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Renal calculi

Renal calculi and hydronephrosis

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Page 1: Renal calculi and hydronephrosis

Renal calculi

Page 2: Renal calculi and hydronephrosis

Renal calculi

Page 3: Renal calculi and hydronephrosis

Presented By Prof. Dr.

Nabil Tadros Mikhail MBBS, MS Pathol., PhD Pathol.

Prof. of Pathology Alexandria University - Egypt

Consultant & Chief Pathologist King Fahad Central Hospital

Gizan - KSA

Page 4: Renal calculi and hydronephrosis

Renal stones is a frequent disorder , occur more common in males.

A familiar tendency has been recognized..

Page 5: Renal calculi and hydronephrosis

Pathogenesis: The cause of stone formation is

often not completely understood , but there is many factors involved in stone formation.

Page 6: Renal calculi and hydronephrosis

Factors involved in stone formation

1. Increased urine concentration of stone constituents, so that it exceeds their solubility in urine (This is the most important factor).

2. Decreased urine flow.3. Absence of a substance in urine that

inhibit precipitation of salts and minerals (ex: pyrophosphate)

Page 7: Renal calculi and hydronephrosis

Types of renal calculi The most important types are:

1. Calcium oxalates 67%.

2. Calcium phosphate 8% 3. Magnesium ammonium phosphate

15%4. Uric acid 8%5. Cystine stone 2%

Page 8: Renal calculi and hydronephrosis

Etiology of renal calculi 1- calcium stone: It may be due to

A-Hypercalciuria that is not associated with hypercalcemia(50%).

It is either due to Increased calcium absorption from gut

(absorptive hypercalciuria) or

Defect in renal reabsorption of Ca (renal hypercalciuria).

Page 9: Renal calculi and hydronephrosis

Etiology of renal calculi 1- calcium stone: It may be due to

B-Hypercalcaemia (10%) ; as in cases of

1. Primary hyperparathyroidism, 2. Vitamin D toxication, 3. Sarcoidosis,…

Page 10: Renal calculi and hydronephrosis

Etiology of renal calculi 1- calcium stone: It may be due to

C- Excessive uric acid excretion in urine:

account for 20% of cases of calcium stones because uric acid favors calcium stone formation..

Page 11: Renal calculi and hydronephrosis

Etiology of renal calculi 1- calcium stone: It may be due to

D- hyperoxaliuria 5%. E- Idiopathic 15%.

Calcium stone occur at any pH of urine.

Page 12: Renal calculi and hydronephrosis

Etiology,…2- Magnesium ammonium phosphate stone

It occur in alkaline urine due to urinary tract infection.

In particular urea splitting bacteria as proteus vulgaris

Page 13: Renal calculi and hydronephrosis

Etiology,… 3- uric acid stone

It occur in acidic urine due to high uric acid levels .

Hyperuricaemia may be primary due to defect in enzyme involved in purine metabolism (1ry gout)

Page 14: Renal calculi and hydronephrosis

Etiology,… 3- uric acid stone

Hyperuricaemia could be also secondary (2nd gout).

with increase cell turnover as in leukemia, chemotherapy and psoriasis.

Also is seen in cases of decreased excretion of uric acid as renal failure.

Page 15: Renal calculi and hydronephrosis

Etiology,… 4- Cystine stone

Is genetically defect in renal transport of cystine .

It is formed in acidic urine

Page 16: Renal calculi and hydronephrosis

Morphology of renal calculi

Calcium stone: Hard, Small to medium in size, Often multiple, Radiopaque.

Page 17: Renal calculi and hydronephrosis

Morphology of renal calculi

Magnesium ammonium stone: may be large size with branching structure

(stag horn stone). it is radiopaque.

Page 18: Renal calculi and hydronephrosis

Morphology of renal calculi

Uric acid stone Yellow Friable Radiolucent

Page 19: Renal calculi and hydronephrosis

Morphology of renal calculi

Cystine stone Brown color May be large Radiolucent

Page 20: Renal calculi and hydronephrosis

Clinical course of renal calculi

May be asymptomatic. May present with renal colic

(during its passage into ureter)

Hematuria. It predispose the patients to urinary

tract infection.

Page 21: Renal calculi and hydronephrosis

Clinical course of renal calculi

Larger stone that cannot pass will lead to

Obstruction and produce

1. hydronephrosis2. hydroureter.

Page 22: Renal calculi and hydronephrosis

Clinical course of renal calculi

Diagnosis is done radiological. Also investigations to detect the

cause is done 1. Serum calcium 2. Phosphorus 3. Uric acid 4. Para Thyroid Hormone,…

Page 23: Renal calculi and hydronephrosis

The passage of calculus through urinary tract

Page 24: Renal calculi and hydronephrosis

Hydronephrosis with calculus at ureteropevic junction.

Page 25: Renal calculi and hydronephrosis

HydronephrosisHydronephrosis

Page 26: Renal calculi and hydronephrosis

Causes of hydronephrosis

Hydronephrosis refers to dilatation of renal pelvis and calyces with accompanying atrophy of parenchyma.

Cause by obstruction to outflow of urine,

The most common causes are:

Page 27: Renal calculi and hydronephrosis

Causes of hydronephrosis

Congenital Atresia of urethra, Aberrant renal artery compressing

the ureter, Renal ptosis with kinking of ureter.

Page 28: Renal calculi and hydronephrosis

Causes of hydronephrosis

Acquired; Foreign Body: Stones Tumors: cancer prostate & bladder tumors

Inflammation: prostatitis, ureteritis, urethritis

Neurogenic: spinal cord damage with paralysis of bladder.

Page 29: Renal calculi and hydronephrosis

The unusually high pressure generated at renal pelvis causes compression of renal vasculature.

Both artery insufficiency and venous stasis occur.

Page 30: Renal calculi and hydronephrosis

The most severe effects is seen in the papillae because they are subjected to the greatest increase in pressure.

Accordingly the Initial functional disturbances are largely tubular,

Manifested by impaired concentration ability,

Later on glomerular filtration begins to diminish

Page 31: Renal calculi and hydronephrosis

The kidney is massively enlarged with greatly distended pelvicalyceal system.

The renal parenchyma is compressed and atrophied with obliteration of the papilla and fattening of the pyramids.

Depending on obstruction one or both ureter may also dilated (hydroureter)

Morphology :

Page 32: Renal calculi and hydronephrosis

Bilateral complete obstruction produce anuria which need soon medial attention

Incomplete bilateral obstruction produce polyuria rather than oliguria as a result of defect in tubular concentrating mechanism

Clinical course

Page 33: Renal calculi and hydronephrosis

Unilateral hyronephrosis may be silent for long period unless other kidney is affected.

Bilateral hydronephrosis usually lead to uremia.

Early removal of obstruction can return the kidney function.

However with the time the changes become irreversible.

Clinical course

Page 34: Renal calculi and hydronephrosis

Hydroureter & hydronephrosis

Page 35: Renal calculi and hydronephrosis

Severe hydronephrosis .The kidney is markedly enlarged.

Page 36: Renal calculi and hydronephrosis

Hydronephrosis affecting mainly the lower pole of kidney due to stone at this site .The upper pole of the kidney is normal