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THRALL - Thom > 41 - Kidneys and Ureters > Flashcards

41 - Kidneys and Ureters Flashcards

1
Q

Which projection provides more longitudinal separation of kidneys?

A

Right lateral

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2
Q

At what level are the kidneys identified in dogs and cats?

A

Dogs: Right T13; Left L1-3 Cats: both L1-L4.

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3
Q

Detail the radiographic measurements of renal length in dogs and cats

A

ALL relative to L2 (VD best)

Dogs - 2.5-3.5

Cats - 2.4-3.0 x L2

Older cats: 1.9-2.6

Intact cats: 2.1-3.2 vs neutered: 1.9-2.6

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4
Q

List 3 contraindications for IVU

A

Hypotension / dehydration

Anuric renal failure

Known sensitivity to contrast agent

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5
Q

Recommended dose of iodine for IVU?

A

600-700mg/kg

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6
Q

At what time is opacification of the renal arteries seen following IVU?

A

5-7 secs

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7
Q

Describe the normal timings of the nephrogram phase in IVU

A

Starts at 10secs -> 2mins, then pyelogram starts

  • Initially cortex may be more opaque

Renal opacification progressively decreases -> only 25% dogs have persistent nephrogram at 2 hrs

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8
Q

Describe the normal features of the pyelogram phase

A

Occurs after approx 2 mins

Neither renal pelvis or diverticula should be blunted or rounded.

Normal renal pelvis <2mm

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9
Q

Name 5 considerations that effect the duration and intensity of opacification in IVU

A

Hydration status

Contrast dose

Renal perfusion

GFR

Tubular resorption of water

-> IMPRECISE measure of renal function

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10
Q

How does the renal cortex compare to the liver and spleen?

A

Hypo to iso in most.

Can be hyper in absence of renal disease

Hyper may be associated with fat deposition in cats!

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11
Q

Describe US measurements of renal size

A

Cats: 3-4.3cm

Dogs: 3-10cm. Or 10mm per 10lb!

5.5-9.1 x Ao diameter at level of kidney

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12
Q

Name the arteries of the kidney

A
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13
Q

What is the normal resistive index and pulsatility index of the kidney in the dog and cat?

A

RI:

Dog: <0.72

Cat: <0.7

PI:

Dog: 1.52

Cat: 1.29

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14
Q

At what time are ureters best visualised in contrast CT? And what positional considerations are there?

A

3 mins

Sternal with pelvis elevated -> pooling in apex away from UVJ

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15
Q

Define CT measurements of renal size

A

vs L2: 2.7 (2.5-2.9)

Length:Ao: 7.4 (7.0-7.7)

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16
Q

List Ddx for changes in renal size, shape

Clue:

Mild enlargement + smooth (8);

Marked enlargement + smooth (7)

Enlargement + irregular (9)

Small + smooth / irreg (4)

A
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17
Q

List US features of acute nephropathy (3)

A

Renomegaly

Cortical hyperechogenicity

Perirenal / subcapsular effusion

18
Q

A change in which parameter has been associated with active tubulointerstitial or vascular disaese?

A

Elevated resistive index

19
Q

What features have been described with ethylene glycol toxicity? Why?

A

Markedly increased cortical and medullary echogenicity. Hypoechoic halo at CM junction; hypoechoic central medullary region.

Attributed to calcium oxalate deposition

20
Q

What US features have been described in renal lymphoma? NPV and PPV have been defined for one feature….

A

Bilateral, irregular renomegaly

Masses, focal/multifocal nodules also described

SUBCAPSULAR RIM

NPV: 66%

PPV: 81%

21
Q

The medullary rim sign is observed with haemorrhage, necrosis and mineralisation. Which disease processed has it been associated with (4)?

ALSO SEEN WITH NORMAL ANIMALS!

A

Acute tubular necrosis

FIP (pyogranulomatous vasculitis)

Hypercalcaemic nephropathy

Lepto

22
Q

What US feature is described with giant kidney worms (Dioctophyme renale)?

A

Ring or band like structures in region of CM junction

23
Q

What is the predominant histopathological finding in CKD?

A

Chronic tubulointerstitial inflammation and fibrosis

24
Q

PKD is associated with which animals??

A 
Long haired cats (autosomal dominant) -\> may be associated with hepatic and pancreatic cysts
CAIRN TERRIERS (autosomal recessive)
25
Q

Nodular dermatofibrosis….

A

GSD and renal cystadenocarcinoma!!!!!

26
Q

List 7 causes of perirenal fluid

A

AKI

Urine leakage

Neoplasia

Abscess

Haemorrhage

Ureteral obstruction

Perirenal pseudocysts

27
Q

List 4 primary types of renal tumour

A

Renal adenocarcinoma

Nephroblastoma

Squamous cell carcinoma

Papillary carcinoma

28
Q

List 5 non-primary tumours of the kidney!

A

LSA

Metastatic carcinoma

Histiocytic sarcoma

HSA

Plasma cell tumour

29
Q

Give 6 causes of pyelectasia

A

PUPD (inc urine production)
IVFT

Obstruction

Pyelonephritis

Ectopic ureter

Ureterocoele

30
Q

Define US features of ACUTE pyelonephritis

Chronic may look like CKD! Small, irregular, mild pyelectasia

A

Acute:
Mild - mod pyelectasia (Mean dogs 3.6, Cats 4mm)

Echogenic material

Distortion of renal pelvis, blunted diverticula

Echogenic rim around pelvis (fibrosis)

Increased cortical echogenicity

Steatitis

Retroperitoneal effusion

Ureteric dilation and thickened wall

31
Q

List secondary signs of renal failure

A

Renal hyperparathyrodism (osteopaenia -> max and mand, with loss of lamina dura)

Metastatic mineralisation

Perirenal fluid

Mild hyperplasia of parathyroid (chronic)

32
Q

List 5 DDx for ureteric dilation

A

Obstruction

Ureteral tears

Ureteritis

Atony

Ectopic

33
Q

What is the prevalence of circumcaval ureter in the cat?

A

22.4%

34
Q

Describe US features of ureteral stricture

A

Narrowing with hyperechoic tissue surrounding

Typically within PROXIMAL ureter

35
Q

What US features have been associated with ureteric obstruction?

A

Renal pelvis dilation >13mm (high specificity)

Resistive index increase once diuretic given

NB: Excretory urography LEAST useful as ureteral opacification poor owing to increased interstitial pressure and decreased renal function

36
Q

What is the sensitivity for detection of ureteroliths when combining XR and US?

A

90%

37
Q

Decribe functional aspects of the excretory urogram

A
38
Q

What is a ureterocoele?

A

A dilation of the submucosal portion of the ureter, often associated with ectopia

39
Q

List 4 primary ureteral masses (ALL ARE RARE)

A

Leiomyoma

Leiomyosarcoma

TCC

(Extension of bladder TCC more common)

Fibroepithelial polyps (reported in dogs -> proximal)

40
Q

What is a urinoma?

A

Encapsulated urine accumulation -> association with ureteral leakage

THRALL - Thom (40 decks)

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