Urinary System 7
OBSTRUCTIVE UROPATHY
• Definition:- Obstructive lesions of urinary tract increase susceptibility
to infection, stone formation, and if unrelieved for a longer duration
leads to permanent renal atrophy termed as hydronephrosis or
obstructive uropathy
• Course:- can be sudden or insidious, partial or complete, unilateral or
bilateral and can occur at any level of the urinary tract
Causes
CAUSES contd
• Posterior urethral valves & uretheral strictures
• Meatal stenosis
• Bladder neck obstruction
• PUJ Obstruction
• Severe vesico-uretheral reflux
• Urinary calculi
• BPH
• Tumors:- carcinoma of prostate, bladder tumors, retroperitoneal
lymphoma, carcinoma of cervix or uterus
CAUSES CONTD
• Inflammation;- prostatitis, urethritis, ureteritis, retroperitoneal
fibrosis,
• Sloughed papillae or blood clots
• Pregnancy
• Uterine prolapse or cystocele
• Functional disorders:-Neurogenic spinal cord damage or diabetic
nephropathy
HYDRONEPHROSIS
• Definition: a term used
to describe dilatation
of the renal pelvis and
calyces associated with
progressive atrophy of
the kidney due to
obstruction to urinary
outflow
HYDRONEPHROSIS: CLINICAL FEATURES
• Acute obstruction: provoke pain due to distension of collecting
system or renal capsule
• Renal calculi: renal colic
• Prostatic enlargement: bladder symptoms
• Unilateral complete or partial hydronephrosis may remain silent for
long periods as the unaffected kidney looks after the renal function
• Bilateral partial obstruction: Early inability to concentrate urine
(polyuria or nocturia) Some patients develop distal tubular acidosis,
renal salt wasting secondary renal calculi and chronic
tubulointerstitial nephritis and scarring and atrophy of papillae and
medulla + hypertension
• Complete bilateral obstruction: rapid onset-oliguria or anuria and
incompatible with survival till the obstructive cause is relieved
HYDRONEPHROSIS: Morphology
UROLITHIASIS (RENAL CALCULI/ RENAL STONE
DISEASE)
• 5-10% of people in US
• Location: m/c is kidney, but can form anywhere in urinary tract
• Men more affected
• Peak age group is 20-30 years
Etiology and Pathogenesis
• Four main types of calculi:
➢Calcium stones ( 7̴ 0%)
➢Triple stones (15%)
➢Uric acid stones (5-10%)
➢Cystine (1-5%)
UROLITHIASIS
• After infection by Urea splitting bacilli
• Largest stones: Staghorn calculi
• pH < 5.5
• Genetic defect
UROLITHIASIS
• Most important determinant for initiation and propagation of stones
is increased urinary concentration of the stones’ constituents such
that it exceeds their solubility (supersaturation)
• Increased concentration of stone constituents, changes in urinary pH,
decreased urine volume and presence of bacteria influence formation
of renal stones.
UROLITHIASIS: Morphology
UROLITHIASIS
• Unilateral in 80%
• Site: Renal calyx and pelvis
• 2-3mm, smooth contour/ irregular spiculated
• Large calculi taking form of pelvicalyceal
system:
Staghorn calculi
UROLITHIASIS: Clinical Features
• Asymptomatic or,
• Renal colic
• Abdominal pain
• Larger stones –hematuria
• Superimposed infection
RENAL CYSTIC DISEASES
Autosomal dominant (Adult) Polycystic kidney
disease (ADPKD)
ADPKD
ARPKD
ADPKD
ADPKD
ADPKD
ADPKD
ADPKD
ADPKD
ADPKD
ADPKD
ADPKD
AUTOSOMAL RECESSIVE (CHILDHOOD)
POLYCYSTIC KIDNEY DISEASE
ARPKD
ARPKD
ARPKD
ARPKD
ARPKD
ARPKD
ARPKD
ARPKD
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