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[The current status of vascular investigations in urinary pathology (author's transl)]
Insights
Renal arteriography plays a key role in diagnosing renal masses and hypertension, especially in complex cases. It aids in identifying vascular lesions in recurrent hematuria and guiding interventions for renal trauma and tumors.
Area of Science:
- Urology
- Diagnostic Imaging
- Nephrology
Background:
- Vascular investigations are crucial in diagnosing various urinary tract pathologies.
- Arteriography is a primary imaging modality for evaluating renal vasculature and detecting abnormalities.
- The utility of arteriography varies depending on the clinical presentation, including renal masses, hypertension, hematuria, trauma, and tumors.
Purpose of the Study:
- To review the current applications and diagnostic value of arteriography in urinary pathology.
- To emphasize the specific indications and limitations of arteriography in different renal conditions.
- To highlight the role of arteriography in conjunction with other diagnostic tools like intravenous urography (IVU) and echotomography.
Main Methods:
- Review of existing literature and clinical guidelines on the use of arteriography in urological conditions.
- Analysis of arteriographic findings in specific scenarios: renal masses, hypertension, hematuria, non-functioning kidneys, renal trauma, upper tract tumors, and renal insufficiency.
- Comparison of arteriography's effectiveness with other diagnostic imaging techniques.
Main Results:
- Arteriography is essential for renal masses, particularly in diagnosing 10% of uncertain cases and identifying invasion via renal vein non-opacification.
- In hypertension, its use is restricted to specific cases of sudden onset in young patients or suspected arterial obstruction.
- For isolated hematuria, arteriography, especially with angiotensin, detects vascular lesions like fistulae and angiomas; it's indicated for recurrent hematuria.
- It's indicated for non-functioning kidneys only when echotomography suggests a solid tumor, and for trauma, it's an emergency tool for non-functioning kidneys or preoperatively.
- For upper tract tumors, arteriography is valuable with calyceal amputation and parenchymal invasion; cavo-urography is preferred over arteriography in renal insufficiency.
Conclusions:
- Arteriography is a valuable diagnostic tool in specific urological conditions, offering critical information beyond initial assessments.
- Its judicious use, guided by clinical presentation and other imaging modalities, optimizes diagnostic yield and patient management.
- Understanding the limitations and specific indications of arteriography is key to its effective application in urinary pathology.
Abstract:
The author reviews the current position regarding vascular investigations in urinary pathology, with particular emphasis on arteriography.--In the presence of a renal mass. Arteriography is necessary in the presence of a mass, though bearing in mind that it offers more information about the state of the renal vessels than diagnostic arguments since the diagnosis of carcinoma of the kidney is confirmed in 9 cases out of 10 before renal arteriograms are performed. However, in the 10% of cases of doubtful diagnosis, renal arteriography offers valuable arguments in the presence of necrosed carcinomas. When the renal vein is not opacified, invasion is highly likely, and hence cavography is indicated.--In hypertension, arteriography is limited to very young sufferers with hypertension of sudden onset and in those cases where timed IVU is in favour of arterial obstruction.--In the presence of isolated haematuria, arteriography has never detected a carcinoma when the IVU is normal. By contrast, in cases of recurrent isolated haematuria, the administration of intra-arterial angiotensin before selective arteriograms or selective renal phlebograms has led to the detection of a certain number of haemorrhagic vascular lesions: arteriovenous fistulae, angiomas, varicosities.--In the presence of a true non-functioning kidney by IVU, renal arteriography is indicated only when there is a renal tumor solid by echotomography.--In renal trauma, the role of arteriography as an immediate emergency is limited to non-functioning kidneys by IVU, and as a delayed emergency preoperatively.--In tumours of the upper excretory tract, renal arteriography is of value only in tumours with calyceal amputation and invasion of the renal parenchyma.--In renal insufficiency, more information may be obtained from cavo-urography (abnormal in retroperitoneal fibrosis) than arteriography.