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22 Cards in this Set

  • Front
  • Back
What patients are known to get radiolucent renal calculi (not seen even on CT)?
HIV patients taking protease inhibitor INDINAVIR
What is the urological threshold for ureteral calculus passage size?
What is the ddx when you have a patient with flank pain and a negative non-con CT?

Renal infarction (may have no other assd signs besides infarct, which cannot be seen on C- scan)

Testicular stuff
What does enhancement in a renal mass indicate?
MALIGNANCY until proven otherwise
What do you do to assess enhancement in a mass that is already hyperintense on T1W noncontrast images?
Perform post - pre subtraction
What does a bright cystic looking lesion on T2 suggest?
Benign cyst, in more than 95% of cases, such that Gado is not even needed
What if it appears complex on T2?

Could be benign (hemorrhagic or septated cyst)

Could be malignant

Need to do Gd enhanced to confirm
When is partial nephrectomy (renal sparing surgery) always attempted?
Solitary kidney

Renal insuff

Bilat RCC
What are exclusion criteria for renal sparing surgery?
No renal artery or vein involvement

No involvement of renal hilum
What is something that needs to be evaluated prior to renal excision?
Function of contralateral kidney. If there is arterial stenosis, then treat with angioplasty before removing diseased kidney..
Why is renovascular hypertension so important to diagnose?
Very common and treatable. Most common treatable cause of HTN.

Also, it is a progressive disease, so that there will be progressive renal artery narrowing
How does treatment of atheromatous renovascular disease differ from FMD?
FMD: Angioplasty only

Ather: Stenting also
What do MIPs do? Overestimate or underestimate vascular stenoses?
What is the MR equivalent of doppler ultrasound?
Phase contrast
What is the MR equivalent of renal scintigraphy?
MR renography
What does captopril do to normal patients?
Not much
What does captopril do to patients with renovascular hypertension?
It causes decrease in glomerular filtration.
Because in renovascular hypertension, there is tonic elevation of renin angiotensin system. This results in constritction of both the afferent and efferent arterioles. But there is more constriction of the efferent, thus renin angiotensin system promotes increased GFR in these patients with diminished pressure head secondary to renal arterial stenosis.

Enter captopril Captopril is an angiotensin converting enzyme inhibitor. This drops the production of angiotensin II (the active form) from angiotensinogen. Thus the efferent arteriole relaxes, and you get a decrease in perfusion pressure through the Bowmans capsule.
What test is normall used to assess this?
Captopril nuclear medicine renal scan
With what tracer?
What does DTPA measure?
At 2-3 min post administration, it gives good reflection of GFR.
How is test done in nucs?
Administer tracer (Tc99m MAG 3), at low dose 1-2 mCi, and do regular scan. Then re-do scan later same day with higher dose (5-10 mCi) one hour after administration of Captopril (25mg p.o.)