L62 Flashcards Preview

P&T Block 5 Renal > L62 > Flashcards

Flashcards in L62 Deck (30)
1

Uses of XR for kidney

Calcification - UT stones
Bony structures
Gas

2

What is IV urography

XR after IV injection of contrast -> circulates to kidneys -> filtered + excreted
No longer used b/c CT

3

What are your 3 major concerns with giving contrast

Nephrotoxic
Allergy
Risk of death

4

How do you do antegrade pyelography?

Percutaneous needle into kidney - inject contrast - XRs
See collecting system only
Pro - do drainage

5

How do you do retrograde pyelography?

Inject contrast retrograde from the bladder -> ureters
XR
Less invasive than anterograde

6

3 reasons you do retrograde pyelography?

Stones
Tumors
Strictures

7

What do you see with US?

Renal cortex
Medullary pyramids
Sinus fat
Vessels

8

Uses of US

Acute + chronic renal failure
Obstruction r/o
Masses + cysts (stone -> hydronephrosis)
Calculi
Recurrent UTI
Renovasc HTN

9

Pros US

Cheap
No radiation
Real time
Vasc evaluation

10

US limitations

Can't see normal collecting system - see dilated collecting duct only
Not greater for ureter obstruction
Bad if obese, bowel gas, bone

11

CT uses

Renal colic/pain
Hematuria
Eval masses/vessels
Cancer staging
Infection

12

CT pros

See a lot // versatile
High res

13

CT cons

Radiation
$$
Contrast: allergy // nephrotox

14

Use MRI

Dx renal masses
Stage cancer
Tissue characterization: fat, blood products, fluid

15

Pros MRI

High contrast resolution/versatile

16

Cons MRI

$ / availability
Claustrophobia
CIs: pacemakers, metal (jts), renal failure

17

How do you do angiography? What do you see?

Inject contrast into arteries
See arteries, veins, renal parenchyma and collecting system

18

Use angiography

NOT 1st LINE
Dx renal art stenosis + vasculitis
Treat arterial steonsis (since you already have arterial access)
- Stent
- Embolize bleeding vessels

19

Cons angiography

Invasive
Radiation
Contrast: allergy + nephrotox

20

What is nuclear scintigraphy?

+ radioactive isotope to molecule metabolized and excreted by kidney
DET FXN

21

L flank pain sharp + intermittent, radiates to groin, gross hematuria w/o fever chills
1. Dx
2. Scan

Renal stone
LOW DOSE CT > XR b/c get all stones, even those not radio-opaque

22

What is the cut off for allowing a stone to pass on own?

5 cm
But location influences therapy - pts of anatomic narrowing

23

Scan for stones in kids + pregnant women

US... duh

24

L flank pain + fever, h/o drug use + HIV
1. Dx
2. Scan
3. Treat

Abscess/infection
Treat: percutaneous drainage + antibiotics
US or CT

25

What is a UTI of the upper vs lower urinary tract

Upper UTI: pyelonephritis
Lower UTI: cystitis

26

Do you image UTI?

No - clinical dx
Image if not responding to treatment

27

What is emphysematous pyelonephritis?

Infection due to bug that causes gas forming infection

28

Best imaging for dx and staging

CT/MR

29

What is the imaging work up for hematuria?

CYTOSCOPY for all - CT urogram

30

Do you image pre, renal, or post-renal causes of renal failure?

Post only - bladder obstruction
US or CT non-con