L62 Flashcards
Uses of XR for kidney
Calcification - UT stones
Bony structures
Gas
What is IV urography
XR after IV injection of contrast -> circulates to kidneys -> filtered + excreted
No longer used b/c CT
What are your 3 major concerns with giving contrast
Nephrotoxic
Allergy
Risk of death
How do you do antegrade pyelography?
Percutaneous needle into kidney - inject contrast - XRs
See collecting system only
Pro - do drainage
How do you do retrograde pyelography?
Inject contrast retrograde from the bladder -> ureters
XR
Less invasive than anterograde
3 reasons you do retrograde pyelography?
Stones
Tumors
Strictures
What do you see with US?
Renal cortex
Medullary pyramids
Sinus fat
Vessels
Uses of US
Acute + chronic renal failure Obstruction r/o Masses + cysts (stone -> hydronephrosis) Calculi Recurrent UTI Renovasc HTN
Pros US
Cheap
No radiation
Real time
Vasc evaluation
US limitations
Can’t see normal collecting system - see dilated collecting duct only
Not greater for ureter obstruction
Bad if obese, bowel gas, bone
CT uses
Renal colic/pain Hematuria Eval masses/vessels Cancer staging Infection
CT pros
See a lot // versatile
High res
CT cons
Radiation
$$
Contrast: allergy // nephrotox
Use MRI
Dx renal masses
Stage cancer
Tissue characterization: fat, blood products, fluid
Pros MRI
High contrast resolution/versatile
Cons MRI
$ / availability
Claustrophobia
CIs: pacemakers, metal (jts), renal failure
How do you do angiography? What do you see?
Inject contrast into arteries
See arteries, veins, renal parenchyma and collecting system
Use angiography
NOT 1st LINE Dx renal art stenosis + vasculitis Treat arterial steonsis (since you already have arterial access) - Stent - Embolize bleeding vessels
Cons angiography
Invasive
Radiation
Contrast: allergy + nephrotox
What is nuclear scintigraphy?
+ radioactive isotope to molecule metabolized and excreted by kidney
DET FXN
L flank pain sharp + intermittent, radiates to groin, gross hematuria w/o fever chills
- Dx
- Scan
Renal stone
LOW DOSE CT > XR b/c get all stones, even those not radio-opaque
What is the cut off for allowing a stone to pass on own?
5 cm
But location influences therapy - pts of anatomic narrowing
Scan for stones in kids + pregnant women
US… duh
L flank pain + fever, h/o drug use + HIV
- Dx
- Scan
- Treat
Abscess/infection
Treat: percutaneous drainage + antibiotics
US or CT
What is a UTI of the upper vs lower urinary tract
Upper UTI: pyelonephritis
Lower UTI: cystitis
Do you image UTI?
No - clinical dx
Image if not responding to treatment
What is emphysematous pyelonephritis?
Infection due to bug that causes gas forming infection
Best imaging for dx and staging
CT/MR
What is the imaging work up for hematuria?
CYTOSCOPY for all - CT urogram
Do you image pre, renal, or post-renal causes of renal failure?
Post only - bladder obstruction
US or CT non-con
