CH 10 Kidneys & Ureters

Question 1

The renal length in normal cats usually varies between ____ and ____cm.

Answer 1

3 and 4.5

Question 2

Intact/neutered cats tend to have larger kidneys.

Answer 2

Actually, several studies report different findings - some that intact have larger, others neutered larger, and a newer (2022) with 60 cats saying no sig dif.

https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.887746/full

Question 3

Kidneys become smaller/larger with age.

Answer 3

smaller

Question 4

Normal canine range for renal length:aortic diameter

Answer 4

5.5-9.1

Question 5

Normal canine range for renalength:L5

Answer 5

1.3-2.7

Question 6

Which artifact causes renal extremities to have a different echogenicity? Are they more or less echogenic?

Answer 6

Anisotropy i.e. difference in tubule angulation, may cause the renal extremities to be more echogenic.

Question 7

Answer 7

The renal cortex is hyperechoic in this cat with normal renal function, presumably due to the accumulation of lipids. Note that some areas of the cortex are more echogenic (*) because of the difference in tubule angulation (i.e., anisotropy).

Question 8

Answer 8

clinically normal 1-year-old Lhasa Apso. The outer medulla is hyperechoic, forming a band (between arrowheads) at the periphery of the inner medulla

Question 9

Subclinical renal dysplasia may have this appearance:

Answer 9

hyperechoic or speckled medulla, leading to loss of corticomedullary distinction

(Seiler et al, 2010)

Question 10

Which canine kidney conditon is more prevalent in Boxer dogs?

Answer 10

JOCKD / JN - juvenile onset CKD, juvenile nephropathy.

Question 11

(Chandler et al, 2007) JOCKD or JN commonly present with which other condition?

Answer 11

urethral sphincter mechanism incompetence

Question 12

Which part of the kidney can become hyperechoic with leptospirosis?

Answer 12

Medulla, or medulla and cortex

Question 13

Which part of the kidney can become hyperechoic with ethylene glycol toxicity?

Answer 13

Cortex

Question 14

Typical cause of this appearance and why

Answer 14

Ethylene glycol, because of oxalate crystal deposition and tubular necrosis

Question 15

The medullary rim sign is pathological - T or F?

Answer 15

Both - can be seen in pathology (acute tubular necrosis, nephrocalcinosis, pyogranulomatous vasculitis in FIP) and in normal cats/dogs.

Question 16

_____________________ may represent sentinel signs of early renal disease or past renal insult (Mantis and Lamb, 2000).

Answer 16

Renal hyperechogenicity and medullary rim sign

Question 17

Small, irregular and diffusely hyperechoic kidneys are generally indicative of ___________.

Answer 17

chronic interstitial nephritis; fibrosis causes hyperechogenicity and architectural distortion.

Question 18

2y GSD. Which part(s) of the kidney is/are abnormal?
Diagnosis?

Answer 18

The inner medulla (M) is markedly hyperechoic, while the outer medulla (arrowheads) and cortex appear normal.

Leptospirosis with acute renal insufficiency.

Question 19

cat

Answer 19

Pyogranulomatous vasculitis, FIP.
Medullary rim sign and peritoneal effusion

Question 20

Which breeds get PKD (dog and cat)?

Answer 20

Cairn terriers
Persians

Question 21

PKD can be associated with __________________.

Answer 21

chronic interstitial nephritis

Question 22

PKD cysts are located usually :

Answer 22

in the cortex or at the corticomedullary junction

Question 23

PKD can be diagnosed as early as _____

Answer 23

3 months

Question 24

Renal cysts (not PKD) can be secondary to _______.

Answer 24

CKD

Question 25

Answer 25

Nephrocalcinosis These 2 dogs had hypercalcemia. Left: cortical mineralisation Right: medullary mineralisation

Question 26

Answer 26

renal lymphoma features: - renomegaly - hyperechogenicity - hypoechoic halo - diverticula dilation

Question 27

Answer 27

Renal lymphoma, a manifestation with heterogeneity and large ill-defined hypoechoic nodules and masses distorting the architecture.

