Urinary tract obstruction

Several risk factors are known to exist in men and women. The common risk factors for UTI in women include sexual intercourse, lack of voiding after intercourse, use of a diaphragm, use of spermicidal jellies, diabetes, and pregnancy. In men, the risks are different, and are primarily centered on lack of circumcision, and at an older age include prostatic hyperplasia. Common risk factors for both men and women include urologic instrumentation, renal transplantation, neurogenic bladder, and urinary tract obstruction.26... 

Enhanced BUN levels clearly signify a renal dysfunction, for instance urinary tract obstruction and nephritis i.e., inflammation of the kidney. 

Special risk patients Administer cautiously to patients with decompensated cardiovascular, cirrhotic, and nephrotic disease circulatory insufficiency hypoproteinemia hypervolemia urinary tract obstruction CHF and to patients with concurrent edema and sodium retention those receiving corticosteroids or corticotropin and those retaining salt. 

Contraindications Active or latent bronchial asthma, acute inflammatory GI tract conditions, anastomosis, bladder wall instability, cardiacorcoronary artery disease, epilepsy, hypertension, hyperthyroidism, hypotension, mechanical GI or urinary tract obstruction or recent GI resection, parkinsonism, peptic ulcer, pronounced bradycardia, vasomotor instability... 

Contraindications Duodenal orpyloricobstruction, GI hemorrhage or obstruction, ileus, lower urinary tract obstruction... 

Contraindications Mechanical GI or urinary tract obstruction, hypersensitivity to anticholinesterase agents... 

Contraindications Hypersensitivitytocarbonicanhydraseinhibitors, local anesthetics, salicylates, sulfonamides, sulfonylureas, sunscreens containing PABA, or thiazide or loop diuretics intestinal or urinary tract obstruction porphyria severe hepatic or renal dysfunction... 

Both urea and creatinine will be elevated with renal injury, and the elevations in both are usually proportional. Calculation of the ureaxreatinine ratio may implicate extrarenal causes for the analyte elevations (see Limitations of the Method , below). Extremely high ureaxreatinine when both are elevated (where urea is elevated markedly out of proportion to creatinine) indicates decreased renal blood flow, urinary tract obstruction or extravasation of urine into the peritoneal cavity. Elevation in the ureaxreatinine ratio as a consequence of pure urea elevation implicates gastrointestinal hemorrhage, high protein diet, increased protein catabolism, or loss of muscle mass. A decreased ratio indicates primary liver dysfunction (due... 

Diltiazem was associated with the development of acute renal insufficiency in a patient being treated for severe retrosternal chest pain who had neither primary kidney disease nor urinary tract obstruction (8,9). 

Treatment of sulfadiazine nephrotoxicity consists in stopping sulfadiazine or decreasing its dosage. The acute kidney injury, however, may resolve despite continuation of the treatment [41]. Hydration and especially alkalinization are the basis for the treatment. Urinary tract obstruction may require placement of ureteral stents [13] or nephrostomy [33]. This complication is essentially reversible and dialysis is rarely needed [27]. 

Catheter specimens are used for microbiological examination in critically ill patients or in those with urinary tract obstruction but should not normally be obtained just for examination of chemical constituents. The suprapubic tap specimen is a useful alternative, because the tap is unlikely to cause infection. After appropriate cleaning of the skin over the full bladder, a 22-gauge spinal needle is passed through a small wheal made by a local anesthetic. The bladder is penetrated and the urine withdrawn into the syringe. 

Urination, also termed micturition, is the discharge of urine. In normal adults adequate homeostasis is maintained with a urine output of about 500mL/day. Alterations in urinary output are described as anuria (<100mL/day), oliguria (<400mL/day), or polyuria (>3 L/day or 50mL/kg body weight/day. The most common disorder of micturition is altered frequency, which may be associated with increased urinary volume or with partial urinary tract obstruction (e.g., in prostatic hypertrophy). 

Initiation factors are factors or conditions that directly initiate kidney damage, and are modifiable by pharmacologic therapy. These factors include diabetes mellitus, hypertension, autoimmune diseases, polycystic kidney disease, systemic infections, urinary tract infections, urinary stones, lower urinary tract obstructions, and drug toxicity. Since diabetes mellitus, hypertension, and glomerular diseases are respectively the first, second, and third most common causes for CKD in the U.S., the following discussion focuses on these three conditions. 

Drug therapy may also cause renal insufficiency due to lower urinary tract obstruction. Ureteral obstruction can be caused by calculi or retroperitoneal fibrosis. Bladder dysfunction with urinary outflow obstruction can result, particularly in males with prostatic hypertrophy, from anticholinergic drugs including tricyclic antidepressants and disopyramide. Bladder outlet and ureteral obstruction may result from bladder fibrosis following hemorrhagic cystitis with cyclophosphamide or ifosfamide therapy. Concurrent treatment with mesna can prevent cystitis and this complication. 

Nephrolithiasis (formation of kidney stones) does not present as classic nephrotoxicity since GFR is usually not decreased. Drug-induced nephrolithiasis represents abnormal crystal precipitation in the renal collecting system, potentially causing pain, hematuria, infection, or occasionally urinary tract obstruction with renal insufficiency. 

Antiandrogens are coadministered during initial therapy to decrease symptoms of tumor flare (bone pain, urinary tract obstruction, or spinal cord compression) associated with the initial increase in serum testosterone levels Administered as a subcutaneous injection of implanted pellets every 1-3 months... 

Furosemide (Lasix) will enhance the detection of a dilated collecting system by rapid washout of the radiotracer from the pelvis and ureter, while in the case of urinary tract obstruction, no change of pelvic retention and in the shape of the time-activity curve is seen (O Reilly 1992). 

AGE inhibitors such as captopril may facilitate the differential diagnosis of renovascular hypertension diuretics such as fiirosemide (Lasix) cause rapid washout of the radiotracer or demonstrate urinary tract obstruction (Kletter 1988). 

Like all sulfonamides, sulfasalazine is contraindicated in patients with known hypersensitivity to other drags containing sulfur (thiazides, furosemide, or oral sulfonylureas), in patients with known hypersensitivity to salicylates, in patients with severe renal or hepatic dysfunction, or porphyria, during pregnancy, and during lactation, and in infants and children under age 2. Sulfasalazine is also contraindicated in patients with intestinal or urinary tract obstructions because of the risk of local GI irritation and of crystalluria. 

Caoili EM, Inampudi P, Cohan RH et al (2005b) Optimization of multi-detector row CT urography effect of compression, saline administration, and prolongation of acquisition delay. Radiology 235 116-123 Catalano C, Pavone P, Laghi A et al (1999) MR pyelography and conventional MR imaging in urinary tract obstruction. Acta Radiol 40 198-202... 

Interventional Radiology in Malignant Urinary Tract Obstruction... 

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