Nephrolithiasis part 2 Flashcards
what are the four ways urinary tracts obstructions can be classified
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According cause; congenital and acquired.
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Congenital anomalies leading to UT obstruction are —>
- horse shoe kidney,
- pelvic ureteric junction obstruction,
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ureter cele.
- These congenital anomalies lead to mechanically embarrassed urinary dynamics
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Congenital anomalies leading to UT obstruction are —>
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According to duration; acute and chronic.
- Acute —> e.g. calculus anuria (urgency in urology)
- Chronic —> e.g. hydronephrosis
- duration is equal to clinical manifestation/
- According to the degree; complete or incomplete
- incomplete —> complications with chronic clinical course e.g. hydronpherosis
- Complete —> complications with acute clinical course e.g. calculus anuria
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According to level of obstruction; upper/ lower UT.
- NB! Sequelae of UT obstruction is always stasis of urine,
- stasis is a term used when the cause is located in the upper UT.
- For lower UT the term retention is used.
classifaction of uroliithiasis according to cause (1/4)
give examples of congeital
how does congenital anomalies lead to stones
According cause; congenital and acquired.
Congenital anomalies leading to UT obstruction are —>
- horse shoe kidney,
- pelvic ureteric junction obstruction,
- uretocele.
These congenital anomalies lead to mechanically embarrassed urinary dynamics
classification of urolithiasis according to duration (2/4)
what are the 2 types
why is duration important clinically
According to duration; acute and chronic.
Acute —> e.g. calculus anuria (urgency in urology)
Chronic —> e.g. hydronephrosis
duration is equal to clinical manifestation/
how is urolithiasis classified according to degree of complications
give an example for each of the 2 types
According to the degree; complete or incomplete
incomplete —> complications with chronic clinical course e.g. hydronpherosis
Complete —> complications with acute clinical course e.g. calculus anuria
give the classificatino of urolithiasis according to the level of obstructinon
what is the most certain sequalae of urinary obstruction
how does this change depending on the level of obstruction
According to level of obstruction; upper/ lower UT.
NB! Sequelae of UT obstruction is always stasis of urine,
stasis is a term used when the cause is located in the upper UT.
retention is used for lower UT
what are the 3 components that define hydronephrosis
(DTE)
- Dilation of collecting system of the kidney - renal pelvis and renal calyx
- Thinning of renal parenchyma - this is known as atrophy
- Embarrassed uro dynamics
DEFINE the 3 components of hydronephrosis
DESCRIBE the CLINICAL EVOLUTION of hydronephrosis
in 3 stages
how is the last stage of the evolution rx based on it’s location
how is the stent placed
???? double check
def of hydronephrosis has 3 parts
Dilation of the collecting system of the kidney (pelvis & calyx)
Thinning/ Atrophy of renal Parenchyma
Embarassed urodynamics d/2 imcomplete obstruction
3 stage development of hydronephtosis
- 1)Hydronephrosis ⇒ 2) Infected Hydronephrosis ⇒ 3) Pyonephrosis: kidney is non functional and filled with thick pus.
- Unilateral or bilateral.
- rx of unilateral pyonephrosis
- temporising maneover?? & percutaneous nephrostomy.
- Other options to solve the problem is a stent placement. via Percutaneus Nephrostomy
- rx of unilateral pyonephrosis
- Unilateral or bilateral.
???? double check
define Pyonephrosis:
3 stages of development
treatment of pyonephrosis
Pynephrosis is = non functional** kidney is filled with **thick pus.
presenting symptom in urine is pyuira. + palpable mass
- can be Unilateral or bilateral.
- rx of unilateral pyonephrosis =
- temporising maneover & percutaneous nephrostomy.
or Other options to solve the problem is a
- stent placement. via Percutaneus Nephrostomy
what are the clinical features of urolithiasis
- most important sx?
- how is renal colic dx to cholelithiasis in terms of the 3 loacations of spread
- when is the kidney palpable
- what is a favourable sign of the stone passing
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Renal colic is 1st and most important sx
- descending radiation of the pain to lower abdomen, groins and external male and female genitalia is typical, unlike for example cholelithiasis.
- uncomplicated => Conservative rx
- complicated= > Surgical rx
- descending radiation of the pain to lower abdomen, groins and external male and female genitalia is typical, unlike for example cholelithiasis.
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LUTS
- Dysuria
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Hematuria: micro and macroscopic,
- microscopic hematuria is typical after renal colic.
- Why is macroscopic hematuria a presenting symptom? …. gross hematuria is variable in case of small stones and after physical exercise.
- NB! Painless hematuria always raises the suspicion of malignancy.
- Urgency:
- Frequency: once the stone anchors the bladder. Very favourable sign for stone passing.
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Associated sx
- Nausea & vomiting,
- lower abdominal rigidity,
- Palpable mass in the loin.
