoma, bladder tumor , retroperitoneal tumors , uterine and cervical cancers Infection – prostatitis, urethritis, ureteritis , retroperitoneal fibrosis Spinal cord damage Pregnancy

13. PATHOGENESIS

14. OBSTRUCTION  BACK PRESSURE ON PELVICALYCEAL SYSTEM  PRESSURE ATROPHY ON RENAL PARENCHYMA . HIGH PRESSURE  COMPRESS VASCULATURE  ARTERIAL INSUFFICIENCY AND VENOUS STATSIS. TUBULES LOOSE CONCENTRATING CAPACITY. GFR IS REDUCED.

15. U/L or B/L B/L when obstruction is below ureter U/L when obstruction occur with ureter C/F: Anuria Defect in glomerular filtration

16. GROSS: ENLARGED KIDNEY DILATED PELVICALCEAL SYSTEM COMPRESSED PARENCHYMA ATROPHY OF PAPILLAE FLAT PYRAMIDS

17. MICROSCOPY Dilated tubules Reduced renal parenchyma Papillary necrosis Obstruction  infection  pyelonephritis

18. CHRONIC PYELONEPHRITIS Chronic tubulointerstitial inflammation and renal scarring associated with pathologic involvement of calyces and pelvis. Important cause for ESRD. Sequelae of recurrent persistent episodes of bacterial infection.

19. Causes Vesicoureteric reflux – regurgitation of urine from bladder into ureter. Urinary infection. Calculi. C/F: Pain – insidious onset. Fever. Pyuria . Bacteriuria . Polyuria and nocturia . Hypertension.

20. GROSS: Deep “U” shaped scars. Blunting papillae. Calyceal deformity. Small, irregular kidney. Dilated calyces.

21. MICROSCOPY: Atrophied tubules Some dilated tubule with flat epithelium and filled with colloid like material. Fibrosis of cortex and medulla. Periglomerular fibrosis. Obliterative intimal sclerosis.