DOPPLER ULTRASCNOGAPHY -1 Spectral or range-gated. Doppler utlrasonography

Frown branches of aorta). A renal angiograin is necessary to confirin the dagnosis. 9. Renal tuinors - (a) Win’s tenor - On plain X-ray, soft tissue incases is seen in region of kidney, which usually does not cross the indene. On IVU distortion and displaceinent of palvi-calyceal systein is seen (displaceinent but no distortion in neuroblsatoina). (b) Adenocarcinoinia (Hypeinaphroina, Grawitz tuinor) -On plain filing large soft tissue shadow with often calcification. IVU - generalized or focal enlargeinent of kidney (It impaired renal function on affected side, nephrotoinography inay be perforined) 10. Congenital posterior urethral valves -Diagnosis can be inade on inicturating cystourethrography. Antegrade and retrograde pyelography - Antegrade pyelography deinonstrates the urinary tract by injection of contrast into renal pelvis with a catheter introduce percutaneously through the join. retrograde pyelography by cystoscopy and urethra catheterization. The techniques are used to identify - (a) Site of uresteric obstruction or (b) deinonstrate sinall lesions in the collecting systein, pelvis and ureter (when not seen adequately on IUV) Renal arteriography - by arterial puncture and enjection of contrast into aorta or direcly Into renal arteries indications - (a) Detection of renovascular -disease inainly. Occasionaly for (b) Trauina. (C) Occult heinaturia. (d) Ansuryain (a) Equivocal inasses on urtrasound or CT scan. DSA - Effective for detection of renal artery atenossis. inultiple injections with different obliquitesof vessels necessary. Video urodynainics (VUD) - for bladder dysfunction. Bladder and rectuin are catheterized with pressure lines and connected to a recording device which can continuously subtract the abdoininal froin intravecicale pressure to give the true detrusor prassure. The biadder is filled with radographc contrastl through a second bladder catheter and interinitently screened to show bladder neck abnorinalties refax and bladder shape. Where the bladder is full, patient voids under screening control and a video infixing facility records pressure generated during filling and voiding .A urine flow inepter dinosaurs .The rate of unpitying VUD can be used id identify - {a) Bladder instability. (b) Naturopathic bladder. {c) Bladder knack an^ urethral abnormalities. (d) Simple stress incontinence. Ulirasonography - gives good details of renal parenchyina and is useful for detection of - (a) Hydronephrosis. (b) Non-opaque stones and to) Perirenal collection. [d] Ureteric diataction (particularly lower) (e) afr bladder abnorinalities (particularly papilluas). (1) Assessinent of size of prostate, bladder voluin before and aftar be ineasured. TRlANSRECTAL ULTRASONOGRAPHY - alsows the prostate and seininal vesicles to be examinee. Biopsy of focal lesions is possible using Iran rectal ultrasound guidance. DOPPLER ULTRASCNOGAPHY -1 Spectral or range-gated. Doppler utlrasonography - gives quantitative Inforination and can be used to assess the of senses, size of shunts or presence of raised peripheral resistance within the renal circulation, 2 Color flow Doppler (CFD) utrasonography-is essentially qualitative and Is useful in detection of both normal and abdominal vessels .Trangrecta CFD of the prostate increases the •detestability of prostate crinoline by identifying areas of abdominal vasculature. Radio stop studies - (a) Dynamitic imaging -using technician -99in (99Tc) DTPA or 99Tc MAG 3 In urethra obstruction on, the radiopharmaceutical accumulates in the kidneys. A similar appearance can occur in a hydronephrotic but not obstructed kidney. The appearance can be differentiated by of arsenide. witch causes dieresis In the non-obstructed kidney. Analysis of time actively curves may enable of renal artery stenos is, in •which there is a delay in arrival of radiopharmaceutical In than kidney, or reflux. in which there is see-saw of activity between the bladder and the kidney {b) Static imaging - utilizes a tracer such as 99mTc DMSA witch binds in the tubules. Such scans are a sensitive method of detecting scarring In patients with renal nephropathy. CT scans - Utility - (a) Staging of renal and bladder tumor. [b) Elucidation of distal urinary obstruction and per renal conditions. (c) To distinguish radio logically non-opaque calculi (xanthenes urine: acid or costing) from other chaliced l filling detects such as blood clots and small tumors. (d) identification of vascular potency and tumor vascular (by rapid sequential imaging during Injection of contrast medium). Maturating cystouethrography is -almost entirely limited to evaluation of urethra reflux in children MRI -like CT. is less widely used in renal disease .it can be of value in imaging-of the pelvis, particularly In the assessment of malignancy and four extension between the different pelvic: organs .Magnate resonance angiography (MRA) - enables flow to be calculated, which, is of value In demonstrating the renal circulation. Percutaneous Renal Biopsy Indications -1 Asyrnotomatic proteinuria- (a} Patients with normal renal function but persistent! proteinuria of 1 g or more>24 hrs. Biopsy may demonstrate a treatable condition such as SLE (b) meribranous nephropathy may present in this manner. (c) Associated neoplasin may be detected in a middle-aged individual. 2 Nephritic syndrome - Therapeutic trials of high dose corticosteroids can be avoided 3