L62

Question 1

Uses of XR for kidney

Answer 1

Calcification - UT stones
Bony structures
Gas

Question 2

What is IV urography

Answer 2

XR after IV injection of contrast -> circulates to kidneys -> filtered + excreted
No longer used b/c CT

Question 3

What are your 3 major concerns with giving contrast

Answer 3

Nephrotoxic
Allergy
Risk of death

Question 4

How do you do antegrade pyelography?

Answer 4

Percutaneous needle into kidney - inject contrast - XRs
See collecting system only
Pro - do drainage

Question 5

How do you do retrograde pyelography?

Answer 5

Inject contrast retrograde from the bladder -> ureters
XR
Less invasive than anterograde

Question 6

3 reasons you do retrograde pyelography?

Answer 6

Stones
Tumors
Strictures

Question 7

What do you see with US?

Answer 7

Renal cortex
Medullary pyramids
Sinus fat
Vessels

Question 8

Uses of US

Answer 8

Acute + chronic renal failure 
Obstruction r/o
Masses + cysts (stone -> hydronephrosis)
Calculi
Recurrent UTI
Renovasc HTN

Question 9

Pros US

Answer 9

Cheap
No radiation
Real time
Vasc evaluation

Question 10

US limitations

Answer 10

Can’t see normal collecting system - see dilated collecting duct only
Not greater for ureter obstruction
Bad if obese, bowel gas, bone

Question 11

CT uses

Answer 11

Renal colic/pain
Hematuria
Eval masses/vessels
Cancer staging 
Infection

Question 12

CT pros

Answer 12

See a lot // versatile

High res

Question 13

CT cons

Answer 13

Radiation
$$
Contrast: allergy // nephrotox

Question 14

Use MRI

Answer 14

Dx renal masses
Stage cancer
Tissue characterization: fat, blood products, fluid

Question 15

Pros MRI

Answer 15

High contrast resolution/versatile

Question 16

Cons MRI

Answer 16

$ / availability
Claustrophobia
CIs: pacemakers, metal (jts), renal failure

Question 17

How do you do angiography? What do you see?

Answer 17

Inject contrast into arteries

See arteries, veins, renal parenchyma and collecting system

Question 18

Use angiography

Answer 18

NOT 1st LINE
Dx renal art stenosis + vasculitis
Treat arterial steonsis (since you already have arterial access) 
- Stent
- Embolize bleeding vessels

Question 19

Cons angiography

Answer 19

Invasive
Radiation
Contrast: allergy + nephrotox

Question 20

What is nuclear scintigraphy?

Answer 20

+ radioactive isotope to molecule metabolized and excreted by kidney
DET FXN

Question 21

L flank pain sharp + intermittent, radiates to groin, gross hematuria w/o fever chills

1. Dx
2. Scan

Answer 21

Renal stone

LOW DOSE CT > XR b/c get all stones, even those not radio-opaque

Question 22

What is the cut off for allowing a stone to pass on own?

Answer 22

5 cm

But location influences therapy - pts of anatomic narrowing

Question 23

Scan for stones in kids + pregnant women

Answer 23

US… duh

Question 24

L flank pain + fever, h/o drug use + HIV

1. Dx
2. Scan
3. Treat

Answer 24

Abscess/infection
Treat: percutaneous drainage + antibiotics
US or CT

Question 25

What is a UTI of the upper vs lower urinary tract

Answer 25

Upper UTI: pyelonephritis

Lower UTI: cystitis

Question 26

Do you image UTI?

Answer 26

No - clinical dx

Image if not responding to treatment

Question 27

What is emphysematous pyelonephritis?

Answer 27

Infection due to bug that causes gas forming infection

Question 28

Best imaging for dx and staging

Answer 28

CT/MR

Question 29

What is the imaging work up for hematuria?

Answer 29

CYTOSCOPY for all - CT urogram

Question 30

Do you image pre, renal, or post-renal causes of renal failure?

Answer 30

Post only - bladder obstruction

US or CT non-con