urinary 3

Dr. Sameer Abdul Lateef

Urinary calculi Common in middle age . High prevalence in tropical countries due to dehydration . Any lesion cause urinary stasis , predispose to stone formation (congenital or aquired lesion ). Metabolic disorder producing hypercalcaemia or hypercalcuria (specially hyperparathyroidism ) are responsible for stone formation .


1- Radio-opaque stones --- more frequent , consist of Ca. oxalate Ca. phosphate Ca. carbonate Ammon. & Mg. phosphate Urate 2- Semi radio-opaque -- cystine stone. 3- Radio-lucent stones –pure uric acid , xanthine

Urinary stones

Renal Calculi
Called nephrolithiasis or urolithiasisMost commonly develop in the renal pelvis but can be anywhere in the urinary tractVary in size –from very large to tinyCan be one stone or many stonesMay stay in kidney or travel into the ureterCan damage the urinary tractMay cause hydronephrosisMore common in white males 30-50 years of age

radio-opaque stones)) KUB

1- Localization of stone in the kidney , in ureter or in the bladder. 2- Number of stones. 3- Soft tissue shadow of enlarged kid.

Renal stone

Ureteric stone (oval shape or elongated

spiky or lamellate)) Vesical stone

Stag horn calculus (large radio-opaque stone casting the shape of pelvi-calyceal system

Calcified lesions other than stones

Radiological appearance:Plain film Localization in the kidney.Scoliosis in severe pain.IVU : Is not used in acute stage , if so compression is not applied . If obstruction is present 1- The kidney increases in size.2- Delayed excretion of contrast .3- Persistent nephrogram.4- Dilatation of ureter down to the site of obstruction .5- Delayed film up to 24 hrs. to see the site of obstruction.6- In the kidney lead to hydronephrosis . In the ureter lead to hydroureter .

Radio lucent stone

Ultrasound

Hydronephrosis

Dense persistent nephrogram



Deposition of calcium with in the renal substance( renal tubules ) in form of small rounded , clusters or less frequently by speckles , it should be differentiated from calcified pathology like Tb. The changes seen in plain film. IVU shows no obstruction.
nephrocalcinosis


* May be unilateral or bilateral . * Age incidence : childhood and early adult life ,rarely after 40 years . * The kidney reduced in size and shows coarse focal scarring with adjoining areas of normal hypertrophied renal tissues . IVU shows : 1- reduction of kidney size . 2-Irreqular out-line . 3-Decreased renal thickness . 4-Calyceal deformity. 5-Disturbed inter-papillary line . 6-Reflux. 7-Evididence of CRF.

Acute pyelonephritis :IVU may show :1- Normal urogram.2- Increased size of kidney .3- Delayed excretion .Chronic pyelonephritis ( reflux nephropathy ):* Common cause of death from renal failure and hypertension .*Caused by infection or vesico-ureteric reflux during childhood .* It’s the end result of chronic bacterial infection of renal substance .

*Almost secondary to Tb infection every where. * Tb. Bacilli reach the kidney via blood and develop tubercles in renal cortex . Tb. Foci enlarged and coalesce , and Tb. Bacilli via tubules form medullary lesions and papillary involvement . *Ulceration of renal pelvis produce urinary symptoms . *Extension along ureters to the bladder , prostate , seminal vesicles , vas deference and epididymus . * In early stage , when the disease confined to cortex and medulla , IVU is normal . * Normal urogram dose not exclude Tb.


Plain film show : 1- Calcification , common , varies in extent from few minute areas to complete cast ( auto-nephrectomy ) . 2- Scarring and fibrosis produce irregular out-line of kidney . 3-Abscess may produce local bulge . 4-ureteric obstruction may produce large kidney .

IVU : 1- Loss of definition of minor calyces . 2- May simulate ch. Pyelonephritis . 3-Calyceal stricture cause narrowing of calyces with proximal dilatation or complete cut off of affected calyces . 4-Ureteric Tb. Produce irregular areas of narrowing and dilatation and tortuous and rigid appearance . 5- uretral obstruction produce hydronephrosis


* Infestation by Schist. Haematobium. *The ova deposited into sub-mucosa of urinary bladder and to less extent at the wall of ureters . *The ova calcify and excrete toxin producing necrosis of tissue lead to granulomatous tubercles and extensive fibrosis . *Calcification is very common and important diagnostic findings. Very common in bladder ,less frequent in lower ureters ,but in advanced case involve the whole length of ureter . *The appearance depends on degree of fullness of bladder ; thin linear opacity outlining bladder wall. Empty bladder shows crowded linear opacities with calcified plaques.

IVU: Early stage –cobble stone Later filling defects due to graneulomatos papilloma Carcinoma is important complication Ureters : dilated and tortuousIn early stage hydroureter and hydronephrosis + reflux


QuizAnswer one of the followings:1- ureterocele.2- IVU findings of horse shoe .kidney