Renal Angiography

Presented by Lisa Erwert

What is Renal Angiography and What is Renal Angiography and what is the prep for an exam?what is the prep for an exam?

►a special x-ray exam to visualize renal a special x-ray exam to visualize renal blood circulation blood circulation

► Inform health care provider of Inform health care provider of allergies, pregnancy, or bleeding allergies, pregnancy, or bleeding problemsproblems

►Restrict fluids and foodRestrict fluids and food►Some patients are given a sedativeSome patients are given a sedative►Remove all jewelryRemove all jewelry

Kidney AnatomyKidney Anatomy

Why do we need kidneys?Why do we need kidneys?• Kidneys remove waste from bloodKidneys remove waste from blood

• Measure 11 cm long, 6 cm wide, Measure 11 cm long, 6 cm wide, and 3 cm thick.and 3 cm thick.

• The kidney is made up of millions of The kidney is made up of millions of functioning units called nephrons. functioning units called nephrons.

• The nephrons consist of glomerulus and tubules.The nephrons consist of glomerulus and tubules.

• The glomerulus is a network of tiny blood vessels The glomerulus is a network of tiny blood vessels surrounded by a cup-shaped structure called the surrounded by a cup-shaped structure called the glomerular (Bowman's) capsule. glomerular (Bowman's) capsule.

The concentration of the filtrate is altered by The concentration of the filtrate is altered by various processes to form urinevarious processes to form urine

Urine leads into the collecting ductUrine leads into the collecting duct

Then drained into renal pelvisThen drained into renal pelvis

The ureter connects the renal pelvis and bladderThe ureter connects the renal pelvis and bladder

Lastly, urine is passed out through the urethraLastly, urine is passed out through the urethra

Indications for a renal Indications for a renal angiogramangiogram

Renal hypertensionRenal hypertension Renal traumaRenal trauma Renal tumorsRenal tumors Renal neoplasmsRenal neoplasms Complications after renal Complications after renal

transplantationtransplantation Evaluate condition of kidneys for Evaluate condition of kidneys for

potential donorspotential donors

PathologiesPathologies

Renal TransplantRenal Transplant

Contrast

A nonionic contrast is used

Quantity injected depends on the size of the area to be injected

Renal requires a smaller quantity of contrast of 6-10ml at a rate of 5-6ml/sec.

Epinephrine injection helps prevent superimposition of arteries

What equipment is used for What equipment is used for renal angiography?renal angiography?

Usual catheterization equipment:Usual catheterization equipment:– X-ray machinesX-ray machines– Fluoroscope with video monitorFluoroscope with video monitor– CathetersCatheters– Flexible guide wireFlexible guide wire– DyeDye– Pressure-injection devicePressure-injection device

Renal Positioning and Renal Positioning and Filming Filming

• Requires a high volume catheter Requires a high volume catheter exchanged for a visceral catheterexchanged for a visceral catheter

• Patient is supinePatient is supine• CR to kidney of interestCR to kidney of interest• Filming rate of 2-3 frames/second during Filming rate of 2-3 frames/second during

the injectionthe injection• Followed by 1 frame/second for 2 secondsFollowed by 1 frame/second for 2 seconds• And 1 fame every other second for 6 And 1 fame every other second for 6

secondsseconds

filming con’t…..filming con’t…..

Start filming 30 seconds after epinephrine Start filming 30 seconds after epinephrine

3 phases should be demonstrated3 phases should be demonstrated Nephron - contrast visualized in glomeruli, Nephron - contrast visualized in glomeruli,

tubules, small veins, and capillariestubules, small veins, and capillaries

Venous - demoed by renal venographyVenous - demoed by renal venography

Arterial – demonstrates lumen size and length Arterial – demonstrates lumen size and length

ProcedureProcedure

► Introduce contrastIntroduce contrast► Give patient anestheticGive patient anesthetic► Insert needle Insert needle ► Place guide wire in artery Place guide wire in artery ► Remove needleRemove needle► Place catheter over wirePlace catheter over wire► Remove wire and inject contrastRemove wire and inject contrast► After images are taken, withdraw catheterAfter images are taken, withdraw catheter► Apply pressureApply pressure

References

Renal Angiography. (2005). Retrieved February 20, 2006 from http://renux.dmed.ed.ac.uk.

Renal Arteriography. (2004). Retrieved February 20, 2006 from http://www.lifespan.org.

Snopek, A. (1992). Fundamentals of Special Radiographic Procedures. Philadelphia, PA. WB Saunders.

Tortorici, M.R., & Apfel, P.J. (1995). Advanced Radiographic & Angiographic Procedures: With An Intro to Specialized Imaging. Philadelphica, PA: F.A. Davis Company.