KIDNEY URETER Tumour Wilms

Wilm's Tumour (Adenomyosarcoma Nephroblastoma) 

The  tumour  is  most  likely  present  at  birth  and  manifests

clinically when the patient is still under the age of two.

The  usual presentation is a unilateral flank  mass.  Haematuria,

weight loss and pain are usual manifestations and occur later  in

the natural history of the disease.

A plain abdominal radiograph shows displacement of the intestinal

gas  shadows  to the contralteral side and  obliteration  of  the

psoas shadow on the side of the lesion.

Excretory urography may show a small rim of displaced functioning

renal tissue the distinct IVP features are shown in Fig. 25.11c.

Kidney  on  the side of the lesion may not be visualised  by  the

intravenous pylogram.

Ultrasonography  can differentiate a hydronephrosis from a  solid

Wilm's  tumour and a CT scan can establish the diagnosis and  aid

staging the disease.

Treatment usually consistes of transperitoneal surgical  excision

followed by postoperative radiation therapy of chemotherapy.

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KIDNEY URETER Tumours renal cell

10. TUMOURS Fig.25.11a+b+c

10.1  Transitional Cell Carcinoma of the renal pelvis  constitute

5%  of  all renal carcinoma and present with  pain  and  symptoms

similar to renal stone disease. Hematuria may also be a prominent

symptom. Treatment is with a nephrectomy. Fig.25.10a.

10.2   Renal   Adenocarcinoma  (Hypernephroma,   grawitz   tumor)

Fig.25.10b

The  most  common malignancy involving the  kidney,  occurs  most

often  in  the  fifth decade of life. Incidence  is  three  times

higher  in  males  than in females. There are  three  cell  types

identified in these tumours:

*  Clear  cells,  large polyhderal cells,  clear  to  light  with

   vaculated cytoplasm

*  Spindle-shaped  cells,   arranged  in  papillary  or   tubular

   structure

*  Granular cells, smaller than clear cells.

SIGNS AND SYMPTOMS

Renal  carcinoma may present with a variety of symptoms  patterns

(Table 25.1). Hypertension occurs in 14 to 40% of patients.

TREATMENT

The  treatment of renal cell carcinoma confined to the kidney  is

surgery.

Surgery  is  not  effective  once the  disease  has  extended  to

adjacent  structures.  When the tumour is confined to  the  renal

substance beneath the capsule itself, survival rates greater than

ninety percent in 10 years can be expected.

The operative approach to renal tumour may be through the  flank,

chest  or  abdomen.  Removal of the  perinephric  fat  and  local

lymphnodes with the kidney provides the best results. Removal  of

primary   renal   tumour  has  been  observed  to   be   followed

occasionally by regression of metastases.

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KIDNEY URETER upper tract obstruction

UPPER URINARY TRACT OBSTRUCTION

* Pelviureteric junction obstruction (P.U.J.)

* Stones

* Transitional cell cancer and

* Tuberculosis

9.1 P.U.J. Obstruction (Fig.25.10a)

This is a common cause of hydronephrosis in the young adults  and

children. The narrowing at the pelviureteric junction is  without

demonstrable  cause  (idiopathic)  and it is  possible  that  the

muscle  in  the region of the narrowing does not relax  to  allow

urine to flow freely.

This may be congenital defect, and is, sometimes, bilateral.

9.1.1 CLINICAL FEATURES

The  patient may present with a painless mass in the abdomen  due

to hydroenphrosis.

A moderate sized mass can give rise to dull ache.

9.1.2. INVESTIGATIONS (Fig.25.10b)

The  PUJ  obstruction can be demonstrated by an I.V.P.  There  is

narrowing  at  the  junction of Pelvis  and  ureter  and  delayed

emptying of pelvis.

9.1.3 TREATMENT

The  narrowed segment is removed and the dilated pelvis  repaired

and the healthy ureter joined to the repaired pelvis.

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KIDNEY URETER Infections 2 acute pylonephritis

ACUTE PYELONEPHRITIS

The  symptoms usually develop rapidly in a few hours and  include

high  fever,  chills,  nausea and vomiting.  There  is  pain  and

tenderness in the renal angle.

On  investigation, there is marked leucocytosis and pus cells  in

the urine with leucocyte casts. Organisms can be cultured in  the

urine and their sensitivity to antibiotics, identified.

8.2.1 Treatment

1.  A  10-14  day  treatment  with   Trimethoprim-Sulfamethazole,

Cephalosporin  or  Ampicillin  usually  controls  the  infection,

unless it is associated with the presence of stones, obstruction,

diabetes or tumour. In such cases, treatment is required for upto

6  weeks,  in  addition  to this,  treatment  of  the  underlying

condition to prevent repeated attacks.

Genitourinary  tuberculosis is secondary to tuberculosis  in  the

lungs of bones. The bacilli reach the kidney by the blood  stream

and  an  ulcero-cavernous lesion forms in the  carlico  medullary

region in 90% of cases. Living bacilli flow down in the urine and

cause   lesions  at  PUJ  ureter,  bladder,   seninal   vesicles,

epidiolymes   and  testis.  Lesions  in  the  ureter  can   cause

obstruction. Treatment is with antitubercular therapy

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