The Kidney
Dr Muhammad Rahil khan assistant professor at department of
pathology
URINARY TRACT OBSTRUCTION
(OBSTRUCTIVE UROPATHY)
• Obstructive lesions of the urinary tract increase
susceptibility to infection and to stone formation,
and unrelieved obstruction almost always leads
to permanent renal atrophy, termed
hydronephrosis or obstructive uropathy.
• Fortunately, many causes of obstruction are surgically correctable or
medically treatable
• Obstruction may be sudden or insidious, partial or
complete, unilateral or bilateral; it may occur at any
level of the urinary tract from the urethra to the renal
pelvis.
• It can be caused by intrinsic lesions of the urinary tract
or extrinsic lesions that compress the ureter.
Common causes of obstructive lesions of the
urinary tract.
what is hydronephrosis?
Hydronephrosis is the term used
to describe dilation of the renal
pelvis and calyces associated
with progressive
atrophy of the kidney due to
obstruction to the outflow of
urine
Clinical features of obstructive
uropathy
• Acute obstruction
• Unilateral complete or partial hydronephrosis
• Bilateral partial obstruction
• Complete bilateral obstruction
UROLITHIASIS (RENAL CALCULI,
STONES)
• The stones may form anywhere in the urinary tract, but most arise in
the kidney.
• Men are affected more often than women, and the peak age at onset
is between 20 and 30 years.
• Familial and hereditary predisposition to stone formation has long
been known.
• Many inborn errors of metabolism, such as cystinuria and primary
hyperoxaluria, provide examples of hereditary disease characterized
by excessive production and excretion of stone-forming substances.
Types of calculi
• There are four main types of calculi
(1) calcium stones (about 70%), composed largely of calcium oxalate or
calcium oxalate mixed with calcium phosphate
(2)15% are so-called triple stones or struvite stones, composed of
magnesium ammonium phosphate
(3) 5% to 10% are uric acid stones
(4) 1% to 2% are made up of cysteine.
• An organic mucoprotein matrix, making up 1% to 5% of the stone by
weight, is present in all calculi.
Calcium oxalate stones
• Calcium oxalate stones are
associated in about 5% of
patients with hypercalcemia and
hypercalciuria, such as occurs
with hyperparathyroidism,
diffuse bone disease,
sarcoidosis, and other
hypercalcemic states
Uric acid stones
• Uric acid stones are common in individuals with hyperuricemia, such
as patients with gout, and diseases involving rapid cell turnover, such
as the leukemias.
• However, more than half of all patients with uric acid calculi have
neither hyperuricemia nor increased urinary excretion of uric acid.
In this group, it is thought that a tendency to excrete urine of pH
below 5.5 may predispose to uric acid stones, because uric acid is
insoluble in acidic urine.
• In contrast to the radiopaque calcium stones, uric acid stones are
radiolucent
Magnesium ammonium phosphate
stones
• Magnesium ammonium phosphate stones are formed
largely after infections by urea-splitting bacteria (e.g.,
Proteus and some staphylococci) that convert urea to
ammonia.
• The resultant alkaline urine causes the precipitation of
magnesium ammonium phosphate salts.
• These form some of the largest stones, as the amount of
urea excreted normally is very large. Indeed, so-called
staghorn calculi
• occupying large portions of the renal pelvis are frequently
a consequence of infection
Cystine stones
• Cystine stones are caused by genetic defects in the renal reabsorption
of amino acids, including cystine, leadingto cystinuria.
• These stones also form at low urinary pH
Factors that influence the
formation of calculi
• Increased concentration of stone constituents
• Changes in urinary pH
• Decreased urine volume
• Presence of bacteria
Clinical Features of urolithiasis
• Urolithiasis may be asymptomatic, produce severe renal colic and
abdominal pain, or may cause significant renal damage.
• Larger stones often manifest themselves by hematuria.
• Stones also predispose to superimposed infection, both by their
obstructive nature and by the trauma they produce.
LOOK AT THE PHOTOGRAPH OF RENAL STONES
AND ANSWER THE FOLLOWING QUESTIONS:
Q#
1
Name the various types of
renal stones?
Q#
2
Name the factors which
enhance stone formation?
Q#
3
Name any three clinical
features of renal stones?
Q#1
Name the various types of renal stones?
Q#2
Name the factors which enhance stone formation?
Q#3
Name any three clinical features of renal stones?
Q#1
Calcium Oxalate, calcium phosphate, Magnesium
ammonium phosphate stones Uric acid and
cystine stones .
Q#2
Increased concentration of constituents, change in urine
Ph, decreased urine volume and bacteria.
Q#3
Renal colic, hematuria, urinary obstruction, UTI.
Correct answer is E
Which of the following is the most frequent cause of nephrotic
syndrome in children?
A. Membranous glomerulopathy
B. IgA nephropathy
C. Focal segemental glomerulosclerosis
D. Membranoproliferative glomerulonephritis
E. Minimal change disease
correct answer is B
Minimal change disease on electron microscopy characterized by ?
A. Dense deposits
B. diffuse effacement of foot processes of visceral epithelial cells
(podocytes)
C. Subendothelial Deposits
D. Subepithelial deposits
E. subepithelial humps
Correct answer is A
In which nephropathy M-type phospholipase A2 receptor (PLA2R)
present as antigen
A. Membranous glomerulopathy
B. IgA nephropathy
C. Focal segemental glomerulosclerosis
D. Membranoproliferative glomerulonephritis
E. Minimal change disease
Correct answer is B
Which nephropathy characterized by the presence of prominent IgA
deposits in the mesangial regions and recurrent hematuria ?
A. Membranous glomerulopathy
B. IgA nephropathy
C. Focal segemental glomerulosclerosis
D. Membranoproliferative glomerulonephritis
E. Minimal change disease
Correct answer is E
In urinary tract infection, most common organism found in urine
culture is
A. Proteus
B. Klebsiella
C. Enterobacter.
D. Streptococcus
E. Escherichia coli