Diseases of upper urinary tact DR. MOHAMMED ALTURKI COSULTANT UROLOGIST

Diseases of upper urinary tact Surgical Medical

Urological Infection. Tumor. Trauma urolithiasis

Renal infections Classic symptoms acute onset of fever, chills, and flank pain. Some patients with these symptoms do not have renal infection. Nonspecific local or systemic symptoms or asymptomatic.

Bacteriuria and pyuria are not predictive of renal infection . may have sterile urine (ureter obstruction or the infection is outside the collecting system.) The pathologic and radiologic criteria for diagnosing renal infection may also be misleading

Acute Pyelonephritis inflammation of the kidney and renal pelvis Symptoms;- physical exa.. tenderness to deep palpation in the costovertebral angle

leukocytosis with predominance of neutrophils. Urinalysis numerous WBCs, often in clumps, and bacterial rods or chains of cocci. Urine cultures are positive, (20% negative results) E. coli, 80% of cases. Proteus, Klebsiella, Pseudomonas, Serratia, Enterobacter, or Citrobacter should be suspected in patients who have recurrent UTIs

Renal Ultrasonography and Computed Tomography Blood cultures are positive in about 25% of cases of uncomplicated pyelonephritis Renal Ultrasonography and Computed Tomography complicated UTIs patient did not respond after 72 hours of therapy Differential Diagnosis. Acute appendicitis, diverticulitis, and pancreatitis

Management uncomplicated infection complicated infection Oral antibiotic (fluoroquinolone ) IV. antibiotic  admission

Acute Focal or Multifocal Bacterial Nephritis Similar to pyelonephritis 50% diabetic sepsis is common represents a relatively early phase of frank abscess formation

a wedge-shaped area of low density

Emphysematous Pyelonephritis acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. diabetic patients fever, vomiting, and flank pain a surgical emergency Most patients are septic

Renal Abscess Renal abscess or carbuncle is a collection of purulent material confined to the renal parenchyma . gram-negative organisms Ultrasound ;- echo-free or low-echodensity space-occupying lesion with increased transmission

Infected Hydronephrosis and Pyonephrosis is bacterial infection in a hydronephrotic kidney pyonephrosis refers to infected hydronephrosis associated with suppurative destruction of the parenchyma of the kidney, in which there is total or nearly total loss of renal function Management. appropriate antibiotic drainage of the infected pelvis.

Perinephric Abscess results from : - rupture of an acute cortical abscess hematogenous seeding from sites of infection Diagnosis; Management

Infectious Granulomatous Nephritis Xanthogranulomatous Pyelonephritis unilateral and result in a nonfunctioning, enlarged kidney associated with obstructive uropathy secondary to nephrolithiasis Proteus to be the most common organism E. coli CT-scan 50 to 80 percent of patients show the classic triad of unilateral renal enlargement with little or no function and a large calculus in the renal pelvis

TUBERCULOSIS The kidneys are the primary site of hematogenous spread of TB. Can effect any urogenital organ. Presentation; LUTS storage symptoms 50% Hematuria and loin pain 30% fever, anorexia, weight loss, and night sweats <20%. Diagnosis: Mycobacterium tuberculosis in the urine

TB. Urine cultures are sensitive in 80% to 90% of cases and have a specificity of nearly 100% Radiography:- KUB .. Calcifications are seen in 30% to 50% CT-SCAN renal parenchymal masses and scarring, thick urinary tract walls .

Antituberculous Drugs. Treatment:- Antituberculous Drugs. Surgical Therapy About 55% of patients with genitourinary TB will require surgical intervention

Renal Echinococcosis is a parasitic infection caused by the Echinococcus granulosus E. cysts of the kidney are usually single and located in the cortex

Diseases of upper urinary tact Infection. Tumor. Trauma Urolithiasis

Tumor of upper urinary tract The first documented nephrectomy was accomplished in 1861 by Wolcott. CLASSIFICATION Renal masses can be malignant, benign, or inflammatory

RENAL CELL CARCINOMA 2% to 3% of all adult malignant neoplasms 30% to 40% of patients with RCC have died of their cancer . RCC in childhood is uncommon. arise primarily from the proximal convoluted tubules. risk factor for RCC tobacco exposure Obesity Hypertension

Clear cell RCC accounts for 70% to 80% of all RCCs. These tumors are typically yellow when they are bivalved and are highly vascular many renal masses remain asymptomatic and nonpalpable until they are advanced

Papillary renal cell carcinoma

Chromophobe renal cell carcinoma

Symptoms: flank pain, gross hematuria, and palpable abdominal. Paraneoplastic syndromes are found in 20% of patients with RCC Hypercalcemia nonmetastatic hepatic dysfunction (Stauffer syndrome )

OTHER MALIGNANT RENAL TUMORS Sarcomas .. 1% to 2% of all malignant Renal lymphoma and leukemia. Metastatic tumor lung, breast, and gastrointestinal cancers, malignant melanoma, and hematologic malignancies Wilms tumor

Benign renal tumor renal cyst Treatment - Nothing aspiration, surgical resection, cyst decortications, sclerotherapy with a variety of different agents

RENAL CORTICAL ADENOMA Histological small, well-circumscribed lesions characterized by uniform basophilic or eosinophilic cells . FNA Surgical

ONCOCYTOMA most common benign tumor that appears as an enhancing renal mass on cross-sectional imaging

ANGIOMYOLIPOMA Less than 10% of renal tumors. benign neoplasm consisting aneurysmal vessels, smooth muscle, adipose tissue spontaneous perirenal hemorrhage selective embolization or open or laparoscopic/robotic partial nephrectomy

Urothelial Tumors of the Upper Urinary Tract and Ureter ( TCC ) Risk Factors Smoking Coffee Consumption Analgesics. Occupation. ( Chemical ) Chronic Inflammation, Infection or Chemotherapeutic Agents Heredity.

TCC Presntation hematuria, either gross or microscopic. obstruction CT-Scan Cystoscopy Urine Cytology URS and Biopsy

Treatment Radical Nephroureterectomy Open Laprascopic Robotic Chemotherapy

URS ,Leaser ablation

Techniques for percutaneous

Diseases of upper urinary tact Infection. Tumor. Trauma Urolithiasis

Upper Urinary Tract Trauma Renal Blunt, penetrating injury

Renal

CT-SCAN

Angioembolization

Ureter Blunt Penetrating Itrogenic

Diseases of upper urinary tact Infection. Tumor. Trauma Urolithiasis

STONE COMPOSITION OCCURRENCE (%) Calcium-Containing Stones Calcium oxalate 60 Hydroxyapatite 20 Brushite 2 Non–Calcium-Containing Stones Uric acid 7 Struvite 7 Cystine 1-3 Triamterene <1 Silica <1 2,8-Dihyroxyadenine <1

Ultrasound

Renal calculi Symptoms; Signs Treatment

Lower calyceal stone

Ureteral calculi