GU REVIEW Flashcards
What is a urinalysis?
Part of routine diagnostic and screening evaluation. Usually part of first-line screening and evaluation
What are the indications for a urinalysis?
Signs and symptoms: flank pain, back pain, dysuria, frequency, hematuria, dyspareunia
Monitoring of CKD and is part of the AKI evaluation
A urinalysis will get info on What?
Urinary tract disease diseases: infection, GN, hydration status
Extra renal disease diseases: diabetes, liver disease
How is urinalysis collected?
Random versus First of the morning
Midstream clean catch versus catheterized: If not obtained either of these ways can risk contamination
What is the ideal way we would like a urine collection?
First of the morning (more concentrated) and a midstream clean catch (clean outside first to avoid bacteria from skin), because it is most accurate
How is the testing for a urinalysis completed?
Should be completed in 30 minutes to an hour after specimen is obtained. After that, it should be refrigerated.
At room temperature: Cells and cast begin to deteriorate, bacteria multiply, bilirubin, urobilinogen, ketones, and glucose will decrease, pH may increase, amorphous phosphates and urates may precipitate
What should be observed on a urinalysis?
Appearance, color, outer
A dipstick urinalysis assesses what?
pH, specific gravity, urobilinogen, bilirubin, blood, leukocyte esterase, nitrates, ketones, Glucose, and protein
A microscopic analysis of a urinalysis will show what?
Cells, crystals, casts, and microorganisms
What should the appearance of urine look like in a UA?
Urine should be clear
If urine looks cloudy on a UA what could that indicate?
white blood cells present and that may indicate some bacteria
If urine has bubbles present or it looks foamy on UA what could that indicate?
proteinuria. (seen more with LARGE amounts of protein)
What should the color Of urine look like on a UA?
A urine should be a pill yellow straw colored or dark yellow
A dark yellow urine color on UA may indicate what?
Dehydration
An Amber urine color on UA may indicate what?
bilirubin metabolism issue or the presence of myoglobin
A red urine color on UA may indicate what?
Blood
A Green, blue, black urine color on UA may indicate what?
Green (psudeomonas), blue (methylene blue from surgery), black MAYBE due to some sort of food, drugs, or genetic errors in metabolism
A strong, sweet odor of urine may indicate what?
DKA
A foul odor of urine may indicate what?
UTI
A stool odor of urine may indicate what?
Enterovesical fistula
What is the only exception to the rules of color on a UA?
Phenazopyridine (Pyridium, aka AZO) because it is a urinary tract analgesic that turns urine orange to red
A normal urine may contain what on microscopic eval?
A few WBCs, a few RBCs, a few bacteria, a few epithelial cells, a few hyaline casts
Outisde of this, we shouldn’t really see much on the microscope slide.
What are the normal WBC on microscopic eval?
Normal = 0-2
When can WBC be increased on microscopic eval?
Can also be increased in inflammatory conditions of the kidneys. Glomerulonephritis and Interstitial nephritis. Increased is called pyuria: when seen in clumps with bacteria are indicative of infection
When can RBC be increased on microscopic eval?
Damage to glomerular membrane-appear dysmorphic
Post-renal injury/trauma- appear normal in shape
Can be seen following strenuous exercise but disappears with rest
What are the normal RBC on microscopic eval?
Normal 0-2
What should normal epithelial cells look like on microscopic eval?
0-2/hpf
What should squamous epithelial cells look like on microscopic eval?
Originate from external genitalia or lower urinary tract. In large numbers typically means not a clean catch urine or contamination from the skin. Recollect and get a clean catch specimen (or from a cath) or talk to the patients about their sx
What should transitional epithelial cells look like on microscopic eval?
Originate from the bladder, uterus, or renal pelvis. A few may be normal but typically elevated in trauma or cancer.
What is a cast?
Cylindrical masss of glycoproteins that form in the tubules.
What should renal tubular epithelial cells look like on microscopic eval?
Originate in nephron tubules. Indicates acute tubular necrosis, acute interstitial nephritiis, or proliferatie glomerulonephritis.
What are the types of casts?
