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Chronic Kidney Disease: Definition, Causes, Symptoms and Treatment
1.
2. HYDRONEPFROSIS
Definition
Chronic aseptic dilatation of the pelvi-calyceal system due to partial
or complete intermittent obstruction.
Etiology
A- Unilateral
Stone
Stricture
External compression
B- Bilateral
1- Causes in both ureters: ex. Stones, stricture, reflux
2- Causes in the bladder / or bladder neck ex. Bladder tumor, BPH
3- Causes in the urethra ex. stricture
3. HYDRONEPFROSIS
Pathophysiology:
Nature of obstruction
A- Functional for example increased collagen deposition
at the UPJ leads to reduced distensilbility
B- Organic
- Partial or complete
- Acute or chronic
Impedance to flow of urineïƒ higher than normal pressure
above the site of obstruction ïƒ Chronic progressive
dilation of pelvi-collecting systemïƒ Vascular
compressionïƒ ischemic atrophy ïƒ loss of kidney
function.
4. HYDRONEPFROSIS
Causes of low intra-pelvic pressure are:
1-Protective arterial vasoconstriction
2-Backflow reflux of the intrapelvic contents into the
renal tubules (pyelotubular)rena , the renal veins
(pyelovenous) or the iterstitium of the kidney (-
pyelointerstitial) .
The first renal function to be affected is urine
concentrating power ïƒ increasd urine output.
8. HYDRONEPFROSIS
TREATMENT
A- If the kidney function is good
ïƒ treat the cause
B- If the kidney function is bad
ïƒ preliminary diversion (Nephrostomy)
ïƒ treat the cause
C- Non-functioning kidney (<10% by isotope)
ïƒ Nephrectomy
10. RENAL FAILURE
The role of urologist:
1- To rule out a correctable obstruction
2- Urologic surgery FOR chronic renal failure of
obstructive cause
11. ACUTE RENAL FAILURE
Definition: Sudden renal deterioration over a
period of hours to days
Daily increase of serum creatinine of >0.5mg/dl
Oliguria : ( Urine output </= 400ml/24 hours )
Anuria : ( Total cessation of urine output )
12. ACUTE RENAL FAILURE
Classification and Causes
I- Prerenal :
A. Volume depletion
- Heamorrhage/ Burns/ Third space losses e.g peritonitis
B. Circulatory
- CHF, Sepsis, Shock, Cirrhosis with ascitis
C. Local renal ischeamia
- Renal artery occlusion/ Renal vein occlusion
II- Renal
Acute tubular necrosis/ Acute glomerulonephritis
III- Postrenal
- Bilateral ureteric obstruction
- Unilateral obstruction of a solitary kidney
13. ACUTE RENAL FAILURE
Drugs Associated with ARF
 Aminoglucosides
 Penicillin
 Sulpha
 Cyclosporin
 Certain anaesthetics
 Iodinated contrast media
 Non-Steroidal anti-inflammatory drugs
 Furosemide and Thiazide
 Captopril
 Cimetidine
15. ACUTE RENAL FAILURE
Treatment
Should be focused on:
1. Reversing the underlying cause
2. Preventing further renal injury
3. Correcting fluid and electrolyte imbalance
4. Providing supportive measures
If ARF is severe and prolonged, it is best treated
with peritoneal dialysis or haemodialysis.

16. CHRONIC RENAL FAILURE
Definition:
 (Slowly progressive decrease in the GFR and
tubular function)
 When the patient requires renal replacement
therapy ïƒ End stage renal disease.
Causes:
-DM - Hypertension
- Glomerulonephritis - Congenital diseases
- Obstructive uropathy -Interstitial nephritis
- Chronic pyelonephritis.
18. CHRONIC RENAL FAILURE
Treatment of CRF
Is the responsibility of the Nephrologist
1-Treatment of Anaemia
2- Correction of Coagulopathy
3- Protein restriction
4- Potassium restriction
5- Sodium restriction
6- Fluid intake
7- Treatment of Ascitis
8-Treatment of Renal osteodystrophy
19. CHRONIC RENAL FAILURE
Dialysis “Nephrologist “
Definition:
(Is any process that changes the concentration of solutes
in the plasma by exposure to a second solution across a
semi- permeable membrane)
Indications:
* Urea nitrogen > 100 mg / DL
* Creatinine Clearance < 0.1 ml / min/ Kg
Types:
A. Peritoneal dialysis
B. Haemodialysis
20. RENAL TRANSPLANTATION
Requirements:
1. Donor
- Living related kidney donor
- Cadaveric renal donor
2. Recipient (ESRD)
3. Pretransplantation work up
4. Immunologic work up
5. Surgical technique
6. Postoperative management
21. RENAL TRANSPLANTATION
Complications:
1. Graft rejection
2. Vascular complications
3. Urologic complications
4. Complications of drugs (Cyclosporin)
Usually, the graft works for about 10 years