Surgery Of The Kidney Flashcards by Corinne Perra

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

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What are the possible surgical disease of the kidney?

Nephrolithiasis
Pyelonephritis 
Trauma 
Neoplasia 
Hydronephrosis 
Pseudocysts 
Renal parasites

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Majority of nephrolithiasis are what type of crystal?

Ca oxalate

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Clinical signs associated with nephrolithiasis ??

Absent or non-specific
Depression, anorexia, hematuria, and pain

Uremia and hydronephrosis

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T/F: Ca oxalate stones can be managed by diet

False

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How can you diagnose nephrolithiasis?

Survey radiographs

unilateral/bilateral
calculi in other areas

Check renal function before surgery

excretory urography
GFR
US

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When is surgery indicated for nephrolithiasis ?

Obstruction

Infection associated with the calculi

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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

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What are the closure options for a nephrolithotomy?

Sutureless closure

> hold 5mins
> forms fibrin seal
> suture capsule only
> release vascular clap

Horizontal mattress

Nephropexy

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When calculi are in the renal pelvis, what surgery would you do to remove it?

Pyelolithotomy

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T/F: the renal artery and vein should be occluded with a bulldog clamp for a pyelolithotomy

False

no occlusion of blood supply needed

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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

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T/F: In a case of trauma t the kidney, hematuria is an indication for surgery?

False

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When is surgery required following renal trauma?

Moderate

capsular tears
extravasated fluids

major trauma
-severe parenchymal damage or vascular damage

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If you have severe parenchymal damage/ vascular damage to your kidney. What should you do?

Parietal nephrectomy

Nephorureterectomy

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Hydronephrosis result in what alternations of the kidney

progressive dilation of the renal pelvis and atrophy of the renal parenchyma

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Acquired causes for hydronephrosis ?

Neoplasia 
Abscess 
Cyst 
Stone 
Iatrogenic

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Congenital causes of hydronephrosis?

Torsion, kinking
Stenosis
Atresia

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Clinical signs of hydronephrosis?

Unilateral

abdominal distention
palpable mass

Bilateral
-severe azotemia /death

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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 ```