Hyaline
Waxy
Cellular
WBC
RBC
Granular
What is a hyaline cast?
Nonspecific and may not be pathologic
Prerenal azotemia and strenuous exercise (dehydrated, not replenishing fluids fast enough)
May be normal
What is a waxy cast?
Nonspecific but pathology
Seen in advanced or chronic kidney disease.
What is a cellular cast?
WBC casts: seen in pyeloneprhitis or interstitial nephritis or glomerulunephritis
RBC casts: classicially seen with acute glomeruluonephritis
Can also be seen with trauma, pyelo, renal tumor, renal infarct, or sickle cell disease
Granular casts: from cellular debris trapped in the glycoprotien
“Muddy brown”-ATN
PATHOLOGIC
Describe crystals on microscopic eval
Presence depends on urine pH, deree of saturation of urine by substance, and presence of other substances that promote crystallization.
What are the characteristics of formation and diagnostic utility of uric acid?
Formation promoted by uric acid. Seen in tumor lysis syndrome and also seen in gout.
What are the characteristics of formation and diagnostic utility of calcium phosphate?
Formation promoted by ALKALINE urine and not suggesitve of any specific systemic disease.
What are the characteristics of formation and diagnostic utility of magnesium ammonium phosphate?
Aka struvite or “triple phosphate”. Formation promoted by ALKALINE urine and seen in UTIs by urease producing organisms
What are the characteristics of formation and diagnostic utility of calcium oxalate dihyrdrate?
Formation is largely independent of urine pH. Not suggestive of any specific systemic disease, but is COMMONLY SEEN IN KIDENY STONES
What are the characteristics of formation and diagnostic utility of calcium oxalate monohyrdrate?
Formation is largely independent of urine pH. Seen in ethylene glycol ingestion.
What are the characteristics of formation and diagnostic utility of cystitine?
Formation promoted by acidic urine and is diagnostic of cystinuria
What are the most common crystals seen in nephrotic syndrome?
Cholesterol
What is the normal ph of urine?
5-8
What would alkaline urine indicate?
Alkalemia, some UTIs (ex: Proteus), Certain drugs
What would acidic urine indicate?
Acidemia, starvation, high meat – protein diet. Associated with crystal formation: uric acid, calcium oxalate, xanthine, cystine
What is specific gravity?
Ratio of weight of a given fluid (urine) To an equal volume of distilled water. It is a measurement of the kidneys ability to appropriately concentrate urine
What is the normal specific gravity?
“Normal”= 1.000-1.030
1.000 is equivalent to pure water
Why is a normal specific gravity relative?
If your patient is dehydrated in their urine is still very dilute, it means the kidneys aren’t concentrating things the way that they should. So even though it may fall within the normal range, if it’s on the lower end, in a patient who’s dehydrated we were to expect for it to be on the higher end
What are the measurements of specific gravity?
Dilute (1.005) : Diuretics, diabetes insipidus, very well hydrated
Concentrated (>1.020): Dehydration, increased solutes
Isosthenuria (1.010): Urine osmolality equals plasma osmolality. Can be indicative of underlying renal disease if kidneys aren’t able to adequately dilute or concentrate urine
What is normal urobilinogen?
Formed by bacterial conversion of conjugated bilirubin in the small intestine
Urobilinogen may be increased in patients with?
Increased turnover of heme (Hemolytic anemia), CHF with liver congestion, cirrhosis, viral hepatitis, drug induced hepatotoxicity
What would normal Bilirubin show?
Always conjugated Bilirubin
Normal: negative
What would abnormal bilirubin look like and what patient populations would it be increased in?
Abnormal would be positive.
It would be increased in patients with intrahepatic cholestasis and Post-hepatic obstruction
What are some causes of blood in the urine?
Trauma, stones, menstruation, cystitis, tumor, glomerulonephritis
If blood in the urine is positive, what happens?
Check RBC’s on microscopic exam
Hematuria= + blood, + intact RBC
Hemoglobinuria= + blood, - RBCs and may be due to lysed RBCs or myoglobinuria (rhabdomyolysis)
What is leukocyte esterase?
