MCUG showed severe narrowing of the distal half of the posterior urethra with attendant dilatation of the proximal prostatic urethra. No vesicoureteric reflux was observed. IVU showed bilateral hydroureteronephrosis with moderate bladder filling implying distal ureteral involvement. The urinary tract infection (UTI), hypertension and schistosomiasis were appropriately treated with antibiotics, amlodipine and praziquantel respectively. Patient was also given Iron for 3 months. Bilateral nephrostomy tubes were insertion and urethral catheter passed. He subsequently underwent surgery for bilateral ureteric re-implantation. Intra-operative selleck chemicals llc findings

showed bilaterally thickened distal ureters with stenosis and a thickened urinary

bladder. Follow up urine culture was sterile and BP was controlled. Repeat USS showed moderate dilatation of right renal pelvis and calyces and no evidence of dilated renal calyces or pelvis on the left. Patient is doing well and is on long term follow up. He has indwelling urethral catheter in place and has been scheduled for urethrocystoscopy to fully evaluate the lower urinary tract and to rule out missed posterior urethral valve. Case 4 Eleven-year-old I.T. was referred from a district hospital with provisional diagnosis of chronic renal failure. Patient hails from Suhum, a community endemic for schistosomiasis. His presenting complaints selleck products included bodily swelling, cough, and chest pain of a week’s duration and terminal haematuria for a year. Essential findings on physical examination were generalised oedema, pallor, dyspnoea, respiratory rate of 36/min and bilateral basal crepitations. The pulse rate was 112/min, BP 140/100mmHg (both systolic & diastolic > 99th centile for age & sex), heart sounds S1S2 were present and normal, there was no murmur. There was non-tender hepatomegaly of 3cm. The bladder was not palpable. Bedside urine dipstick showed protein 3+ and blood 4+. Laboratory test results were as follows: Hb 8g/dl, MCV 75 fl., WBC 6.5× 109/l Platelet count of 220 × 109/l; Urine microscopy showed pus cells > 20/HPF, RBCs > 100/HPF, granular cast 2+; S. haematobium ova ++; urine culture was negative;

blood urea 37mmol/l , creatinine 786µmol/l, Na+ 121 Endonuclease mmol/l, K+ 5.7 mmol/l, Ca2+ 1.8 mmol/l, Mg2+ 0.9mmol/l, PO4- – 1.4mmol/l , albumin 32g/l, total protein 70g/l and cholesterol 5.7mmol/l. CXR showed cardiomegaly with pulmonary oedema and USS showed severe bladder wall thickening with right hydroureteronephrosis. Left kidney was shrunken with increased echogenicity and loss of corticomedullary differentiation Diagnoses of congestive cardiac failure 2° hypertension, and chronic renal failure 2° obstructive uropathy from chronic urinary schistosomiasis were made. Heart failure was appropriately treated with high dose frusemide, and hypertension treated with amlodipine. Urethral catheter was passed. Urine output over 24 hours into admission was 0.48mls/kg/hr.