Chapter 7 Clinical Procedures

Front 1

CT scan

Back 1

X-ray image showing a detailed cross-sectional view of organs and tissue. Transverse x-ray views of the kidney, taken with or without contrast material, are useful in the diagnosis of tumors, cysts, abscesses, and hyronephrosis.

Front 2

kidney, ureters, and bladder (KUB)

Back 2

X-ray examination (without contrast) of the kidneys, ureters, and bladder. A KUB study demonstrates the size and location of the kidneys in relation to other organs in the abdominopelvic region.

Front 3

reneal angiography

Back 3

X-ray examination (with contrast) of the vascular system (blood vessels) of the kidney. This procedure helps diagnose kidney tumors and outline renal vessels in hypertensive patients.

Front 4

retrograde pyelogram (RP)

Back 4

X-ray imaging of the kidneys, ureters, and bladder after injection of contrast through a urinary catheter into the ureters. This technique is useful in locating urinary stones and obstructions.

Front 5

voiding cystourethrogram

Back 5

X-ray record (with contrast) of the urinary bladder and urethra obtained while the patient is voiding urine. The bladder is filled with contrast material, followed by x-ray imaging. The ureters may be seen when there is reflux of urine into the lower end of the ureters.

Front 6

ultrasonography

Back 6

Process of imaging urinary tract structures using high-frequency sound waves. Kidney size, tumors, hydronephrosis, polycystic kidney disease, and ureteral and bladder obstruction can be diagnosed using ultrasound techniques.

Front 7

radioisotope scan

Back 7

Image of the kidney after injecting into the bloodstream a radioactive substance (radoisotope) that concentrates in the kidney. Pictures shows the size and shape of the kidney (renal scan) and its functioning (renogram). These studies can indicate size of blood vessels, diagnose obstruction, and determine the individual functioning of each kidney.

Front 8

magnetic resonance (MR)

Back 8

A magnetic field and radio waves produce images of the kidney and surrounding structures in all three planes of the body. The patient lies within a cylindrical magnetic resonance machine, and images are made of the pelvic and retroperitoneal regions using magnetic and radio waves.

Front 9

cystoscopy

Back 9

Direct visual examination of urinary bladder with an endoscope (cystoscope). A urologist introduces a hollow metal tube into the urinary meatus and passes it through the urethra into the bladder. Using a light source, special lenses, and mirrors, the bladder mucosa is examined for tumors, calculi, or inflammation. When a catheter is placed through the cystoscope, urine samples are withdrawn and contrast material is injected into the bladder. A penendoscope is a cystoscope that gives a wide-angle view of the bladder.

Front 10

Hemodialysis (HD)

Back 10

Uses an artifical kidney machine that receives waste-filled blood from the patient's bloodstream, filters it, and returns the dialyzed blood to the patient's body. An arteriovenous fistula (communication between an artery and wein) is created surgically to provide access for hemodialysis.

Front 11

Peritoneal dialysis (PD)

Back 11

Uses a peritoneal catheter (tube) to introduce fluid into the peritoneal (abdominal) cavity. Chemical properties of the fluid cause wastes in the capillaries of the peritoneum to pass out of the bloodstream and into the fluid. The fluid (with wastes) is then removed by catheter. When used to treat patients with chronic kidney disease, PD may be performed continuously by the patient without mechanical support (CAPD--continuous ambulatory PD); or with the aid of a mechanical apparatus at night during sleep (CCPD--continuous cycling PD).

Front 12

Lithotripsy

Back 12

Urinary tract stones are crushed and either removed or pass from the body in urine. The extracorporeal method uses shock waves directed toward the stone from the outside of the body. The patient receives light sedation or an analgesic (pain medication). The endoscopic method uses an endoscope in the ureter and a laser to crush the stone under direct vision. A basket is used to retreive larger pieces of the stone.

Front 13

renal angioplasty

Back 13

Dilation of narrowed areas in renal arteries. A balloon attached to a catheter is inserted into the artery and then inflated to enlarge the vessel diameter. Afterward, stents (metal meshed tubes) may be inserted to keep the vessel open.

Front 14

renal biopsy

Back 14

Removal of kidney tissue for microscopic examination by a pathologist. Biopsy may be performed at the time of surgery (open) or through the skin )percutaneous, or closed). When the latter technique is used, the patient lies in the prone position and, after administration of local anesthesia to the overlying skin and muscles of the back, the physician inserts a biopsy needle downward into the kidney.

Front 15

renal transplanation

Back 15

Surgical transfer to a complete kidney from a donor to a receipient. Patients with renal failure may receive a kidney from a living donor, such as an identical twin (isograft) or other person (allograft), or from a cadaver (dead body). Best results occur when the donor is closely related to the recipient--better than 90 percent of the kidneys survive for 1 year or longer.

Front 16

urinary catheterization

Back 16

Passage of a lexible, tubular instrument through the urethra into the urinary bladder. Catheters are used primarily for short- or long-term drainage of urine. A Foley catheter is an indwlling (left in the bladder) catheter held in place by a balloon inflated with air or liquid.