RENAL SYSTEM -HYDRONEPHROSIS

HydronPhrosis
Hydronephrosis :-
Refer to dilation of the renal pelvis & calyces with accompanying atrophy of the parenchyma caused by obstruction to the outflow of urine.
The most common causes
congenital atresia of the urethra , renal ptosis, kinking of the ureter.
Acquired :
Foreign bodies calculi
Tumors :- B. P. H, ca of prostate, bladder tumor contiguous malignant diseases ca. of the cervix.
Inflammation : Prostititis, utereitisNeurogenic : spinal cord damage with paralysis of the bladder* bilat hydronephrosis occurs only when the obstruction is below the level of the ureters.
Pathogenesis :
The affected calyces pelvis become dilated high pressure thus generated in the renal pelvis, the initial functional disturbances are largely tubular, manifested primarily by impaired concentrating ability.
Microscopically: show tubular dilation, followed by atrophy & fibrous replacement of the tubular epithelia.
Clinically : unilat hydronephrosis may remain completely silent for long period unless the other kidney become. Non functioning
Renal stone
80 % ? calcium oxalate or ca. oxalate mixed with calci phosphate .
10 % ? magnesium ammonium phosphate
10 % ? uric acid or cystine stones
The most important cause is increased urine concentration of the urine constituent s
Calcium stones have hyper calciuria.
Magnesium stones almost always occur in persons with a persistently alkaline urine due to UTI.
The urea splitting bacteria, such as proteus vulgaris & the stephyGout, leukemia lead high uric acid levels in the urine, & uric acid stones.The low PH favors uric acid stone formation Tumors
R. C. C. :-
Represent 80 – 85 % of all malignant renal tumors.Common from sixth – seventh decade.M:F 2:1
The risk factors :-  smokers.Hypertensive or obese.Occupational exposure to cadmium.Acquired polycystic diseases.
Majority of RCC occurs sporadically
Tobacco smoking contributes to 24-30% of RCC cases
- Tobacco results in a 2-fold increased risk
Occupational exposure to cadmium, asbestos, petroleum
Obesity, HTN
Chronic phenacetin or aspirin use
Acquired polycystic kidney disease due to dialysis results in 30% increase risk