1. Diseases of upper urinary tact
DR. MOHAMMED ALTURKI
COSULTANT UROLOGIST

3. Diseases of upper urinary tact
Surgical
Medical

4. Urological
Infection.
Tumor.
Trauma
urolithiasis

5. 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.

6. 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

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

8. 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

9. 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

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

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

12. a wedge-shaped area of low density

13. 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

15. 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

16. 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.

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

18. 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

19. 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

20. 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 .

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

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

26. Diseases of upper urinary tact
Infection.
Tumor.
Trauma
Urolithiasis

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

28. 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

30. 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

31. Papillary renal cell carcinoma

32. Chromophobe renal cell carcinoma

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

37. 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

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

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

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

41. 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

43. 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.

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

45. Treatment Radical Nephroureterectomy Open Laprascopic Robotic
Chemotherapy

46. URS ,Leaser ablation

47. Techniques for percutaneous

48. Diseases of upper urinary tact
Infection.
Tumor.
Trauma
Urolithiasis

49. Upper Urinary Tract Trauma
Renal
Blunt, penetrating injury

50. Renal

51. CT-SCAN

52. Angioembolization

53. Ureter
Blunt
Penetrating
Itrogenic

55. Diseases of upper urinary tact
Infection.
Tumor.
Trauma
Urolithiasis

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

57. Ultrasound

59. Renal calculi
Symptoms;
Signs
Treatment

60. Lower calyceal stone

62. Ureteral calculi