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SAS scs RUSVM > Kidney and Ureters (E1) > Flashcards

Kidney and Ureters (E1) Flashcards

1
Q

What is the arterial supply of the kidney? Venous?

A

Renal artery (arises form aorta between cranial and caudal mesenteric A’s) then BRANCHES into dorsal and ventral at hilus (sometimes more than 1 renal A on left side)

Renal vein (empty into caudal vena cava)

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2
Q

What are the most common nephroliths?

A

Most common: Calcium oxalate

2nd: Struvite

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3
Q

What clinical signs are associated with nephroliths?

A

Can be absent or non specific

Depression

Anorexia

Hematuria

Pain

(Uremia, Hydronephrosis)

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4
Q

How are nephroliths diagnosed?

A

Survey rads

Ultrasound

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5
Q

What parameters are used to determine the best management for nephroliths?

A

Type of calculi

Anatomical location

Clinical effects

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6
Q

When is surgery for nephroliths indicated? What is indicated before surgery (tests/examinations)?

A

Sx indicated if OBSTRUCTED or INFECTION (pyelonephritis) associated with the calculi is present

Prior to surgery: Check renal function - excretory urography, GFR, Ultrasound

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7
Q

A ______ is the excision of the kidney. A ________ is a surgical incision into the kidney. A _______ is th creation of a permanent fistula leading to the renal pelvis.

A

NephrECTOMY - Excision

NephrOTOMY - incision (cuT)

NephroSTOMY - fiSTula

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8
Q

What techniques can be used to perform a renal biopsy?

A
  1. Blind percutaneous

2. Percutaneous, US guided (PREFERRED)

  1. Laproscopic
  2. Keyhole abdominal incision
  3. Wedge or incisional (via ventral midline ceiliotomy) (most diagnostic, requires vessel occlusion)

(Best if using spring-loaded biopsy needle (Monopty biopsy needle) or biopsy gun, manual devices (e.g. Tru-Cut) not as good b/c can produce fragmented samples)

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9
Q

What type of incision do you make to perform a nephrolithotomy? What organs must you retract to visualize the kidneys?

A

Ventral midline celiotomy

Mesocolon (left) or mesoduodenum (right)

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10
Q

To isolate the renal vessels, what will you need to dissect?

A

Retroperitoneal fat

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11
Q

When performing a nephrolithotomy, what instruments can you use to occlude the renal vessels? How long can they remain occluded?

A

Rumel Tourniquet (red rubber catheter, umbilical tape and hemostat)

Bulldog vascular clamps (very atraumatic if placed gently)

Satinsky clamp

20 minutes

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12
Q

When performing a nephrolithotomy, what type of incision do you make to open the kidney? How do you close the surgical site?

A

Sagittal

Suture-less closure (hold for 5 minutes, then suture only the capsule) or

Horizontal mattress (Use absorbable suture like PDS or Vicryl)

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13
Q

When performing a nephrolithotomy, after removing the stone, what do you do next (3 things)?

A

Culture the renal pelvis

Flush the pelvis/ureter with heparinized saline

Catheterize the ureter to ensure patency

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14
Q

What are the advantages of pyelolithotomy over a nephrolithotomy? When is a pyelolithotomy indicated?

A

Does not require occulusion of the blood supply

Does not damage nephrons

Indicated when the calculi are in the renal pelvis and the pelvis and the proximal ureter(s) are dilated

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15
Q

What are the what are the treatment options for nephroliths (2 options for asymptomatic, 2 options for symptomatic)? Give advantages and disadvantages for each.

A

If the patient is asymptomatic:

  1. Monitor renal function/renal imaging

(+) No iatrogenic damage from meds or sx

(-) Disease may progress

  1. Medical mgmt

(+) No damage from surgery, no anesthesia

(-) Medication side effects, may eventually need sx anyway

If symptomatic:

  1. Surgery to remove stones

(+) Definitively removes the stone(s)

(-) Surgery causes nephron/kidney damage

  1. Lithotripsy

(+) Shock waves break up stone(s) into pieces small enough to void, so avoid surgery

(-) Pieces may get stuck in and damage or occlude ureters/urethra, can damage kidney, not readily available

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16
Q

What type of incision do you make in the kidney for a pyelolithotomy?

A

Longitudinal

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17
Q

What is the post-op management of a nephrolithotomy (what procedures, tests and treatments)?

A

Post-op rads (for calculi)

Monitor: PCV, CVP (hydration), urine output, renal enzymes and e-lytes

Provide diuresis (to maintain perfusion and minimize clot formation)

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18
Q

How can you diagnose renal trauma (3 ways)?

