22 September 2015 CKD and Urology
22 September 2015
CKD and Urology
KidneysPaired retroperitoneal structuresFiltration and excretion of metabolic waste
productsRegulation of electrolytes, fluid, and acid-
base balanceStimulation of RBC production
Kidneys
Kidneys
Kidneys
NephrolithiasisRenal calculiA common cause of renal failureSupersaturation of the urine by stone-forming
constituentsCalcium, oxalate, and uric acidDehydration, low fluid intake
Kidney stones can cause kidney damage in two primary ways
An untreated obstructing stone that causes persistent severe blockage
Infection related stones can lead to ongoing chronic urinary tract infections that cause damage slowly through inflammation and scarring of the kidney tissue
Nephrolithiasis
Nephrolithiasis
Nephrolithiasis
Nephrolithiasis
PresentationsPainHematuriaUTIRenal failureAsymptomatic
InvestigationsUrine examinationPlain KUBBUN, CreatinineIVP CT scan
Plain KUB
IVP
IVP
Treatment of renal calculi
Conservative, medicationESWL ( extracorporeal shockwave lithotripsy )RIRS ( retrograde intrarenal surgery )PCNL ( percutaneous nephrolithotomy )Open Sx ( Anatrophic nephrolithotomy,
Pyelolithotomy )Nephrectomy
ESWL
RIRS
PCNLPercutaneous nephrolithotomyPRS : Percutaneous Renal SurgeryA minimally invasive technique to access the
kidney to remove large stones (>2cm) or stones
Small puncture wound
PCNL
ANL
Obstructive uropathy
Obstructive uropathyBlockage of the flow of urine out of the bodyCommon cause of acute and chronic renal
failureIntrinsic and extrinsic causeUrine stasis, infection, stone formation,
anatomical changes, renal deterioration
Obstructive uropathy Post-renal renal failureSupravesical obstruction (Bilateral ureteral
obstruction) infravesical obstruction (Bladder outlet
obstruction)HydronephrosisSurgical anuriaOverflow incontinence
HintUnderlying diseasesPrevious renal functionSigns of CKDLUTSHistory of KUB stone
InvestigationsCBCBUN, Cr., electrolyteUAPlain KUBUltrasound
Renal UltrasonographyHydronephrosis : a hallmark of urinary tract
obstructionMeasurement of kidney size and echogenicity
as part of an evaluation of chronic kidney disease
No exposure to radiationInterpretation is operator-dependent
Obstructive uropathyUrinary diversionFoley catheterIntake, output monitoringNephrotoxics avoidanceElectrolyte imbalance
Urinary diversionA surgical procedure that reroutes the
normal flow of urine out of the bodyUrine cannot flow out of the body External diversion (nephrostomy)Internal diversion (double J stent)
nephrostomy
Double J stent
Bladder outlet obstructionA blockage at the base of the bladder that
reduces or prevents the flow of urineBPH, Urethral stricture, Urethral calculiLUTS (lower urinary tract symptoms)Mechanical, FunctionalFoley catheter
Thank You