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MIDS 237 > Ch 22 Renal Vasculature > Flashcards

Ch 22 Renal Vasculature Flashcards

1
Q

What is a post-stenotic signal?

A

-Signal taken immediately distal to a stenosis
-Waveform shows decreased PSV

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2
Q

What is the renal-aortic velocity ratio?

A

PSV of RA / PSV of Ao

-Recorded at the level of the celiac or SMA
-Used to identify RA stenosis

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3
Q

RA stenosis is m/c due to ___ or ___?

A

Atherosclerotic disease or medial fibromuscular dysplasia

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4
Q

What is a RA stent used for?

A

Helps hold stenotic artery open, is inserted during arterial dilation (angioplasty)

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5
Q

What is the renal cortex?

A

-Outermost area of kidney tissue beneath the renal capsule
-The fibrous covering of the kidney

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6
Q

What is the renal hilum?

A

Area where RA, RV + ureter enter/exit kidney

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7
Q

What is the renal medulla?

A

-Middle area of kidney b/w sinus + cortex
-Contains pyramids

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8
Q

What is the renal ostium?

A

Opening of RA from aortic wall

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9
Q

What is renal parenchymal disease?

A

Medical disorder affecting tissue function of kidneys

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10
Q

What is the renal sinus?

A

-Central echogenic cavity in kidney
-Contains RA, RV, collecting + lymphatic systems

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11
Q

What is the SSN?

A

Indentation at base of neck where neck joins sternum

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12
Q

What is the symphysis pubis/pubic bones?

A

Prominence of pelvic bones noted in lower abdomen

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13
Q

RA stenosis is the m/c cause of what 3 things?

A

-Secondary hypertension
-Chronic renal insufficiency
-Incident end stage renal disease

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14
Q

2 main S/S of RA stenosis?

A

-Azotemia (buildup of nitrogen + creatinine in blood)
-Discrepant renal size > 1.5cm

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15
Q

Location of kidneys?

A

-Retroperitoneal
-B/w T12 + L3

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16
Q

Which kidney sits more inferior?

A

RT (due to liver)

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17
Q

Normal kidney length + width?

A

Length: 9-13cm
Width: 5-7cm

(note: size decreases with age)

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18
Q

What is the m/c organ anomaly?

A

Horseshoe kidneys

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19
Q

Horseshoe kidneys are joined at their ___ poles by an isthmus of tissue, anterior to Ao at L4 or L5?

A

Lower poles

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20
Q

When a horseshoe kidney is present, the renal arteries may be supplied by what 3 arteries?

A

-Distal Ao
-CIA
-IMA

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21
Q

What is the m/c congenital anomaly of the urinary tract?

A

Duplex collecting system (partial duplication is m/c)

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22
Q

Differentiate b/w complete + partial duplication with duplex collecting systems?

A

Complete:
-2 pelvicalyceal units
-2 ureters
-2 ureters insert separately into bladder

Partial: (m/c)
-Renal pelvis is bifid
-1 or 2 ureters (converge into 1 along course to bladder)
-1 ureter inserts into bladder

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23
Q

List the 4 renal segments?

A

Hilum:
-where RA, RV + ureter enter/exit

Sinus:
-contains RA, RV, collecting + lymphatics
-made of fat + fibrous tissue
-echogenic

Cortex:
-outermost area where urine is produced
-lies b/w pyramids
-isoechoic to liver

Medulla:
-12-18 pyramids that carry urine from cortex into pelvis
-hypoechoic

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24
Q

___ plane is an important surface landmark for sonographic localization of RA’s?

A

Transpyloric (b/w SSN + symphysis pubis)

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25
Q

RA’s branch from lateral Ao approx ___ cm below transpyloric plane?

A

2cm

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26
Q

What color will the RT + LT RA’s have with CD?

A

RT: red
LT: blue

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27
Q

What is the course of the RRA + LRA?

A

RRA:
-courses anterolaterally + then posterior to IVC + RRV

LRA:
-originates more cephalad, passes posterior to LRV + is crossed by IMV

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28
Q

RA’s give rise to how many branches that supply blood to segments of the kidney?

A

2-5 branches

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29
Q

At the hilum, the RA divides into a ___ anterior branch + a ___ posterior branch?

A

Large anterior, small posterior

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30
Q

The ant + post RA branches give rise to what 3 arteries within the renal parenchyma?

A

-Interlobar
-Arcuate
-Interlobular

31
Q

RAs lie b/w the ___ + ___ in the hilum?

A

RV + ureter

Order:
anterior: RV
mid: RA
posterior: ureter

32
Q

What is the course of the RRV + LRV?

A

RRV:
-short course from hilum to IVC

LRV:
-courses anterior to Ao, below SMA

33
Q

Is RA stenosis m/c found in men or women?

A

Men

34
Q

Atherosclerotic lesions m/c affect the ___ + ___ of the RA?

A

Ostium + prox third of RA

35
Q

What is the 2nd m/c cause of renovascular disease?

A

Medial fibromuscular dysplasia

36
Q

Medial FMD m/c affects which segments of the RA?

A

Mid-to-distal segments

37
Q

Medial FMD m/c affects males or females?