Estimate of pyuria (WBCs in urine)
Normal: Negative to trace
What are the causes of an abnormal Leukocyte esterase?
UTI, sterile pyuria, acute interstitial nephritis, inflammatory processes in the GU tratc, that may not necessarily have infection
Why is nitrite important in a UA?
Indirect indicator of UTI
Specific but not highly sensitive
Organisms (mostly gram-negative bacteria) convert nitrates to nitrite
Some staph species, E. coli, Klebsiella (knowing which, may help guide abx choice)
What are the normals and abnormals of nitrites on UA?
Normal is negative
Abnormal is positive
Causes: UTI w/ positive leukocyte esterase
Why is glucose important in a UA?
Filtered in the glomerulus but nearly completely reabsorbed in the proximal tubule
Serum glucose > about 180, will spill over into the urine and that is when we wil start to get positives on the dipstick
What are the normals and abnormals of glucose on UA?
Normal is negative
Abnormal is positive
What are some causes of glucose on UA?
Diabetes mellitus, renal tubular disease, some medications: IV dextrose administration, SGLT2i (treat diabetes, things like jiardiance, farciga)
What are the normals and abnormals of ketones on UA?
Normal: negative
Abnormal is positive and the derangement of carbohydrate metabolism. In association with + glucose is suggestive of uncontrolled DM (DKA)
What are some of the causes of abnormal ketone levels?
Pregnancy, carbohydrate free diet (Keto), starvation, febrile illness in children
Why is protein important on UA?
Primarily measuring albumin
What are the normals and abnormals of protein on UA?
Normal: Negative
Abnormal: Trace amounts
What are the causes of protein abnormals?
Intrinsic renal disease like glomerulonephritis, nephrotic syndrome, DM nephropathy, preeclampsia in pregnant women, and multiple myeloma
What are the expected UA outcomes for diabetes mellitus?
Positive glucose, negative ketones
What are the expected UA outcomes for DKA?
Positive glucose, Positive Ketones
What are the expected UA outcomes for starvation/low glucose diet?
Negative glucose, positive ketones
What are the expected UA outcomes for developing kidney disease?
Positive protein, later stages – specific gravity is about 1.01 repeatedly
What are the expected UA outcomes for ATN?
Positive muddy brown cast, plus or minus renal tubule cells
What are the expected UA outcomes for acute interstitial nephritis?
Positive WBCs, Positive WBC cast, positive leukcyte esterase, Negative nitrites, no bacteria
What are the expected UA outcomes for acute cystitis?
Positive WBC’s, positive leukocyte esterase, +/- nitrites, positive bacteria, +/- triple phosphate crystals
What are the expected UA outcomes for pyelonephritis?
Positive WBC, positive WBC clumps, positive bacteria, positive leukocyte esterase, +/- Nitrites, =/- WBC casts
What are the expected UA outcomes for glomeruloneprhitis?
Positive blood, positive RBC’s, positive dysmorphic RBC’s
What are the expected UA outcomes for cancer?
Positive blood, positive RBC, +/- cells
What are the expected UA outcomes for nephrolithiasis, ureterolithiasis, cystolithiasis?
Positive blood, positive RBC, no dysmorphic cells, +/- Crystals
What are the expected UA outcomes for hemolytic anemia?
Increased urobilinogen, no bilirubin
What are the expected UA outcomes for hepatocellular inflammation (hepatitis)?
Positive bilirubin, increased urobilinogen
What are the expected UA outcomes for biliary obstruction?
Positive bilirubin, low urobilinogen
What are the expected UA outcomes for rhabdomyolysis?
Positive blood, no RBC’s
What are the expected UA outcomes for nephortic syndrome ?
Positive protein
What are the expected UA outcomes for acidic urine?
Calcium oxalate, amorphous, uric acid crystals
What are the expected UA outcomes for alkaline urine?
Triple phosphate, ammonium biurate crystals
What is the indication for a urine culture?
Recurrent infections and treatment failure
Complicated UTI
Pregnancy
What are the common UTI micro-organisms?
2+ Organisms reported typically contamination
Either gram-positive or gram-negative
What are the common UTI gram-positive organisms?
