obstructive uropathy
DESCRIPTION
Obstructive Uropathy. Dr Rodney Itaki Lecturer Anatomical Pathology Discipline. University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology. Some Definitions. Hydronephrosis- Dilation of the renal pelvis or calyces - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/1.jpg)
Obstructive Uropathy
Dr Rodney ItakiLecturer
Anatomical Pathology Discipline
University of Papua New GuineaSchool of Medicine & Health SciencesDivision of Pathology
![Page 2: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/2.jpg)
Some Definitions
• Hydronephrosis- Dilation of the renal pelvis or calyces
• Obstructive uropathy- functional or anatomic obstruction of urine flow at any level of the urinary tract
• Obstructive nephropathy- when obstruction causes function or anatomic renal damage
![Page 3: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/3.jpg)
Anatomy Review
![Page 4: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/4.jpg)
Types of Obstruction
Ref: Robins Pathological Basis of Diseases, 6th Ed.
![Page 5: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/5.jpg)
Causes of Obstruction
![Page 6: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/6.jpg)
Prevalence
Ref: Jamie Bartley Teaching Slides, Detroit, 2009
• 3.1% in autopsy series• No gender differences until 20 years
– Females more common 20-60– Males more common older than 60
• 2-2.5% of children at autopsy• PNG Population unknown
![Page 7: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/7.jpg)
Pathophysiology
• Effects variable and depend on whether the obstruction is unilateral or bilateral.
• Mechanical obstruction of urine outflow results in:– Increase backflow pressure into kidneys– Stagnation of urine– Increased risk of infection– Increased risk of formation of stones– Induce non-infective inflammation in interstitial
tissue of kidneys • Progressive dilation of renal pelvis and
calyces• Progressive atrophy of renal parenchyma
Ref: Robins Pathological Basis of Diseases, 6th Ed.
![Page 8: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/8.jpg)
Morphology
• Sudden & complete – reduced GFR leads to mild dilation and atrophy of renal parenchyma
• Subtotal or intermittent - normal GFR leads to progressive dilation
Dilation of perlvis & calyces depends on whether obstruction is sudden & complete or incomplete and chronic
Ref: Anjali Shinde Teaching Slides
![Page 9: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/9.jpg)
Hydronephrosis
Ref: Robins Pathological Basis of Diseases, 8th Ed.
![Page 10: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/10.jpg)
Morphology• Chronic cases – cortical atrophy and
diffuse institial fibrosis.• Advanced stages – kidneys become
a thin wall cystic structure, significant parenchymal atrophy and obliteration of renal pyramids and thin cortex.
![Page 11: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/11.jpg)
Clinical Presentation• Acute obstruction – pain (renal colic)
if calculi lodged in ureters. Prostatic enlargement cause urinary symptoms.
• Unilateral complete or partial hydronephrosis - asymptomatic for long periods of time. Present late.
• Bilateral partial obstruction – polyuria and nocturia (unable to concentrate urine).
• Hypertension common in chronic cases
• Acute complete bilateral obstruction – oliguria, anuria and azotemia. Surgical Emergency.
![Page 12: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/12.jpg)
Prognosis• Depends on site, partial or
complete, acute or chronic and duration of obstruction.
• Generally if diagnosed early and obstruction relieved, recovery is good with return to normal kidney function.
• Late diagnosis – chronic renal failure.
![Page 13: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/13.jpg)
Urolithiasis (Renal Calculi, Stones)
• 4 types of stones• Calcium oxalate (phosphate) – 75%• Struvite (Magnesium Ammonium
Phosphate) – 10-15%• Uric Acid – 6%• Cystine – 1-2%• Unknown - ?10%
![Page 14: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/14.jpg)
Pathogenesis• Calcium oxalate stones –
hypercalcemia and hypercalciuria from various causes
• Magnesium ammonium phosphate stones – infections from urea splitting bacteria (e.g. Proteus and some staphylococci).
• Uric acid stones – hyperuricemia (e.g. gout, leukemias). However, >50% of patients with urate stones do not have hypeuricemia nor increased urine uric acid excretion
• Cystine stones – caused by genetic defects in renal reabsorption of amino acids & cystine.
![Page 15: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/15.jpg)
Urolithiasis Pathogenesis• Cystine stones form at low urinary
Ph.• Risk factors for kidney stone
formation:– increased concentration of stone
constituents (saturated and thus precipitate)
– Changes in urinary Ph (low Ph, higher risk).
– Decreased urine volume– Urinary tract infection
• However, many calculi occur in the absence of these factors. ? Deficiency of inhibitors of crystal formation. Long list. Read up.
![Page 16: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/16.jpg)
Site of Kidney Stone Formation
• Unilateral in 80%• Renal calyces and pelves common
sites• small (2-3 mm)• smooth or irregular spiked edges• Bladder• Staghorn calculi - large stone at
pelvis forming a cast of the pelvic and calyceal system.
![Page 17: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/17.jpg)
Clinical Presentation of Kidney Stones
• Symptoms appear if causing obstruction, or produce ulceration and cause bleeding.
• Can by asymptometic• Smaller stones pass into ureters
producing intense pain (renal colic).• Hematuria• Recurrent UTI
![Page 18: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/18.jpg)
Laboratory Diagnosis• UEC • BUN • Urinalysis – hematuria, crystals,
pyuria• Other modes of investigation – USS,
X-ray, CT
![Page 19: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/19.jpg)
Prognosis – Kidney Stone• Generally good.• Depends on underlying cause of
kidney stone formation
![Page 20: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/20.jpg)
End
Main Reference: Robins Pathological Basis of
Diseases, 6th Ed. Chapter on The Pancreas.
Download seminar notes on: www.pathologyatsmhs.wordpress.com
File in PDF and PPT format
![Page 21: Obstructive Uropathy](https://reader033.vdocuments.us/reader033/viewer/2022061610/56815d91550346895dcba908/html5/thumbnails/21.jpg)
FeedbackWhat was presented well and you understood concepts?
What was not presented well and not understood well?
How can seminar be improved?
Go to www.pathologyatsmhs.wordpress.com and leave feedback comments