Urinary system

The urinary system consists of?

- 2 kidneys
- 2 ureters
- 1 bladder
- 1 urethra

Where are the kidneys located?

beside the spine, between T12- L4

Which kidney is more superior (sits up higher)?

the left kidney. due to the liver located in the RUQ

The kidneys lay In what kind of plane?

an oblique plane

What radiographic positions best demonstrate the kidneys?

30° LPO (Left Posterior Oblique) or RPO (Right Posterior Oblique).

In a 30° LPO or RPO position, how does the lower pole of the kidney lie in relation to the IR?

Perpendicular to the IR.

In a 30° LPO or RPO position, how does the upper pole of the kidney lie in relation to the IR?

Parallel to the IR.

Where does filtration occur in the kidney?

In the renal cortex.

What is the functional unit of the urinary system?

The nephron (located in the renal cortex)

Where do the ureters begin?

At the ureteropelvic junction (UPJ) of the renal pelvis.

How do the ureters descend through the body

Anteromedially to the psoas muscle, anterior to the lumbar vertebrae

In males and females, what structure do the distal ureters pass behind?

male: ductus deferens

female: uterine artery

What is the purpose of contrast media in urology?

To help visualize the urinary system during imaging exams.

How is contrast media administered in an antegrade exam?

It is injected intravenously.

What is another name for an intravenous urogram?

Pyelogram.

How is contrast media administered in a retrograde exam?

Through a catheter.

functional study showing bladder and urethra while voiding is

Voiding Cystourethrogram (VCUG), syudy of the bladder and urethra

what contrast does intravenous urography (IVU) use

water-soluble, iodinated contrast agent

common side effects

temporary hot flash, metallic taste in teh mouth

patient medication history

metformin and glucophage

Name three types of retrograde contrast procedures.

- VCUG/CUG

- cystography

- retrograde pyelogram.

What is the purpose of an intravenous urogram?

To visualize the anatomy of the urinary system's collecting portion.

What functional aspect does an intravenous urogram assess?

The functional ability of the kidneys

Is an intravenous urogram a timed procedure?

Yes, it is timed to evaluate how well the kidneys function over time.

What information should be included in a patient history for contrast media use?

- Clinical complaints

- consent form

- allergies

- past reactions

- asthma/hay fever/hives, and lab values.

What key question should be asked to diabetic patients before a contrast procedure?

"Are you currently taking Glucophage or other medication for diabetes mellitus?"

What must be done with metformin meds before and after iodinated contrast procedures?

They must be withheld for 48 hours after the procedure.

What is the general eGFR threshold below which contrast media should not be used?

Less than 60 mL/min/1.73 m².

What are some contraindications (where a treatment should not be used because it could harm the patient.) for contrast media in IVU?

- Graves' Disease (radioactive iodine therapy)

- Pheochromocytoma (adrenal tumor)

- Sickle Cell Anemia (can trigger crisis)

- Renal Failure (risk of death if kidneys can't filter contrast)

- eGFR < 60 mL/min/1.73m² (poor kidney function)

What is the normal creatinine level for adults?

0.6 to 1.3 mg/dL

What is the normal BUN (blood urea nitrogen) level for adults?

6 to 20 mg/dL

What is the normal GFR (glomerular filtration rate) for adults?

Greater than 60 mL/min/1.73 m²

What happens to ionic contrast media when injected?

It dissociates into separate ions.

What happens to nonionic contrast media when injected?

It does not dissociate.

What type of condition does ionic contrast create?

A hypertonic condition.

What type of condition does nonionic contrast maintain?

It remains near isotonic.

How does ionic contrast affect blood osmolality?

It increases blood osmolality.

How does nonionic contrast affect blood osmolality?

It causes no significant increase in osmolality.

pre-medication protocol

• pre treated with benadryl and prednisone over 12 or more hours before procedure

• if there a history of allergic reaction, only adminnister contrast to patient with radiologist approval

• no guarantee that there will be no reaction

In an RPO (Right Posterior Oblique) position, the kidney that is best demonstrated parallel to the image receptor (IR) is:

Left kidney

What is Extravasation? what is the first step in treating it?

IV has come out of the vein and contrast is injected directly in to the tissue

Notify the department nurse and/or physician.

Why should the affected extremity be elevated above the heart?

