Nephrology & Urinary Diagnostic Studies Flashcards
Reasons for a Renal Ultrasound
should be preformed for all kidney failure pts. when the cause of failure is unknown
Able to detect…
- cystic disease
- parynchymal disease
- urinary obstruction
- hydronephrosis
- masses
- pyleonephritis
- abcess
- initial dx. of choice in an AKI
Can use doppler for…
- renal artery stenosis
- vein thrombosis
- infarction of the kidney
+ = no contrast!
- obstruction in the urinary tract may not be see/can be obstructed by other lower abdomen structures
Reasons for a CT scan of kidneys
a non-contrast CT scan is gold standard for the dx. of nephrolithasis to see stone and extent of obstruction/location
Contrast CT used for…
- masses
- cysts (complicated (like malignancy) and not)
- abscess
- vasculature issues
- obstructions
Cyst on US
- well-marginated boarders and thin walls = uncomplicated
- thick, irregular walls and septations = complicated cyst (think RCC)
- multiple cysts= think PCKD & its spread to other organs
Bladder on US
why would you
what you would see with post-void v retention
to inspect for post-void residual
rough, thimble shaped wall = indicates retention
- can be used to inspect for proper catheter placement
- insoect trauma
how will renal masses appear on CT
(differ from cyst– cyst will be black bcu fluid filled v masses will be grey/white because tissue)
- no ring enhancements = benign
- angiomyolipoma: beging mass of kidney showing a fat containing cyst/mass
- ring enhancments, abnormal boarders = think cancerous
how will Stones appear on CT
- see them as small, bright (because solid, calcification) within the kideny or urinary tract (ureter)
IVP
Renal arteriography
radionuclide scan
IVP: intravenous pyleogram (rarely used now) but was used for hydronephrosis 2/2 stones
- administer imaging
- then give contrast & image again
- wait and get KUB
- compress then get imaging as bladder fills
Renal arteriography
- see vasculature and treat wihtin kidney
Radionucloscane
- see the defects of color in spcific areas to indicate infection of kidney
Pyleonephritis
kidney infection
when to image
- severely ill pt.
- presistant abx. despite abx for 72 hours
- sus of urinary tract obstruction
- recurrance of infection
- also has stone
- sus for abscess
on CT
- see “hypodense triangles” of streaks coming out of the kidney center
Hydronephrosis
fluid accumulation in kidney – a sign of another disease process
conditions to think of
- stones
- clots
- scar tissue
- tumor/cancer
- prostate enlargement
- prgnancy
- UTI
- inflammation in urethra or urinary tract
see on US
- increase fluid and dilation of the major and minor calyces
Hydroureter
ureter dialted > 3mm from
- obstruction (intraluminal, clots, necrosis, stone)
- intramural (malignancy, stricture, inflammation)
- vessel issue
- vesicureteral reflex
- uueterocele
ON US & CT
- see the dilation (darker, wider space of the ureter)
Rena Trauma
when to get imaging
Grading system of renal traumas
get imagins when…
- penetrating trauma
- blunt trauma (MVA, falls, etc.) + hematuria
- suspected that the injury is renal related
- the pt. is unstable
Grading System
- Grade I = most minimal
- Grade V = completelt shattered kidney, etc.