A

Contrast excretory urography

US

Exploratory sx

(Clinically, may have hematuria)

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19
Q

How would you treat/manage minor renal trauma? What is considered moderate trauma and how would you treat/manage it? What about major trauma?

A

Minor: Conservative treatment

Moderate: Capsular tears, extravasated fluid

Tx- Repair w/Sx, use hemostatic agents, Omental patching

Major: Severe parenchymal or vascular damage

Tx- Repair with Partial nephrectomy or Nephroureterectomy

20
Q

What are the indication for performing a nephroureterectomy?

A

Severe infection

Severe trauma

Obstructive calculi w/persistent hydronephrosis

Neoplasia

Transplant

21
Q

Although it is infrequently performed, when would you chose a partial nephrectomy? What are the advantages and disadvantaged vs a nephroureterectomy?

A

If the other kidney is compromised (decreased GFR), trauma or neoplasia is focal

(+) Preserves renal function

(-) Technically more difficult, higher incidence of post-op hemorrhage

22
Q

In a partial nephrectomy, do you ligate the vessels together or separately? Where do you separate and ligate the ureter?

A

Separately

At vesicoureteral junction

23
Q

What are the clinical signs associated with hydronephrosis, uni and bilateral? How is it diagnosed? How is it managed? What is the prognosis if the obstruction is <1 week? >4 weeks?

A

CS (unilateral): abdominal distention, palpable mass

CS (bilateral): severe azotemia, death

Dx: Abdominal rads, Excretory urogram, US

Mgmt: Eliminate cause, evaluate function; if non-functional or severely damaged parenchyma then SX- Nephroureterectomy

Prognosis <1week: complete resolution

>4weeks: MAY regain 25%

24
Q

What are the clinical signs associated with pyelonephrosis? What are possible causes? How is it diagnosed? How is it managed?

A

CS: PUPD, lethargy, depression, fever, and anorexia

Causes: Complication of obstructive uropathy, ascending infection, hematogenous, post-parenchymal damage (can predispose)

Dx: US and IV pyelography

Mgmt: Nephrouretectomy if advanced

25
Q

What are the clinical signs associated with the giant kidney worm (Dictophyma renale)? How is it diagnosed? How is it managed?

A

CS: Can be asymptomatic, or same as renal failure (due to worm causing parenchymal damage), vomiting when L3 penetrate stomach

Dx: Often on necropsy, exploratory sx, possibly see eggs in urine (urine sedimentation)

Mgmt: Nehrouretectomy, Nephrotomy

(Fun fact, usually affects RIGHT kidney or found in peritoneal cavity)

26
Q

What is the most common benign kidney tumor in dogs and cats? Most common malignant kidney tumor? How are these tumors managed?

A

Benign: Renal adenoma

Malignant (more common): Renal cell carcinoma (dogs), Renal lymphoma (cats)

RCC: (Unilateral) nephrouretectomy and chemo, Exploratory laparotomy for metastatic lesions and biopsy (best method for biopsy)

Lymphoma: Usually not Sx unless tumor itself is causing an issue (e.g. obstruction), chemo

27
Q

What do you call rapidly developing, malignant mixed tumors that arise from embryonal elements of the kidney? What is the typical signalment? How is it managed?

A

Nephroblastoma

Young dogs and cats

Mgmt- if unilateral Nephrouretectomy, if bilateral could consider Partial nephrectomy (Nephron sparing sx); Chemo can be attempted

(Note: Metastasis VERY common, MST= 6 mo)

28
Q

What are the clinical signs of renal neoplasia? How is it diagnosed?

A

CS (depend on type, size and location): hematuria (most common), abdominal distention, anorexia, weight loss, depression, abdominal pain

Dx -Best = IV Urography; abdominal palpation, abdominlal rads, US, CT, MRI

29
Q

What parameters are used to determine if a renal biopsy is indicated? What are contraindications? What are the risks of performing this procedure?

A

Suspected neoplasia

Nephrotic syndrome

Renal cortex disease

Non-diagnosed ARF

(Only perform if benefits outway risks)

C/O’s: coagulopathy (can cause fatal hemorrhage), hypertension, severe chronic hydronephrosis

Risks: Hemorrhage, Blood clot formation (can cause ureteral obstruction which can cause hydronephrosis)

30
Q

What are indications for a feline renal transplant? Contraindications?

A

Irreversible ARF

Decompensated CRF

PKD

C/O’s: viral positive (FeLV, FIV), cardiac disease, neoplasia, fractious

31
Q

What screening parameters are used to assess feline renal transplant candidates? What are some special considerations that must be made/owners must be made aware of? What is the prognosis post-transplant?