Staph species
Enterococcus species (hygiene issues from GI tract)
What are the common gram-negative organisms?
Lactose fermenting
E. coli (most common)
Enterobacter (most common)
Klebsiella (more common in immunocompromised)
Non-lactose fermenting
Proteus
Pseudomonas
How long does it take to receive the report for a urine culture?
It can take up to 48 hours to get a urien culture back, so a lot of times we will need to treat the patient empirically and change abx as needed
What urine culture colony counts indicate infection?
> 100,000 CFU/mL = infection
10,000-100,000 CFU/mL = Possible infection
< 10,000 CFU/mL = No infection
CFU= colony forming units
What are the indications for a microalbumin?
Monitor for developing disease-typically diabetic nephropathy (especially in kids): Recommend that patient’s older than 12 with a diagnosis of diabetes mellitus receive an annual microalbumin testing
Monitor for response to treatment
What is the technique for a microalbumin?
Random urine specimen
What are the indications for a urine albumin/ Creatinine ratio (ACR)?
To quantify the amount of albuminuria present
Simply measuring albumin concentration and urine can be misleading (False positive or a false negative) as it is influenced by the volume of urine
What are the levels for a normal and abnormal ACR?
> 300 mg/g is likely significant albuminuria
What is the technique for an ACR?
random urine specimen
What are the indications for a urine protein/ Creatinine ratio (PCR)?
To quantify the amount of protein present
This is just a screening tool used to make adjustments of treatment
What is the technique for a PCR?
Random urine specimen
What are the abnormal values for a PCR?
> 3000 mg/day is nephrotic range
What is an important note about a urine PCR and urine ACR?
Urine PCR and urine ACR should be similar. If there is a significantly larger urine PCR than this is concerning for abnormal proteins in the blood. This could be indicative of diseases like multiple myeloma
What is the difference between microalbumin and ACR?
Microalbumin is more of a screening tool that is qualitative
ACR is more of a screening tool that is quantitative
What is the difference between ACR and PCR?
ACR: Measures only albumin. Quantifies albuminuria. Should be performed if microalbumin screen is positive
PCR: Measures all proteins. Quantifies all proteins. Should be performed at least once in work up of proteinuria to make sure no additional proteins present
One or the other should be performed at least yearly on pts with known proteinuria
What is the indication to do a 24 hour urine assessment?
Accurate assessment of proteinuria
Protein analysis (UPEP)
Accurate assessment of renal function (for CrCl)
Needs serum specimen collected at the time jug is returned
What are the abnoramls for urine sodium?
Low (<20 mEq/L)- Dehydration, kidney disease, or adrenal insufficiency
High (>220 mEq/L)- Diuretic use, salt losing nephropathy, hypernatremia
What are the causes for abnormal values of urine osmolality?
Clinical scenario must be taken into account
Patient comes in that hasn’t eaten in four days and has had nausea vomiting and diarrhea for that entire time
Normal for them should be on the higher end and the abnormal for them would be on the low to mid normal
If urine osmolality remains close to serum osmolality despite the clinical scenario that could have significant indications of CKD
What are the causes of abnormal serum osmolality?
High-Dehydration, hypernatremia, hyperglycemia, kidney disease, diabetes insipidus, certain medications
Low- Excessive water intake, hyponatremia, SIADH, Burns, certain meds
What is BUN?
Comes from protein waste products after metabolism in the liver
What is the normal range for BUN?
5-20 mg/dL
What is the normal range of creatinine?
0.5-1.3 mg/dL
Depends on the muscle mass of the patient
An increase in both BUN and creatinine is indicative of what?
Renal pathology
What are the indications for a creatinine clearance assessment (CrCl)?
To assess renal function
What is the technique for a creatinine clearance assessment (CrCl)?
Most accurate is 24 hour urine collection with serum creatinine
What are the notes for a creatinine clearance assessment (CrCl)?
Creatinine is found in skeletal muscle
Creatinine is a form of creatine that is targeted for removal by kidneys
Creatinine is produced at a relatively constant rate
How can the BUN and creatinine ratio help us determine the causes of acute kidney injury?