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ONLY when the kidney is enlarged.!!
- e.g. hydryhonephrosis
- w/ pyonephrosis the presenting symptom in urine is pyuira.
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ONLY when the kidney is enlarged.!!
whan is renal colic considered complicated
F. A. P criteria fro complicated stones
Criteria to define as complicated renal colic;
- Fever with or without chills
- Protracted or prolonged renal colic - colic lasting more than 24h
- Anuria - main symptom is empty urinary bladder Complicated requires some type of surgical treatment.
what does anuria suggest in UROLOGY
what are the 4 surgical subrenal reasons of anuria/ ARF
how is ormond’s disease treated
how does prostate cancer cause anuria and which type is usually the cause
which other 3 types of malignancies cause anuria
list 2 examples of adjacent tumors causing anuria
Anuria = means acute renal failure!!!
Subrenal Surgical reasons for Anuria or ARF —
- Urinary stone disease - the most common reason is stones located on ureters,> kidney. According to location of stone in ureter, most common is UretoVesicularJunction kidney stones rarely cause anuria
- Retroperintoneal fibrosis - Ormonds disease. = proliferation of fibrous tissue in the retroperitoneum, can cause bilateral obstruction to the ureters.
- obstruction is always bilateral
- Clinical manifestation of this obstruction is anuria.
- Temporising maneouver is percutaneous nephrostomy or stent placement.
- Definitive treatment is open surgery —> reconstruction of ureters in abdominal a cavity, this means to move the ureters in the abdominal cavity.
- Iatrogenic trauma to the ureter! Ligature of the ureters during extended abdominal or gynaecological operations
- Malignancies
- mg in retroperitoneal space. For further reading know several histological types of retroperitoneal tumours.
- Malignancies of UB.
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Prostate cancer especially Locally advanced prostate cancer may infiltrate intramural ureters => complete obstruction , leads stasis of urine and anuria.
- In cases of prostate cancer, what is the temporising maneouver —> bilateral percutaneous nephrostomy
- cancers of adjacent organs e.g. endometrial cancer, cervical, colorectal carcinoma.
give histological examples of Reteroperitioneal malignancies
Extremely rare group of tumors (The most common type is liposarcoma(90%).
order of frequency of histological types
liposarcoma
malignant fibrous histiocytoma
leiomyosarcoma
rhabdomyosarcoma
fibrosarcoma
malignant peripheral nerve sheath tumor
hemangiopericytoma
extragonadal germ cell tumor
primary retroperitoneal adenocarcinoma
Mechanisms of calculus anuria
there’s 2 principle mechanisms
what are the 2 anatomically solitary kidney causes
what’s dumb kidney
what kind of obscruction causes calculus anuria in urology
Solitary kidney obstruction vs Bilateral obstruction
Solitary = anatomical or functional
anatomically causes
- 1) removal of the kidney (nephrectomy) for several reasons e.g. RCC.
- 2) Congenital anomaly to kidney (renal agenesis or renal aplasia).
Functional causes
Non functional kidney e.g. nephrosclerosis.
- diagnosied with IVU/CT contrast medium —> “dumb kidney”
Bilateral obstruction
- bilat obs of renal pelvis
- bilat obs of the ureters => Proximal, Mid, Distal
what is dumb kidney
how is dumb kidney dg
Non functional kidney e.g. nephrosclerosis.
diagnosied with IVU/CT contrast medium —> “dumb kidney”
NB: what are the complications of urothelial disease
DO NOT CONFUSE W/ 2NDARY PATHOLOGICAL EFFECTS (Migration, Obstruction, Infection, UIceration, Malignisation)
there are 4 classifications of complications list them all
give 2 examples for each type
which is the most common type for chronic urolithisasis
which has the most dangerous spread
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According to clinical manifestation/course - acute and chronic
- acute: → Renal colic, Anuria/ ARF, Acute calculus obstructive Pyelonephritis, urosepsis,
- chronic → CRF (most common), Hydrpnephrosis→Pyonephrosis, Chronic calculus Pyelonephritis. Synonym of complications is morbidity.
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According to mech of occurrence - obstructive & inflammatory.
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Obstructive → several examples is 1)calculus anuria, 2)
acute calculus pyelonephritis, - inflammatory mechanism → 1)infected hydronephrosis, 2)pyonephrosis, acute and chronic calculus pyelonephritis.
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Obstructive → several examples is 1)calculus anuria, 2)
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According to type of changes - morphological and functional.
- Morphological → 1)hydronephrosis 2)pyinephrosis 3)infected pyelonephritis
- Functional → 1) acute and chronic renal failure, 2)renal hypertension
- According to the spread - unilateral or bilateral. NB! bilateral is more dangerous
how to present dx of urinary stones
PRESENT AS TABLE NB
