Nephrology focuses on diagnosing and treating kidney diseases. The kidneys filter waste, balance fluids, regulate blood pressure, and manage acute and chronic conditions.
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High blood pressure caused by a narrowed renal artery (renal artery stenosis) can be treated directly by an interventional radiologist. This procedure is called angioplasty.
The doctor inserts a thin tube called a catheter into a blood vessel in the groin or wrist. Using X-ray guidance (fluoroscopy), they navigate this catheter up to the renal artery. Once at the blockage, a tiny balloon at the tip of the catheter is inflated. This pushes the plaque against the artery wall, opening the vessel and restoring blood flow to the kidney. Often, a small metal mesh tube called a stent is left in place to keep the artery open permanently. This procedure improves blood flow, can cure or improve high blood pressure, and helps preserve kidney function.
Occasionally, the goal is to stop blood flow rather than start it. Embolization is a procedure used to block blood vessels. This therapy is commonly used for kidney tumors or to stop severe bleeding from a trauma or biopsy complications.
The radiologist guides a catheter to the specific vessel feeding the tumor or the bleeding site. They then inject tiny particles, coils, or glue to block the vessel. By cutting off the blood supply, a tumor can be starved and shrink (used for angiomyolipomas or before cancer surgery). In trauma cases, embolization can stop life-threatening bleeding without the need to remove the kidney surgically, saving the organ.
For small kidney cancers in patients who are not good candidates for major surgery, interventional radiology offers a curative option called ablation. This technique destroys the tumor without cutting it out.
The doctor inserts a special needle through the skin of the back, directly into the tumor, guided by CT or ultrasound. Once the needle is in place, energy is applied. Radiofrequency ablation uses heat to cook the tumor cells, while cryoablation uses extreme cold to freeze them. The dead tumor cells are gradually reabsorbed by the body. This procedure enables the treatment of kidney cancer in elderly or frail patients, requiring only an overnight hospital stay or even an outpatient procedure.
When a kidney is blocked by a stone or tumor and urine cannot drain into the bladder, it causes pain and infection. An interventional radiologist can place a nephrostomy tube to bypass the blockage.
Using ultrasound and X-ray guidance, a thin tube is inserted through the skin of the back directly into the kidney’s collection system. This tube drains the urine into a bag outside the body. It relieves the pressure instantly and allows the kidney to recover from infection. Once the blockage is treated (for example, the stone is removed), the tube is removed. is a life-saving procedure for patients with infected, obstructed kidneys (sepsis).
We previously discussed biopsies as a diagnostic tool, but the act of performing a biopsy is a treatment procedure handled by the radiology team.
Using ultrasound or CT guidance ensures the needle hits the exact spot needed while avoiding major blood vessels. This precision reduces the risk of bleeding and ensures that the sample taken contains enough tissue for a diagnosis. It transforms a “blind” procedure into a precise, targeted intervention.
Recovery from interventional radiology procedures is generally quick. Patients might lie flat for a few hours to prevent bleeding at the puncture site. Most go home the same day or the next day.
Follow-up imaging is essential. If a stent was placed, a Doppler ultrasound might be done a few months later to ensure it is still open. If a tumor was ablated, a CT scan or MRI is done every few months (for example, every three, six, or twelve months) to make sure it hasn’t come back. This surveillance is a key part of the treatment plan, ensuring long-term success and catching any recurrences early when they are easiest to treat.
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You are given sedation and local anesthesia, so you typically don’t feel pain. You might feel some pressure when the balloon is inflated. The puncture site in the groin may be sore for a few days.
There is a small chance of recurrence, which is why follow-up scans are mandatory. However, success rates for small tumors are very high, comparable to surgery.
The tube stays in until the blockage (like a stone) is treated by a urologist. This could be a few days or a few weeks.
Yes, fluoroscopy (live X-ray) is used to guide catheters. The doctors use the minimum amount necessary and shield body parts not involved in the procedure.
You should rest for a few days to a week to allow the puncture site to heal. Your doctor will give you specific activity restrictions based on the procedure.
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