To decrease capillary pressure and promote reabsorption of contrast media.

What compresses are used in treating extravasation, and in what order?

Cold compresses first to relieve pain, followed by warm compresses to promote reabsorption.

What is the first image taken in an IVU exam?

a Scout radiograph.

What must be noted at the beginning of the IVU injection?

The exact time of the injection.

What is the imaging routine at 1 minute post-injection?

Nephrogram or nephrotomography basically a KUB

What is the imaging routine at 5 minutes post-injection?

AP supine.

What is the imaging routine at 10-15 minutes post-injection?

AP and posterior obliques.

What is the final imaging step in the IVU routine?

Postvoid (urinated) image (either prone or erect).

What is the purpose of an AP nephrotomogram?

to demonstrate the renal parenchyma or functional portion of the kidney.

nonionic iodine contrast agents differs from anionic agents in that nonionic

hey do not break down or dissociate into charged particles (cations and anions) when dissolved in blood plasma

which contrast agent contain positively charged cation

which contrast agent contain positively charged cation

How do you estimate the kidney level for tomography?

Divide the total A-P measurement by 3 (kidneys are in the posterior 1/3 of the abdomen).

How many tomo cuts are typically taken for the kidneys?

Three tomo cuts at the calculated level and posterior.hw

what is the CR for AP nephrotomogram

CR perpendicular to IR directed to MSP midway between xiphoid process and iliac crest

SID 40wh

at is being demonstrated in an AP nephrogram

renal parenchyma

what is the CR for AP IVU

perpendicular to IR, directed to MSP and iliac crestwh

what are critics needed to include in AP IVU

entire urinary system visuazlied from upper renal shadows to distal urinary bladder. symphysis pubis should be included

what is the CR for IVU posterior oblique (RPO LPO)

perpendicular to IR, directed to MSP and iliac crest

rotate body 30 degrees

what are critics needed in IVU posterior obliques

upside kidney = parallel to plane of IR

downside ureter = free of superimposition

whats the CR for AP/PA post void

perpendicular to IR, directed to MSP and iliac crest

How is contrast media delivered in cystography?

Through a urinary catheter using gravity flow of CM

150-500 mL

what is the CR for AP axial bladder

perpendicular, directed to MSP and symphysis pubis

for voiding study CR has 15 degree caudad angle (for VCUG akla voiding cystourethrography)

purpose of Custourethrography

functional study of bladder and urethra

whats the CR of axial posterior oblique bladder

perpendicular to IR at 2’’ superior to upper border of pubicx symphysis and 2’’ medrial to upper ASIS

voiding; perpendicular to level of pubic symphysis

what are the patietn position and anatomy shown on axial posterior oblique bladder

45-60 posterior onlique

urinary bladder not superimposed by pubic bones or lower lumbs

When should AP nephrotomogram (IVP) images be taken?

At 1 minute post-contrast injection.

benign prostatic hyperplasia (BPH)

enlargement of the prostate

bladder calculi

stones that form in the urinary bladder

bladder carcinoma

tumor usually at old age. symptoms hematuria and frequency in urination

oliguria

low urine output

anuria

almost no urine production

polyura

excessive urine output

urinary incontinence

loss of bladder control

micturition

act of urinating/voiding urine

uremia

waste products build up in the blood because kidneys are failing e

ectopic kidney

kidney that remains in the pelvis and failed to descend into the abdomen

horseshoe kidney

fusion of kidney in fetal developmennt

cystitis

inflammation of the urinary bladder caused by bacterial or fungal infection glo

merulonephritis

inflammation of the capillary loops of the glomeruli of the kidneys

hydronephrosis

distention of renal pelvis and calyces of the kidney that results from obstruction of ureter or renal pelvis

polycystic kidney disease

cysts scattered througout kidney. most common cause of enlarged kidneys

pyelonephritis

inflammation of kidney and renal pelvis caused by pyogenic

renal calculi

calcification that occur in the uminal aspect of urinary tract reba

renal cell carcinoma (hypernephroma)

common malignant tumor of kidney

renal hyperntension

increased blood pressure to kidney through the renal artery due to atherosclerosis

whats the routine of IVU

• AP (scout and series)

• nephrotomogram

• RPO and LPO

• AP

voiding cystourethography routne

Male - RPO

female - AP