Question 28

In (species and breed), renal (type of neoplasia) is associated with dermatofibrosis.

Answer 28

GSD, cystadenocarcinoma

Question 29

Renal telangiectasia is reported in (species/breed). It is benign/malignant condition.

Answer 29

Welsh pembroke corgis benign

Question 30

Typical lesion of renal telangiectasia

Answer 30

Cavernous masses filled with blood (may mimic neoplasia).

Question 31

Because of their variable characteristics, renal pri- mary or metastatic neoplastic processes cannot be easily distinguished with ultrasonography. However, lymphoma and malignant histiocytosis (histiocytic sarcoma) tend to appear as _______________.

Answer 31

hypoechoic nodules or masses

Question 32

The kidneys can be affected by carcinomas, sarcomas, and round cell tumours - true or false?

Answer 32

True, also others - nephroblastoma

Question 33

Appearance of renal infarcts on US

Answer 33

well-defined, linear or wedge-shaped, hyperechoic lesions in the cortex perpendicular to the capsule when chronic, they cause focal cortical depressions or atrophy

Question 34

Answer 34

embolic infarcts the hypoechoic focus (arrow) represent a septic embolism

Question 35

Answer 35

infarct

Question 36

Causes of pyelectasia ?

Answer 36

IVFT diuretic therapy diuresis due to CKD or other polyuric disease pyelonephritis ureteritis distended bladder ectopic ureter

Question 37

The term hydronephrosis is used over pyelectasia when ------

Answer 37

obstruction is present

Question 38

A pelvic height of _____ is predictive of obstruction. Why is this not a perfect marker?

Answer 38

≥13mm However, the pelvic height can remain at ≤ 2 mm with partial obstruction

Question 39

What is pyonephrosis?

Answer 39

pyelonephritis + hydronephrosis a urinary obstruction with infection

Question 40

When combining radiography and ultrasonography, the sensitivity to detect urolithiasis in cats has been reported to reach __% (Kyles et al. 2005).

Answer 40

90

Question 41

Using which modality/ies is the sensitivity of detecting urolithiasis in cats reported to reach 90%? (Kyles et al. 2005)

Answer 41

combining radiography and ultrasonography

Question 42

Congenital ectopic ureters are more common in male/female dogs.

Answer 42

female

Question 43

Where do ectopic ureters commonly and less commonly terminate?

Answer 43

the urethra, most commonly, or the vagina or the colon

Question 44

Ectopic ureters are usually hard to follow because of their small size - true or false?

Answer 44

False - These ureters are often distended because of partial obstruction at the site of termination or intramural tunneling, ileus, and/or ascending infection.

Question 45

Visualization of a urine jet into the bladder lumen excludes the possibility of ectopic ureters - true or false?

Answer 45

False - there is still the possibility of a tunneling ectopic ureters with multiple fenestrations.

Question 46

Which other congenital condition (of the ureter) is sometimes present concurrently with ectopic ureter(s)?

Answer 46

Ureterocele is another congenital ureteral malformation, which can sometimes be associated with ectopia (Stiffler et al. 2002). An intravesical ureterocele is characterized by a focal cystic dilatation of the distal submucosal portion of the ureter that protrudes into the bladder lumen (see Figure 11.31). A thin-walled, round structure containing anechoic fluid can be observed within the neck of the bladder by means of ultrasonography (Stiffler et al. 2002).

Question 47

According to a report on 26 cats, subcapsular perirenal pseudocysts are formed by accumulation of a__________(tyoe of fluid) between the capsule and parenchyma of the kidney, because of underlying __________, and may contribute to abdominal discomfort (Beck et al. 2000). ________ may also be contained in these pseudocysts (Ochoa et al. 1999).

Answer 47

transudate parenchymal disease Urine

Question 48

Ddx for perinephric pseudocyst? especially with trauma history

Answer 48

urinoma