الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Obstructive renal failure is a common urological emergency in Egypt, however, it is very important as it is correctable, and it cause 4% of cases of end stage renal failure requiring treatment (Mathew, 1986).
Urinary tract obstruction is a frequent cause of renal failure that is potentially life threatening but reversible; if it is promptly recognized and corrected. The level of urinary tract obstruction is variable, dependent on the underlying disease and may range from the loop of Henle to the urethral meatus. The clinical manifestation are most commonly due to renal failure but the history and physical examination can aid in determining the localization and cause of the obstruction laboratory findings may suggest urinary tract obstruction as the etiology for acute renal failure. Radiologic procedures, most prominently ultrasonography, can establish the diagnosis. The ultrasonic measurement of renal parenchymal thiCkness was used to give an idea about the renal tissue reserve therefore helping in prognosis after drainage or surgery. This sign was helpful in acute cases but not with all chronic cases.
Correction of renal failure caused by urinary tract obstruction makes it different from renal failure caused by parenchymatous diseases of the kidneys. The main items of differentiation are the ability of the kidney to recover and regain its functions following correction of the obstructive lesion and consequently keep the patient away from the dilema of dialysis and making his life more comfortable.
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So accurate Diagnosis of the cause of obstruction is mandatory before embarking on direct surgical attack. Correction of biochemical abnormalities (such as hyperkalemia, acidosis, serum creatinine and blood urea nitrogen) and drainage of the obstructed renal system should be established prompetly at first by PCN, ureteral catheter, urethral catheter or suprapubic — tube until the renal function has been improved and uremic status become normalized. Then definitive surgical or endurological procedures well be done to remove the cause of obstruction.
Both preoperative and post operative dialysis may be required, to tide the patients over a critical period. Careful monitoring of fluid balance, electrolytes and serum creatinine are mandatory in such
patients.
In the treatment of infections renal function should always be taken in consideration by choosing non nephrotoxic agents or adjusting the dose of nephrotoxic drugs if used — careful monitoring of patients with respect to fluids, electrolytes and acid base balance is
essential in all patients.
In conclusion :
Accurate diagnosis, primary drainage, correction of biochemical abnormalities, proper preoperative preparation, correct timing, good surgical technique and careful post operative management are the only way to increase the success rate in patients with obstructive renal failure and not only save the kidney but also
save the patient.