Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

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1 Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

2 Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis and management of kidney disease, blood pressure,, regulating electrolytes, balancing fluids in the body, and administering dialysis. Nephrology is a subspecialty of internal medicine.

3 Conditions requiring a Nephrologist: Acute Kidney failure (a sudden loss of kidney function) Chronic Kidney Disease (declining kidney function over months/years) Hematuria/Proteinuria (blood and protein in the urine) Kidney stones (recurrent stone formers) Hypertension management Electrolyte and acid/base disorders Dialysis and renal transplant patients

4 Urologist a physician who is a surgical specialist of the urinary tract and is usually involved in kidney diseases that might be amenable to a procedural intervention. Conditions requiring a Urologist Disorders involving the kidneys, adrenal glands, ureters, urinary bladder, urethra,, and the male reproductive organs i.e. Recurrent urinary tract infections, benign prostatic hyperplasia (BPH), cancers, the correction of congenital abnormalities, correcting stress incontinence and urinary tract obstructions.

5 Urinary Tract Anatomy

6 Urinary Tract Obstruction Can occur anywhere along the path of the urinary tract. Can be acute or chronic in nature. Can have either a complete or partial blockage Can be unilateral (one kidney) or bilateral (both kidneys). Numerous causes

7 The major causes of UTO vary with the age of the patient: Anatomic abnormalities account for the majority of cases in children. Calculi (kidney stones) are most common in young adults Prostatic hypertrophy (BPH) or carcinoma, other abdominal cancers or scarring, and calculi are the primary causes in older patients

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9 Symptoms and Signs The clinical manifestations of UTO vary with the site, degree, and rapidity of onset of the obstruction Pain (variable) - Upper ureteral or intra-renal renal lesions lead to flank pain or tenderness, whereas lower ureteral obstruction causes pain that may often radiate to the ipsilateral groin or bladder region. Kidney failure often manifested as decreased urinary output. Hypertension - variable Laboratory abnormalities often high potassium and acidosis

10 Diagnosis Early diagnosis of UTO is important, since most cases can be corrected and a delay in therapy can lead to irreversible kidney injury. If suspected urinary catheter. Radiology examinations:

11 Renal Ultrasound - test of choice CT scan IVP (Intravenous pyelogram) MRI very rarely

12 Magnetic resonance urogram clearly showing right-sided hydronephrosis and the full course of the right ureter.. The left renal tract has a normal appearance.

13 Treatment As per Dr. s Lastarria and Kasulke

14 Kidney stones (Nephrolithiasis( Nephrolithiasis) Very common Often present with the classic symptoms of renal colic (pain) and hematuria. Asymptomatic or have atypical symptoms: vague abdominal pain Nausea Urinary urgency, frequency, or difficulty urinating Penile or testicular pain.

15 Etiology 80% are calcium-based stones. Remainder include uric acid, struvite (chronic urinary infection), and cystine stones. Several theories on stone formation, however urinary supersaturation is at the center of all!

16 Risk factors Dietary: Low calcium intake, high oxalate intake (spinach), high animal protein intake, high sodium intake, low fluid intake, and increased intake of Vitamin C. Prior kidney stones Family history of stones Enhanced intestinal oxalate absorption (gastric bypass procedures, bariatric surgery, short bowel syndrome Hypertension, diabetes, obesity, gout, primary hyperparathyroidism, and excessive physical exercise Certain medications

17 Clinical Manifestations Pain (often intermittent) Hematuria (blood in urine) Nausea, vomiting, pain on urination, urgency Passed stone or gravel

18 Evaluation Imaging Kidney Ultrasound CT scan Others: IVP, Plain film (Xray( Xray) Stone analysis

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21 Laboratory studies: 24 hour urine collection for Stone risk analysis (volume, electrolytes, oxalate, citrate, uric acid, etc.) Blood tests rule out possible endocrine cause or electrolyte abnormalities

22 Treatment Medical Preventative in nature Based on results of 24 hour urine collection, stone analysis, blood tests Increased fluid intake (>1/2 gallon per day) Decreased salt, oxalate, animal protein, etc. Occasionally medications (thiazide( diuretics, allopurinol, Kcitrate) Avoid becoming dehydrated!

23 Surgical per Dr. s Lastarria and Kasulke!