Radiology Imaging of the Renal Tract

Question 1

Plain Film Imaging?

Answer 1

Cheap, but does use radiation, often first imaging modality.

• Useful for finding ‘radio-opaque’ (most common, calcium-filled) kidney stones

Look for them along the lines of the Ureters (along T. processes)

Question 2

What are the non-opaque kidney stones you can get?

Answer 2

Non-calcified stones filled with uric acid , common in maori men with gout. Hard bc they can’t be seen!

Question 3

How does a patient with Renal Colic present?

Answer 3

‘Loin-to-groin’ pain. In men can even start at the testis.

Patient extremely restless due to incredibly pain that is coming in waves. (**whereas appendicitis is so sore for them to move at all)

Blood in urine, decreased urine output.

Question 4

Why are the little stones the problem?

Answer 4

because they are the ones that drop out of the kidney and make their way down the ureters (5mm), and big ones can’t get anywhere.

Question 5

Ultra sound, although extremely useful (esp for kidney stones/mass, bladder issues) and with no radiation, is operator/patient-dependant. How is this an issue?

Answer 5

Patients are getting fatter. The fatter the patient, the harder it is of getting down to the kidneys are significantly reduced.

Question 6

Why can’t US find the ureters?

Answer 6

Because we can’t see through the air that is within the bowels!

Question 7

Pros and cons of CT scan?

Answer 7

• More accurate, assess soft tissue, fluid calcification
• Expensive and uses radiation. May need to inject dye.

Question 8

What is this?

Answer 8

An ultrasound of a normal kidney

Question 9

What does this tell us?

Answer 9

Right side has been given the contrast, whereas the left isn’t indicating a blocking (in this case cancer)

Question 10

What is this?

Answer 10

Coronal CT scan of kidney. Can see anatomy of kidney

Question 11

Pros/cons of MRI

Answer 11

• Even more accurate for soft tissues!
  BUT
• MORE expensive, and a much longer scan time of 30-45 mins (so a wriggling patient wont work)

Question 12

Differences of Renal imaging at different stages of life?

Answer 12

Different clinical concerns/radiation issues.

Question 13

Kidney issues with Antenatal babies?

Answer 13

• Congenital abnormalities (eg: no kidneys ‘agenesis’, polycystic kidneys)
• Obstructed Kidneys (at level of renal pelvis, post. uretral valve that blocks bladder flow “dribbly urine!”)
• Reflux

Question 14

How does stone size on CT correlate with patient treatment?

Answer 14

Tells us if it’s gonna pass naturally or need intervention.

Cut-off = ~6mm

over >6mm there’s a 99% need for intervention?