INVESTIGATIONS - renal Flashcards
Choice of imaging for definitive diagnosis of renal calculi?
Non-contrast CT
First line imaging for renal colic?
KUB x-ray
Imaging choice for calculi in pregnancy?
Ultrasound or MRI
A 60 year old patient presents with macroscopic haematuria. What imaging modality would you choose to examine the kidneys and ureters?
CT urogram (with contrast)
A 60 year old patient presents with macroscopic haematuria. What imaging modality would you choose to examine the bladder and urethra?
Cystography
A 40 year old patient presents with macroscopic haematuria. What imaging modality would you choose?
Ultrasound (to detect calculi and renal parenchymal tumours)
or cystoscopy to look for occasional bladder tumours or calculi, or evidence of prostatitis
What would warrant CT urgraphy in a patient <50?
Persistent macroscopic haematuria with normal ultrasound and normal cystoscopy
How do most renal masses present?
Incidental finding
What imaging modality is used to asses size, density and internal morphology of renal masses?
CT
What kind of renal mass may be diagnosed with ultrasound alone?
Simple cyst
What’s the choice of imaging for staging malignant renal tumours?
CT
What types of imaging are used to examine the renal collecting ducts?
IV urogram (i.e. x-ray KUB with contrast) CT urogram (with contrast)
What type of imaging is used to assess renal pre-renal renal impairment e.g. artery stenosis?
MR (or CT) angiography
In a patient with post-renal impairment (i.e. obstruction), what type of imaging would you choose to exclude hydronephrosis?
Ultrasound
In a patient with renal impairment due to ureteric obstruction, what type of imaging would you choose to establish the cause of obstruction?
CT
What imaging modality would you choose to investigate a painful scrotum or scrotal swelling?
Ultrasound
What imaging modality would you use to asses renal trauma / injury?
CT
What imaging modality would you use to asses ureteric injury in trauma?
CT
What imaging modality would you use to asses bladder injury / trauma?
Contrast cystography
+/- CT
What would you do if urethral injury was suspected?
Call a urologist. Contrast and urethrogram needed.
How would you investigate a patient with renal impairment due to parenchymal disease, drugs or toxins?
US guided biopsy
Give a possible cause of hypervascular testis / epididymis on ultrasound?
Epididymo-orchitis
How would testicular torsion appear on ultrasound?
avascular
If a patient presents with renal impairment and positive antibodies, what should be done next?
Renal biopsy
Give three indications for renal biopsy in AKI
Positive immunology (ANA, ANCA, GBM) Renal cause (e.g. drugs, parenchymal disease, toxins) Current management not working
A patient has high calcium, low Hb and Bence Jones proteins present.
What’s the likely diagnosis?
Myeloma
What size should a healthy kidney be on ultrasound?
10-12 cm
ECG findings in hyperkalaemia?
Tall T waves
Broad QRS
Lost P wave
Bradycardia
What would you find on investigation of a patient with nephrotic syndrome?
Proteinuria
Lipiduria
Hypoalbuminaemia (due to loss in urine)
Hypercholesterolaemia (liver trying to compensate)
Oedema (decreased intravascular oncotic pressure)
What type of cell has been damaged if there’s protein (but no RBCs) in the urine?
Podocytes
What type of cell has been damaged if there’s red cells in the urine?
mesangial or endothelial cells
What’s the definitive investigative test for glomerulonephritis?
Renal biopsy
What’s the trademark histological finding of diabetic glomerulosclerosis?
Kimmelstiel-wilson nodules
round eosinophilic nodules
What do epithelial crescents on histology suggest?
Severe glomerular damage (e.g. rapidly progressive glomerulonephritis)
First line imaging in suspected PCKD?
Ultrasound
CT / MRI if US is unclear
