Kidney Flashcards
What is the most common type of nephrolith?
Ca oxalate
What are the clinical signs of nephrolithiasis?
- can be absent
- depression, anorexia, hematuria, pain
How is nephrolithiasis diagnosed?
- radiographs
- ultrasound
When is surgery indicated for nephrolithiasis?
- obstruction
- infection associated with the calculi
Describe a nephrolithotomy
- ventral midline celiotomy
- retract mesocolon
- isolate and temporarily occlude vessels
- mobilized kidney
- make sagittal incision and remove stone
- flush pelvis/ureter
- catheterize ureter
- close
What are the closure options for a nephrolithotomy?
- sutureless closure (hold for 5 minutes to form fibrin seal, suture capsule only)
- horizontal mattress
- nephropexy
How long can you clamp tissue/vessels before damage occurs?
20 minutes
When is a pyelolithotomy done?
to remove calculi when proximal ureter and renal pelvis are dilated
What are the advantages of doing a pyelolithotomy?
- does not require occlusion of blood supply
- does not damage nephrons
How is renal trauma diagnosed?
- contrast excretory urography
- ultrasound
- exploratory
What are the indications for a nephroureterectomy?
- severe infection or trauma
- obstructive calculi with persistent hydronephrosis
- neoplasia
- transplant
Describe the nephroureterectomy technique
- mobilize the kidney from attachments
- identify vessels and ligate separately
- separate and ligate ureter at vesicoureteral junction
Why would a partial nephrectomy be indicated?
when there is compromised GFR in the other kidney
Describe the partial nephrectomy procedure
- occlude blood supply
- incise and peel back capsule
- pass suture with straight needle
- divide into thirds and tighten
- close capsule
What is hydronephrosis?
progressive dilatation of the renal pelvis and atrophy of the renal parenchyma
What are the clinical signs of hydronephrosis?
unilateral - abdominal distention, palpable mass
bilateral - severe azotemia, death
How is hydronephrosis diagnosed?
- abdominal radiographs
- excretory urogram
- ultrasound
How is hydronephrosis treated?
- eliminate cause
- if non-functional or severe damage: nephroureterectomy
What is pyelonephritis?
a complication of obstructive uropathy
- ascending hematogenous infection
What is the name of the giant kidney worm?
How is it treated?
- Dictophyma renale
- neproureterectomy or nephrotomy
What is the most common benign renal neoplasm?
renal adenoma
What is the most common malignant renal neoplasm in dogs?
renal cell carcinoma
What is the most common renal neoplasm in cats?
renal lymphoma
What is a nephroblastoma?
- a congenital neoplasia associated with hypertrophic osteopathy
- arises from embryonic tissue
What are the clinical signs associated with renal neoplasia?
- hematuria
- abdominal distension
- anorexia, weight loss
- depression
- abdominal pain
How is renal neoplasia diagnosed?
- abdominal palpation
- abdominal radiographs
- ultrasound
- IV urography, CT, MRI
How is renal neoplasia generally treated?
- exploratory laparotomy
- unilateral nephroureterectomy
What are the indications for a renal biopsy?
- suspected neoplasia
- nephrotic syndrome
- renal cortex disease
- non-diagnosed ARF
What are the contraindications for a renal biopsy?
- coagulopathies
- hypertension (risk of hemorrhage)
- severe chronic hydronephrosis
Describe the percutaneous approach to a kidney biopsy
- for small dogs and cats (can palpate kidneys well)
- secure kidney against abdominal wall
- blind technique
Describe the ultrasound guided approach to a kidney biopsy
- preferred method
- advance needle into prepared area
- penetrate capsule
Describe the keyhole approach to a kidney biopsy
- modified surgical flank approach
- secure kidney to incision
Describe the laparoscopic approach to a kidney biopsy
- forceps hold kidney
- needle placement through skin incision
Describe the wedge or incisional approach to a kidney biopsy
- ventral midline celiotomy
- occlude renal vessels
- crescent shaped sample
- close with mattress suture
What are possible complications with kidney biopsy?
- severe hemorrhage (hypertension, NSAID within 5 days, coagulopathy)
- hematuria (resolves)
- hydronephrosis
What are the indications for a renal transplant?
- irreversible acute renal failure
- decompensated chronic renal failure
- polycystic disease
How is an animal screened for a renal transplant?
- CBC/Chem (PCV 30%, BUN < 8)
- urinalysis and culture
- ab radiographs, US, echo
- FeLV, FIV, toxoplasmosis
Under what conditions would a patient be rejected for renal transplant?
- viral positive
- cardiac disease
- neoplasia
- fractious
What is done pre-op for a renal transplant?
- dialysis
- erythropoietin
- immunosuppression
What are possible complications for a renal transplant?
- acute rejection
- infection
- chronic rejection
