1. Renal Angiography Presented by Lisa Erwert

2. What is Renal Angiography and what is the prep for an exam? ► a special x-ray exam to visualize renal blood circulation ► Inform health care provider of allergies, pregnancy, or bleeding problems ► Restrict fluids and food ► Some patients are given a sedative ► Remove all jewelry

3. Kidney Anatomy

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

5. The concentration of the filtrate is altered by various processes to form urine Urine leads into the collecting duct Then drained into renal pelvis The ureter connects the renal pelvis and bladder Lastly, urine is passed out through the urethra

6. Indications for a renal angiogram Renal hypertension Renal hypertension Renal trauma Renal trauma Renal tumors Renal tumors Renal neoplasms Renal neoplasms Complications after renal transplantation Complications after renal transplantation Evaluate condition of kidneys for potential donors Evaluate condition of kidneys for potential donors

7. Pathologies

8. Renal Transplant

9. 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

10. What equipment is used for renal angiography? Usual catheterization equipment: Usual catheterization equipment: –X-ray machines –Fluoroscope with video monitor –Catheters –Flexible guide wire –Dye –Pressure-injection device

11. Renal Positioning and Filming Requires a high volume catheter exchanged for a visceral catheterRequires a high volume catheter exchanged 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 the injectionFilming rate of 2-3 frames/second during the injection Followed by 1 frame/second for 2 secondsFollowed by 1 frame/second for 2 seconds And 1 fame every other second for 6 secondsAnd 1 fame every other second for 6 seconds

12. filming con’t…..  Start filming 30 seconds after epinephrine  3 phases should be demonstrated Nephron - contrast visualized in glomeruli, tubules, small veins, and capillaries Nephron - contrast visualized in glomeruli, tubules, small veins, and capillaries Venous - demoed by renal venography Venous - demoed by renal venography Arterial – demonstrates lumen size and length Arterial – demonstrates lumen size and length

13. Procedure ► Introduce contrast ► Give patient anesthetic ► Insert needle ► Place guide wire in artery ► Remove needle ► Place catheter over wire ► Remove wire and inject contrast ► After images are taken, withdraw catheter ► Apply pressure

14. 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.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.