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Related Concept Videos

Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
Ureters01:22

Ureters

The ureters are retroperitoneal tubes located on either side of the vertebral column. They are responsible for transporting urine from each kidney to the urinary bladder. These tubes have thick walls and are approximately 25-30 cm long. Their diameter is around 10 mm at the renal pelvis, gradually narrowing to 1 mm as the ureter obliquely enters the posterior bladder wall through the ureteric orifices. The shape of these orifices is slit-like, which helps to prevent urine backflow toward the...

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Unilateral Ureteral Obstruction Model for Investigating Kidney Interstitial Fibrosis
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Prognostic factors in malignant ureteric obstruction.

Andrew Lienert1, Andrew Ing, Stephen Mark

  • 1Urology, Christchurch Hospital, Christchurch, New Zealand. andrewlienert@hotmail.com

BJU International
|April 3, 2009
PubMed
Summary

This study validates a prognostic model for patients with malignant ureteric obstruction, identifying low serum albumin and metastatic disease as key indicators for poor prognosis and risk stratification.

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Published on: November 22, 2019

Area of Science:

  • Nephrology
  • Oncology
  • Medical Prognostics

Background:

  • Malignant ureteric obstruction causes obstructive nephropathy with poor prognosis.
  • Previous research identified low serum albumin, hydronephrosis, and metastatic disease events as prognostic indicators.
  • A validated model is needed for risk stratification before palliative decompression.

Purpose of the Study:

  • To externally validate a prognostic model for patients with obstructive nephropathy due to malignant ureteric obstruction.
  • To stratify patients into different prognostic groups based on identified indicators.
  • To assess the utility of previously reported prognostic factors.

Main Methods:

  • Retrospective chart review of patients who underwent nephrostomy tube insertion for malignant ureteric obstruction.
  • Analysis of laboratory and clinical factors influencing prognosis.
  • External validation of a previously proposed risk stratification model.

Main Results:

  • A total of 49 patients were included, with a median survival of 174 days.
  • Low serum albumin (>30 g/L), low serum sodium (<135 mmol/L), and ≥3 metastatic events were significantly associated with shorter survival.
  • The validated model effectively stratified patients into different risk groups (P = 0.002).

Conclusions:

  • Low serum albumin and metastatic disease events indicate a poor prognosis in malignant ureteric obstruction.
  • Low serum sodium may also be associated with a worse prognosis.
  • The validated model aids in prognostic stratification, though palliative decompression carries significant morbidity.