Can only use this test when both are elevated
Normal: 10:1 to 20:1
Abnormal:
> 20:1
Prerenal, acute post renal, intrarenal-GN
<15:1
Intrarenal-ATN, AIN, chronic post renal
When can we use the BUN and creatinine ratio diagnostically for AKI?
Can only use when both BUN and creatinine are elevated
What is the fractional excretion of sodium (FENa)?
Value < 1.0 = cause of AKI likely from underperfusion
Kidneys respond to decreased perfusion by conserving Na
Value > 2.0 = cause of AKI likely from tubular damage
Inability to conserve Na
What is eGFR?
Sum of the filtration rate of all functioning nephrons
Unable to measure a true GFR, closet equivalent is a 24 hr urine CrCl
Useful only in stable renal function
What are the indications for complements?
Done as part of AKI evaluation when etiology incertain.
Screens for and diagnoses hereditary deficiencies of complement peptides and monitors activity of autoimmune diseases like Lupus and severly type of nephritis
What is anti-neutrophilic cytoplasmic auto antibodies (ANCAs)?
DEFINITELY WANT THESE IF THERE IS BLOOD IN THE URINE
Associated w/ vasculitides which can lead to AKI
pANCA and cANCA
What are anti-glomerular basement membrane antibodies (Anti-GBM Ab)?
Indicative of autoimmune induced nephritis (Good pasture Syndrome)
Autoimmune disorder against the glomerular basement membrane
Pathognomonic triad: presence of circulating antibodies, glomeruloneprhitis (hematuria), and pulmonary hemorrhage (hemoptysis), maybe some proteinuria
What are the indications for serum protein electrophoresis (SPEP)?
Evaluation of kidney disease when etiology is unknown or uncertain
Evaluation with suspect of possible multiple myeloma (M-spike)
What is the technique for SPEP?
Blood draw
What are the indications for urine protein electrophoresis (UPEP)?
Evaluation of kidney disease when etiology is unknown or uncertain
Evaluation with suspect of possible multiple myeloma (M-spike)
What is the technique for UPEP?
24 hour urine collection
What could cause an increased BUN?
An increased BUN could be caused by AKI, CKD, G.I. bleed, steroid use, or a high protein diet/IV nutrition.
What is azotemia?
Azotemia is another term for increased BUN.
What could cause a decreased BUN?
A decreased BUN could be caused by severe liver disease.
What is creatinine?
Creatinine is a product of the breakdown of creatinine phosphate and is secreted by the kidneys.
When is creatinine elevated?
Creatinine is elevated when there are issues with the kidneys.
What are the indications of a kidney biopsy?
Diagnose cause of renal disease, evaluate possible malignancy if patient not a surgical candidate, evaluate transplant rejection.
What is the difference between SPEP and UPEP?
SPEP is a blood test and UPEP is a 24 hour urine test. Typically SPEP is done during initial screen and UPEP often done if SPEP + or high suspicion.
What are the indications for a stone analysis?
Nephrolithiasis: can help determine positive agent and aid inappropriate lifestyle modifications.
What is the technique for a stone analysis?
Stone sent to pathology: retrieved during cystography, collected after passage, surgically removed.
What are the notes for a stone analysis?
Most common stone type is calcium oxalate.
What are the indications for a stone panel?
Recurrent stone formation and to help determine factors that can be modified.
What is the technique for a stone panel?
24 hr urine collection.
What are the indications for labs for testosterone?
Evaluate ambiguous sex characteristics, precocious puberty, female virilizing syndrome (which may indicate issues like PCOS), male infertility.
What are the indications for labs for semen analysis?
Evaluate the quality of sperm for infertility eval, document the adequacy of vasectomy.
What are the indications for antispermatazoal antibody?
Infertility screening to detect antibodies against their own sperm. The presence of antibodies can result in diminished fertility.
What is Streptococcal Testing for AKI?
Includes antistreptolysin O (ASO), Anti-DNase (ADB), Streptococcus Group B antigen (Streptozyme)
What are the indications for an x-ray KUB?
Useful in visualizing calcifications along the urogenital system
What is the technique for an x-ray KUB?
