Surgery Of The Kidney Flashcards
What vessels supply the kidney?
Arise off aorta —> renal artery and vein —> dorsal and ventral branches at hilus —> interlobular branches do not cross midline
-> left ovarian/testicular vein attaches to left renal vein
What are the possible surgical disease of the kidney?
Nephrolithiasis Pyelonephritis Trauma Neoplasia Hydronephrosis Pseudocysts Renal parasites
Majority of nephrolithiasis are what type of crystal?
Ca oxalate
Clinical signs associated with nephrolithiasis ??
Absent or non-specific
Depression, anorexia, hematuria, and pain
Uremia and hydronephrosis
T/F: Ca oxalate stones can be managed by diet
False
How can you diagnose nephrolithiasis?
Survey radiographs
- unilateral/bilateral
- calculi in other areas
US
Check renal function before surgery
- excretory urography
- GFR
- US
When is surgery indicated for nephrolithiasis ?
Obstruction
Infection associated with the calculi
How would you perform a nephrolithotomy?
Ventral midline celiotomy
Retract mesocolon or mesoduodenum
Dissect retroperitoneal fat to isolate vessels -> clap vessels with rumel tourniquet or bulldog vascular clamp
Mobilize kidney and make sagittal insicison
Remove stone and submit, culture renal pelvis
Flush pelvis/ureter with heparinized saline
Catheterize ureter to ensure patency
What are the closure options for a nephrolithotomy?
Sutureless closure
- > hold 5mins
- > forms fibrin seal
- > suture capsule only
- > release vascular clap
Horizontal mattress
Nephropexy
When calculi are in the renal pelvis, what surgery would you do to remove it?
Pyelolithotomy
T/F: the renal artery and vein should be occluded with a bulldog clamp for a pyelolithotomy
False
- no occlusion of blood supply needed
How would you manage your nephrolithotomy/pyelolithotomy patients post-op?
Post op radiographs
Monitor PCV
CVP (hydration status)
Monitor urine output
Monitor renal enzymes/electrolytes
Provide diuresis
-> maintain renal perfusion and minimize clot formation
T/F: In a case of trauma t the kidney, hematuria is an indication for surgery?
False
When is surgery required following renal trauma?
Moderate
- capsular tears
- extravasated fluids
major trauma
-severe parenchymal damage or vascular damage
If you have severe parenchymal damage/ vascular damage to your kidney. What should you do?
Parietal nephrectomy
Nephorureterectomy
Hydronephrosis result in what alternations of the kidney
progressive dilation of the renal pelvis and atrophy of the renal parenchyma
Acquired causes for hydronephrosis ?
Neoplasia Abscess Cyst Stone Iatrogenic
Congenital causes of hydronephrosis?
Torsion, kinking
Stenosis
Atresia
Clinical signs of hydronephrosis?
Unilateral
- abdominal distention
- palpable mass
Bilateral
-severe azotemia /death
Treatment of hydronephrosis ??
Eliminate cause
Evaluate fxn
- less than a week obstructed => complete resolution
If non functional or severe parenchymal damage => nephroureterectomy
When would you do a nephroureterectomy in a case of pyelonephritis ?
Advanced cases
- predisposed by damaged parenchyma
Treatment for dioctophyma renale?
Giant kidney worm - destroy renal parenchyma
Nephrotomy or nephroureterectomy
What is the most common benign renal neoplasia?
Renal adenoma
Primary tumors of the kidney?
Renal cell carcinoma
TCC
Nephroblastoma
Metastatic renal tumors?
Lymphosarcoma
Hemangiosarcoma
SCC
What is the most common renal neoplasia in dog?
Renal cell carcinoma
- increased incidence in males and with age
Treatment for renal cell carcinoma?
Nephroureterectomy and chemo
Most common renal neoplasia in cat?
Renal lymphoma
Treatment for renal lymphoma ?
Usually bilateral -> chemo
Surgery not indicated
What is a congenital neoplasia that is found i young dogs and cats ?
Embryonic nephroblastoma
Clinical signs associated with renal neoplasia?
Hematuria Abdominal distention Anorexia Weight loss Depression Abdominal pain
Diagnosis of renal neoplasia ?
Abdominal palp
Rads -abdominal or renal masses
US -abdominal and kidney mass
IV urogrpahy, CT, MRI
Exploratory laparotomy - metastatic lesions, preferred method for biopsy
Indications for a nephroureterectomy?
Severe infection/trauma
Obstructive calculi with persistent hydronephrosis
Neoplasia
Transplant
What technique do you use for nephroureterectomy ?
Mobilize kidney
Identify vessels and ligate separately
Separate and ligate ureter at vesicoureteral junction
When would a partial nephrectomy be indicated?
When the contralateral kidney has compromised GFR
Trauma/focal hemorrhage/neoplasia
Preserves renal function
-
What is the main complication of a partial nephrectomy?
Higher incidence of post op hemorrhage
What are the steps of a partial nephrectomy?
Occlude blood supply
Incise and peel back capsule
Pass suture through kidney with straight needle —> divide into thirds and tighten suture
Remove distal part of kidney
Loosen tourniquet
Close capsule
What are the indications form renal biopsy?
Suspected neoplasia
Nephrotic syndrome
Renal cortex dz
Non diagnosed ARF
When would renal biopsy be contraindicated?
If results dont:
- > alter therapy
- > change prognosis (CRF)
- > owner wont pursue further therapy
Coagulopathies
Hypertension (hemorrhage risk)
Severe chronic hydronephrosis
What should be your sample size for a renal biopsy?
Obtain > 5-6 glomeruli
What are the possible biopsy techniques for the kidney?
Percutaneous Ultrasound guided Keyhole Laparoscopic assisted Wedge or incisional
How is a percutaneous biopsy done?
In small dogs and cats
Secure kidney against abdominal wall
Blind technique that does not visualize target lesions
What is the preferred method to take a kidney biopsy?
Ultrasound guided
What is the keyhole biopsy technique?
Modified surgical flank approached
Secure kidney to incision and introduce biopsy needle
How is a wedge biopsy performed?
Ventral midline celiotomy
Occlude renal vessels
Take a crescent shaped sample
- 5-10mm long
- 5mm deep
Close with mattress suture
What are possible complications from renal biopsies?
Severe hemorrhage
- hypertension
- NSAIDS within 5 days
- coagulopathies
- poor technique
Hematuria
-usually resolve in 2-3days
Hydronephrosis (ureteral obstrucion from clot)
What are indications for renal transplants?
Irreversible acute renal failure
Decompensated chronic renal failure
Polycystic disease
What screening do you do for renal transplant patients?
CBC, Chem UA an culture Abd rads U/S Echo FeLV, FIV, toxo
Rejected if .. viral positive Cardiac dz Neoplasia Factious
