kidney surgery Flashcards
what is the arterial and venous supply of the kidneys?
renal artery and renal vein
what are the most common nephroliths ?
calcium oxalate - most common and struvite
what clinical signs are seen with nephroliths?
they may be absent or non-specific like depression, anorexia, hematuria, pain
how do you diagnose nephroliths ?
- radiographs
- ultrasound
what parameters do you use to determine the best management for nephroliths?
- type of calculi
- location
- clinical effects
when is surgery for nephroliths indicated ?
- obstruction
- infection from the calculi
- peristent pain or hematuria
what are some treatment options for nephroliths?
- nephrolithotomy
- pyelollithotomy
- lithotripsy (shock waves)
what are the advantages and disadvantages of pyelolithotomy ?
- no occlusion of blood supply
- no nephron damage
what is pyelolithotomy ?
when calculi is in the renal pelvis and dilated
how do you close a nephrolitotomy?
- sutureless closure to form a fibrin seal
- then suture the capsule only
what instruments can you use in a nephrolithotomy to occlude the renal vessels?
- bulldog vascular clamp
- rumel torniquet
how long can you occlude the renal vessels for during a nephrolitotomy ?
20 minutes
what is the post operative management of nephrolithotomy ?
- post op rads to check for calculi
- monitor renal enzymes/electrolytes
- monitor urine output
- provide diuresis
how do you diagnose renal trauma?
- contrast excretory urography
- ultrasound
- exploratory
how do you treat renal trauma?
- minor cases: conservative treatment
- moderate cases: surgery to repair like omental patching
- major trauma: partial nephrectomy or nephroureterectomy
when would you use a nephroureterectomy in cases of renal trauma?
when there is severe parenchymal or vascular damage
what is hydronephrosis ?
progessive dilation of the renal pelvis and atrophy of renal parenchyma
what are the two ways of acquiring hydronephrosis and examples?
- acquired: neoplasia, cyst, stone
- congenital: torsion, stenosis, atresia
what are the clinical signs of hydronephrosis?
unilateral - abdominal distention and palpable mass
bilateral - severe azotemia and death
how do you diagnose hydronephrosis?
- abdominal rads
- excretory urogram
- ultrasound
how do you treat hydronephrosis?
- eliminate cause
- nephroureterectomy
what is the giant kidney worm called?
dioctophyma renale
what is the most common kidney neoplasia of dog ?
renal cell carcinoma
what is the most common kidney neoplasia of the cat?
lymphoma
what is the most common benign kidney tumor?
renal adenoma
is xray or ultrasound better at diagnosing kidney neoplasia?
ultrasound
what is the treatment for renal cell carcinoma?
nephroureterectomy and chemotherapy
what is the treatment for renal lymphoma ?
surgery is often not indicated
what is nephroblastoma?
congenital neoplasia in the developing kidney
what kind of patient is nephroblastoma more common in?
young dogs and cats
what is the treatment for nephroblastoma?
unilateral nephroureterectomy
when would you perform a partial nephrectomy over a nephroureterectomy?
when the other kidney isn’t working well
what are the disadvantages of a partial nephrectomy ?
- higher incidence of bleeding
- more difficult to perform
what are the indications of performing a nephroureterectomy?
- severe infection
- severe trauma
- obstructive calculi with persistent hydronephrosis
- neoplasia
when is a renal biopsy indicated?
- suspected neoplasia
- nephrotic syndrome
- renal cortex disease
how big should the sample size be for a renal biopsy?
at least 6 glomeruli
what techniques can be used for renal biopsy?
- percutaneous
- ultrasound guided
- keyhole
- laparoscopic assisted
