**6.1 Renal anomalies**

278 Chronic Kidney Disease

complication is found in endourologic procedure via upper pole access. Patients with significant hydrothorax usually need intercostal drainage. (Lojanapiwat & Prasopsuk, 2006). (Fig. 23, 24) Other minor complications are small perforations with collection, malfunction of nephrostomy tube, persistence nephrocutaneous fistula and sepsis in patients with

Fig. 23, 24. Hydrothorax: Immediate post-operative and post intercostal tube drainage chest

Patients who develop postobstructive diuresis (POD > 3 liters per day or > 200 ml/hr for 12 to 24 hours) following urinary diversion should be treated with intravenous fluid of 0.45 percent NaCI at a two hourly rate equal to one half the previous two hours urine output.

Nephrostomy tube dislodgement from the skin can be undertaken even when carefully fixed to the skin with silk suture. Zhou and colleges reported a new technique to reinforce the nephrostomy tube in 48 patients by using 2 cm long rubber drainage tube as the outer tube to encase the nephrostomy tube and suturing the longitudinal cutting edges together with the skin suture. This technique can significantly decrease the dislodgement incidence

Prevention of nephrocutaneous fistula, a nephrostogram should show radio-opaque contrast medium passing freely down the ureter into the bladder. Clamping the catheter should be done before removing the catheter and should cause no pain and no leakage

Foreign-body calculi at nephrostomy tube can occur after long term placement. Dalton et al reviewed the inducement of foreign-body calculi in laboratory animals as 1) Stone may develop on foreign bodies in absence or presence of infection, 2) Urea-splitting organisms enhance the formation of foreign-body stones, 3) Diuresis and urinary acidification inhibits foreign-body stone formation. Iatrogenic foreign body stones lead to a significant proportion of this urologic problem such as ureteral catheters or nephrostomy tubes. (Dalton et al., 1975).

x-ray of patient following upper pole percutaneous nephrolithotomy.

(Gulmi et al., 1998)

around the catheter.

of nephrostomy tube. (Zhou et al., 2011)

infected urine. (de la Rosette et al., 2011) (Fig. 25)

Due to abnormal anatomy of patients with renal anomalies such as horseshoe kidney; in prone position, the site of access is relatively median often at paraspinous area.