A

Females aged 25-50

38
Q

Medial FMD m/c affects the RRA or LRA?

A

RRA

39
Q

Medial FMD has what known appearance?

A

String of pearls

40
Q

What is the nutcracker syndrome (aka mesenteric compression syndrome)?

A

When the LRV gets compression by the SMA

(LRV is b/w SMA + Ao)

41
Q

RAs lie immediately inferior to which vessel?

A

LRV

42
Q

How to achieve the banana peel view?

A

-Pt in LLD
-Image Ao in SAG
-Heel toe probe for a 0 degree doppler angle
-RAs seen as they arise off lateral Ao walls

43
Q

How to identify the RRA + LRA?

A

RRA:
-easy to follow from hilum to Ao

LRA:
-hilum at 5 o’clock = will course slightly to RT before entering kidney
-hilum at 7 o’clock = will course slightly to LT before entering kidney

44
Q

Differentiate b/w accessory/duplicated RAs vs polar RAs?

A

Accessory: enter hilum
Polar: course to surface of kidney

45
Q

___ arteries are the only low-resistance vessels distal to the SMA?

A

Renal

46
Q

Where should we use spectral doppler on the kidney to assess renal perfusion?

A

-Sample throughout upper, mid + lower poles of the renal sinus, medulla + cortex
-Keep highest PSV + EDV from each segment

47
Q

Kidney length should always be measured during deep ___?

A

Inspiration

48
Q

A difference >1cm b/w kidneys suggests what?

A

Compromised flow on side with smaller kidney

49
Q

Revascularization is unlikely when kidney length is ___ cm?

A

<9cm

50
Q

The prox Ao carries blood to ___ resistance vascular beds?

A

Low-resistance (liver, spleen, kidneys)

51
Q

The mid Ao (inf to RAs) carries blood to ___ resistance vascular beds?

A

High-resistance (lumbar arteries + lower extremity arteries)

52
Q

Differentiate b/w RA stenosis <60% + >60%?

A

Stenosis <60%:
-No post stenotic turbulence
-Increase in PSV <180 cm/s

Stenosis >60%:
-Has post stenotic turbulence
-Increase in PSV > 180 cm/s
-Parvus tardus signal

53
Q

What would doppler signals show if there was RA occlusion?

A

-Absent flow in main RA

-Low amplitude + velocity signals in medulla + cortex (due to blood supply from adrenal + ureteral collaterals)

54
Q

What would the PSV in the cortex be with chronic RA occlusion?

A

< 10 cm/s

55
Q

What would the kidney length be with chronic RA occlusion?

A

<9cm (atrophic)

56
Q

What is intrinsic parenchymal dysfunction (aka medical renal disease)?

A

An accumulation of interstitial cellular infiltrates + edema, resulting in impedance to arterial inflow to kidney + increased renovascular resistance

57
Q

Spectral doppler in the presence of renal disease will show ___ resistance flow patterns?

A

High-resistance

58
Q

Formula for resistive index?

A

PSV - EDV / PSV

59
Q

RI > ___ indicates medical renal disease?

A

> 0.8

60
Q

Is AI or AT more accurate?

A

AT

61
Q

What is acceleration index (AI)?

A

Slope of systolic upstroke / transmitted frequency

(AI < 291 cm/s suggests prox flow-reducing RA stenosis)

62
Q

What is acceleration time (AT)?

A

Time interval b/w onset of systole + initial compliance peak

(AT > 100 ms suggests prox RA disease)

63
Q

A renal-aortic ratio of ___ indicates significant RA stenosis (>60%)?

A

> 3.5

64
Q

When should we NOT use the renal-aortic ratio?

A

When Ao PSV is:
>100 cm/s (increased CO = underestimation)
or
<40 cm/s (decreased CO = overestimation)

65
Q

What would the PSV + stent-aortic ratio be with RA stents?

A

PSV: >240 cm/s
Ratio: >3.2

66
Q

What imaging plane are prox RA stents best seen in?

A

TRV

67
Q

Pediatric kidney length?

A

4-6cm

68
Q

How do pediatric kidneys differ from adults?

A

-Lower in abdomen
-Cortex lobulations
-Parenchyma more echogenic
-Pyramids prominent
-Sinus less echogenic

69
Q

RA stenosis in peds is diagnosed on what 3 criteria?

A

-Elevated PSV
-Delayed systolic upstroke
-Presence of post stenotic turbulence

70
Q

RV thrombosis should be suspected in pt’s with what 2 things?

A

-Hypercoagulable states

-Suspicion of RCC or Wilms tumor with extension into RVs or IVC

71
Q

SF of acute vs chronic thrombosis?

A

Acute: dilated RV + enlarged kidney
Chronic: contracted RV + kidney atrophy

72
Q

If RV thrombosis is present, how will the RAs appear on spectral?

A

Retrograde + blunted diastolic flow

73
Q

If RV thrombosis is present, how will spectral doppler appear prox + dist to it?

A

Prox: continuous, non-phasic, low velocity flow
Dist: no/minimal flow, phasic if collaterals present

MIDS 237 (23 decks)

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