Diseases of upper urinary tact

Diseases of upper urinary tact

DR. MOHAMMED ALTURKI COSULTANT UROLOGIST

Diseases of upper urinary tactSurgical

MedicalUrological Infection.Tumor.TraumaurolithiasisRenal infectionsClassic 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 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 pancreatitisManagement uncomplicated infection complicated infection

Oral antibiotic (fluoroquinolone )IV. antibiotic admissionAcute Focal or Multifocal Bacterial Nephritis

Similar to pyelonephritis 50% diabeticsepsis is common represents a relatively early phase of frank abscess formation

a wedge-shaped area of low density Emphysematous Pyelonephritisacute 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 Abscessresults 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 TUBERCULOSISThe kidneys are the primary site of hematogenous spread of TB.Can effect any urogenital organ.Presentation; LUTSstorage symptoms 50% Hematuria and loin pain 30%fever, anorexia, weight loss, and night sweats