Renal Procedures

Renal Arteriography

A renal arteriogram is a special type of X-ray picture that helps doctors see the blood vessels in your kidneys. This exam is used for patients who have high blood pressure that may be caused by a kidney problem. It is also helpful in patients who may have a kidney artery that is closed or whose arteries are inflamed.

This procedure is performed by a radiologist who is assisted by specially trained nurses and technologists. Using a needle, the doctor inserts a thin wire into a large artery in the groin area. This wire is used to guide a small tube called a catheter into the large artery leading to your kidneys. Once the catheter is in place, the X-ray dye is injected through the catheter, and X-rays are taken of the arteries.

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Renal Angioplasty

Renal angioplasty is a procedure performed to improve blood flow to the kidney. A balloon catheter is inserted through an artery (usually through the femoral artery in the groin area) and passed through your bloodstream to the narrowed artery in the kidney. The balloon is inflated to help redistribute the fat deposits within the inner walls of the artery, improving the blood flow.

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Renal Stents

Percutaneous transluminal angioplasty is a procedure done to improve blood flow to a blocked artery. A balloon catheter is inserted into the blockage and inflated to compress the fat deposits within the inner wall, thereby improving blood flow. At times, re-closure can occur. To offset this possibility, the stent was developed. A stent is a tiny coiled wire or mesh that is permanently placed at the angioplasty site to maintain the new opening. This is often done after a recent blocked artery.

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Renal Venous Sampling

Renal venous sampling is used to measure renal renin secretion by selective sampling of renal vein blood. The test is used to select hypertensive patients with renal artery blockages who may benefit from renal artery dilation or surgery.

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Percutaneous Nephrostomy Tube Placement

Percutaneous nephrostomy or nephropyelostomy is an interventional procedure used mainly to open a blocked kidney waste collection system. The main reason that percutaneous nephrostomy tubes are placed is for temporary urinary diversion due to urinary obstruction secondary to calculi. Other common indications include:

  • Diversion of urine from the renal collecting system in an attempt to heal fistulas or leaks due to traumatic or iatrogenic injury, malignant or inflammatory fistulas or hemorrhagic cystitis
  • Treatment of nondilated obstructive uropathy
  • Treatment of urinary tract obstruction related to pregnancy
  • Treatment of complications related to renal transplants
  • Access for interventions such as direct infusion of substances for dissolving stones, chemotherapy and antibiotic or antifungal therapy
  • Access for other procedures (eg, benign stricture dilatation, antegrade ureteral stent placement, stone retrieval, pyeloureteroscopy, endopyelotomy)
  • Decompression of nephric or perinephric fluid collections (eg, abscesses, urinomas)

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Percutaneous Nephroureterostomy Tube Placement

Similar to a nephrostomy, but differs in that a longer tube is used and the distal end is placed in the bladder or ileal conduit to allow both internal and external drainage of urine.

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Ureteral Dilatation

Abnormalities of the smooth muscle of the urethra or nerve supply may cause partial or total ureteral dilation or obstruction. Prognosis depends on the integrity of nearby muscles of the ureter. Treatment is surgical.

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Treatment of Ureteral Occlusion

Urinary fistula after treatment for cancer poses a dilemma for your physicians, especially in patients who have had various other treatments. Patients with urinary leakage can be treated conservatively with percutaneous transrenal balloon catheters.

If a patient has persistent urinary leakage despite treatments and catheter drainage, then further procedures may be suggested by your physician, such as placement of small Foley balloon and angioplasty catheters. These devices are inserted under the skin and into the affected areas.

Long-term ureteral occlusion with percutaneous transrenal balloon catheters appears to be safe. Using this approach, urinary fistulas can heal in some patients without the need for open surgery.

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Urinary Tract Dilatation for Lithotripsy

Without entering the kidney with surgery, kidney stones can be broken up with high-energy sound waves. The process uses a device called a lithotriptor. One type uses sound waves, while the other type uses ultrasound (sound waves we cannot hear). These waves travel easily through the soft tissues of the body without any damage. The stones absorb the energy from these waves and break up. Stone fragments are then passed in the urine. The treatment is not painful, but passing the stone fragments may be. For this reason, the urinary tract is dilated for lithotripsy. Certain types of stones will respond to this treatment better than others.

If lithotripsy is indicated, stone removal may be fairly simple. Your recovery time will be much shorter than with surgery. However, this procedure does not alter the reasons that the stones formed. To prevent future stone development, follow the therapy and dietary changes that your health care provider recommends.