AP, Supine
Borders: lateral abdominal wall, just above the kidneys, inferior pubic rami
What is an example of a normal KUB?
What is this pathology?
KUB
Kidney stone in the left kidney or ureter
What is this pathology?
KUB
Urethral stone, abnormal calcification causing obstruction of the pubic symphysis, right in line with where the urethral should be exiting
What is pyelography?
Aka pyelogram, having to do with the renal pelvis, so where the kidney concentrates urine
IVP vs retrograde vs antegrade
Less commonly used now if CT available.
X-ray with contrast to enhance renal system
What are the indications of pyelography?
Use when concerned for an obstructive process. Evaluation of urinary tract for proposed pelvic surgery, after trauma to the urinary system, or when concerned about urinary outlet obstruction
What kinds of things can we find with pyelography?
Ureteric obstruction
Upper tract tumor
Papillary necrosis (damage to the renal papules)
Anatomical variants
Course of ureters
What is an example of a normal IV pyelography (IVP)?
Contrast is passing through the renal pelvis and into the ureters
What is the pathology?
IVP
Abruptly stops in the right ureter and is indicative of an obstruction
What are the indications for a retrograde pyelogram?
Used to evaluate ureters and renal pelvis
Nonvisualization of ureteral segment on IVP or CT urography
Better characterization of ureteral or pelvicalyceal abnormalities seen on IVP or CTU
Contrast is never going to cross into the bloodstream
What are the techniques for a retrograde pyelogram?
The catheter is placed in the bladder and then in the ureter of interest. Water soluble iodinated contrast was given via catheter, but because it is not entering the blood vessels, we don’t have to worry too much about kidney issues. Multiple images obtained looking at areas of concern
What are some examples of normal retrograde pyelograms?
What is the test of choice for male GU imaging?
US is generally the imaging modality of choice. Evaluate masses- testicular cancer and hydrocele. Evaluate blood flow for testicular torsion (doppler studies).
What is an example of the male GU US?
This is a Doppler study where blue and red indicate blood flow on the left. On the right, the Doppler study does not have any blue or red highlights indicating testicular torsion.
What is cystoscopy?
Endoscopic evaluation of the urethra, bladder, and ureters.
What are the indications for cystoscopy?
Suspected pathology of GU tract, hematuria, recurrent UTI, and a variety of GU complaints. Can be used to obtain biopsy and can be diagnostic and therapeutic.
How can cystoscopy be diagnostic?
Direct visualization, identify stone location, identify the source of hematuria.
How can cystoscopy be therapeutic?
Stone retrieval (UPJ or urethra pelvic junction), removal or treatment of small bladder tumors, dilatation of urethra or ureters, placement of stents (lithotripsy to break up the stone).
What is urodynamics?
A series of tests to evaluate bladder function.
What are the indications of urodynamics?
Frequent UTIs, incontinence, overactive bladder, urinary retention.
What are the findings of urodynamics?
Degree of retention, sensation of bladder fullness, bladder compliance and pressures, urine stream pressure and flow.
What are the contraindications of urodynamics?
Active UTI, can affect the result and has a risk of introducing or causing an infection.
What are the complications of urodynamics?
Active UTI, can affect the result and has a risk of introducing or causing an infection.
What is Post-void residual?
Measurement of how much urine is in the bladder, before and after micturition. Pre and post-void management should be less than 50 ml.
What are the diagnostic criteria for bladder cancer?
Diagnostic via cystoscopy w/ biopsy +/- cytology. No dx serum marker available- some markers such as CEA can be elevated but are not specific enough to be considered diagnostic.
What is the dx test for prostate cancer?
Prostate-specific antigen (PSA) (total, bound or unbound).
What are the indications for prostate cancer?
Screening for early detection of prostate cancer, monitoring response to therapy and for recurrence.
What are the notes for prostate cancer?
Elevation is associated with prostate cancer but not specific.
< 4.0 cancer is less likely
> 10.0 cancer is likely
4-10 can be cancer but could also represent: BPH or prostatitis.
Collect PSA antigen before doing what?
A digital rectal exam.
What does the USPSTF recommend as screenings for prostate cancer?