A

Screening: CBC/chem, U/A and culture, abdominal rads, US, Echo, test for FeLV, FIV, and Toxo

Considerations: Very expensive, many vet visits, lifelong immunosupression, owner must adopt donor cat too

Prognosis: 613 days (23% do not survive to discharge)

#1 complication is acute rejection

32
Q

Which breeds are predisposed to ectopic ureter? Is it more common in males or females? Young or old?

A

Siberian

Huskies

Labrador/Golden Retrievers

WHWTs

Females

Young

33
Q

What clinical signs are associated with ectopic ureter?

A

Incontinence (most common)

Failure to house-break

UTIs

Urine scalding

34
Q

What are the classifications of ectopic ureter and what do they mean? Which is more common?

A

Extramural: Enters and exists in the wrong place; Ureter bypasses the bladder to enter urethral lumen; enters into neck, urethra, or vagina

Intramural: Enters normally but exits abnormally, it extends submucosally within the bladder wall before entering the uretheral lumen

Intramural is most common in dogs (Bilateral ectopic ureters are also common)

35
Q

How do you diagnose and classify ectopic ureter?

A

Excretory urography

+/- Fluoroscopy

(Can do Pneumocystography first)

Cystoscopy (most reliable, sensitive and specific)

36
Q

How do you treat extramural ectopic ureters? Intramural? What is the prognosis post-treatment?

A

Surgery- Neouretercystostomy (Extra and Intramural)

Cystoscopic Laser treatment (INTRAmural)

Prognosis: 60% incontinence improves, 90% improvement when add meds (PPA); other functional abnormalities may still exist (remember, congenital anomalies usually don’t show up alone)

37
Q

What is an ureterocele? What are the 2 types of ureteroceles? What are the clinical signs?

A

Definition: Dilation (‘Ballooning’) of the distal ureter where it opens into the bladder, due to a persistent embryonic membrane

Intravesicular

Ectopic

CS: UTI, incontinence, azotemia if obstructed

38
Q

How are ureteroceles diagnosed and what specifically are you looking for? How are they treated?

A

IV urography to look for the “Cobra head sign”, US

Intravesicular: Ureterocelectomy (removal of ureterocele)

Ectopic: Neoureterocystostomy with ureterocelectomy (remove ureterocele and re-transplant ureter to normal position)

39
Q

What are the causes of ureteral trauma? How is it diagnosed?

A

Main cause is IATROGENIC

Also blunt trauma and obstruction

Dx: Presence of uroretroperitoneum/ uroabdomen, Rads, IV UROGRAPHY (localizes lesion)

40
Q

What are the criteria fro treating ureteral trauma? What are the treatment options (include advantages and disadvantages of each)?

A

Time, location, severity

If have normal contralateral function, can remove the entire affected kidney and ureter (cheaper, easier sx, but not ideal because removing the kidney)

Nephroureterectomy

(+) Minimizes complications

(-) Expensive

Ureteroureterostomy/ ureteral anastomosis (procedure of choice for proximal ureter)

(+) Only option for proximal ureter because cannot reimplant

(-) Special requirements (magnification), very difficult, complications common (strictures, dehiscence)

Neoureterocystotomy / ureteral reimplantation

(+) Good for cats

41
Q

What are the 2 methods are available for urinary diversion after ureteral surgery?

A

Ureteral stent

Nephrostomy tube

42
Q

What procedures can be used if you have loss of length of the distal or proximal ureter?

A

Renal descensus (suture kidney to lumbar musculature)

Nephrocystopexy (suture kidney to cranial edge of bladder)

Psoas hitch (suture bladder craniodorsally to psoas minor)

Transureteroureterostomy (connects ureters to each other across midline)

For DISTAL ureter: Bladder wall flap

43
Q

What are the clinical signs of ureterolithiasis? How is it diagnosed?

A

CS: Asymptomatic UTI, hematuria, anorexia, lethargy, pain (primarily occurs in CATS)

Dx: Rads (most are CaOx), US (also see dilation of ureter/pelvis)

44
Q

What are the non-surgical treatment options for ureterolithiasis? What are the indications for surgery?

A

Tx’s: IVF Diuretics Smooth muscle relaxers (Prazosin)

Sx indications: Completely obstructed, Azotemia, Pyelonephrotis, 2 weeks of unsuccessful medical treatment

45
Q

What surgical procedures are done for ureterolithiasis?

A

Cystotomy and retrograde flushing followed by removal via Pyelithotomy

Ureterotomy followed by Nephrostomy drainage

46
Q

What are the indications for permanent ureteral stenting?What are the advantages and disadvantages?

A

Indications: Stone, Tumor, Stricture, Blood clot

(+) Decreased morbidity, shorter hospitalization, less complications

(-) Specialized equipment, steep learning curve

SAS scs RUSVM (24 decks)

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