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

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