Age 55-69 screen those who wish to undergo screening. Shared decision after discussion of risk/benefit. Benefit-small potential benefit of reducing the chance of death from prostate cancer. Risk-false positive. Further required evaluation. Possible need for biopsy. Age > 70 years old- do not screen. Currently under review.
What are the newer tests for prostate cancer?
Free PSA and Free/Total PSA Ratio, Prostate Health Index (PHI). If PSA or PHI are elevated, need additional imaging and biopsy.
What is a Free PSA and Free/Total PSA Ratio in relation to cancer?
Free PSA is decreased in cancer.
What is the technique for a prostate and rectal US?
Local in office (urology) vs sedation in OR. 10-12 specimens obtained to be accurate.
What are the indications for a ProstaScint Scan?
Staging of prostate cancer.
What is the technique for a ProstaScint Scan?
Nuclear medicine study. Uses radioactive tracers that is taken up by prostate cancer cells.
What are the notes for a ProstaScint Scan?
Not a screening test. It is just looking for the extent of the metastatic disease.
What is a cystography?
Aka voiding cystography (VCUG)
What are the indications of cystography?
Evaluation of the bladder.
Examples: recurrent UTI, dysuria, dysfunctional vomiting, hydronephrosis/hydroureter, hematuria, trauma that is not acute, neurogenic dysfunction of bladder, congenital anomalies of GU tract, post-op eval of GU tract.
What is normal cystography?
Bladder looks full and we can still see the catheter in place.
What is cystography pathology?
Vesicoureteral reflux. Contrast went backwards while the catheter was still in place. Causes: overgrowth of this area, trauma, muscular issue.
What are the different types of CT?
CT Abd/Pelvis without contrast, CT Abd/Pelvis with contrast, CT Urography, CT Angiography.
What is CT Abd/Pelvis without contrast used for?
Nephrolithiasis/ureterolithiasis (don’t want to use contrast, because it may mask or hide the stone).
What is CT Abd/Pelvis with contrast used for?
Masses or lesions of GU tract.
What is CT Urography?
Renal study with triple phase: w/o contrast, with contrast in the nephrins, with contrast in the renal pelvis/ureters.
What is CT Angiography used for?
Renal artery stenosis.
What is the pathology observed in the CT Abd/Pelvis with contrast?
The right kidney has renal cell carcinoma sitting in the cortex, indicated by changes in color and shape.
What does the CT Angiography reveal?
The left renal artery is extremely constricted, which may indicate stenosis. This can provide measurements for further evaluation with renal artery Doppler ultrasound.
What pathology is indicated by the kidneys not being symmetric after contrast?
This is severe pyelonephritis. The left kidney tissue is inflamed and swollen, not taking up contrast as expected.
What is pathology?
presence of fluid-filled cysts on the kidneys. This may indicate autosomal dominant kidney disease or polycystic kidney disease, characterized by hundreds or thousands of cysts, leading to enlarged, lumpy kidneys.
What is this pathology?
A horseshoe kidney is a congenital condition where the kidneys are fused together at the lower end.
What is this pathology?
An abnormal rengogram shows a patient before and after receiving a tracer. The left kidney appears to get darker, indicating good function, while the right kidney shows little change. The tracer is excreted into the bladder.
What does a normal renal ultrasound show?
A normal renal ultrasound shows the kidney’s position, sizes, ureters, and hydronephrosis. It may also include a bladder ultrasound to check post-void residual.
What are the indications for an MRI?
Indications for an MRI include evaluation of masses and for patients who cannot have iodinated contrast due to allergy.
What is a major concern when using MRI on certain patients?
Patients with renal impairment should not receive IV gadolinium contrast for MRI due to the risk of nephrogenic systemic fibrosis, a rare but painful condition.
What is an ultrasound (US)?
An ultrasound is a safe imaging technique that does not use contrast and is the study of choice for general GU evaluation, except for kidney stones.
What are the indications for an ultrasound?
Indications for an ultrasound include flank pain, hematuria, UTI concerns, AKI/CKD evaluation, congenital abnormalities, cysts or masses detection, post-op evaluation, and renal artery stenosis assessment.
