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SON130 > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

What are the two principle functions of the urinary system?

A

Two principle functions- excreting wastes and regulating composition of blood.

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2
Q

True or false: Kidneys are within the retroperitoneum

A

True

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3
Q

Where are the renal pyramids located?

A

Renal pyramids are within the medulla

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4
Q

What do the nephrons do?

A

Numerous collecting tubules (nephrons) bring the urine from its site of formation in the cortex to the pyramids.

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5
Q

What is the relationship of the renal artery to the renal vein?

A

Renal artery is posterior and superior to the renal vein

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6
Q

What is the Gerota’s Fascia?

A

Renal fascia, known as Gerota’s fascia surrounds the true capsule and perinephric fat.

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7
Q

What do nephrons filter?

A

Nephrons filter the blood and produce urine

Consist of two main structures—renal corpuscle and renal tubule

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8
Q

Where is blood filtered?

A

Blood is filtered in the renal corpuscle

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9
Q

What is urine made up from?

A

Waste products, excess water, and other substances not needed by the body pass into the collecting ducts as urine

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10
Q

Define urethra

A

Urethra is a membranous tube that passes from the anterior part of the urinary bladder to the outside of the body (not routinely visualized)

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11
Q

What is the urinary bladder lined by?

A

Urinary bladder is lined by an elastic material, it is thin when the bladder is distended and a series of folds when empty (appears thicker)

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12
Q

Where does the ureter leave from? and enters what?

A

Ureter leaves renal pelvis and at its distal end enters the bladder along the lateral wall

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13
Q

What are the urinary bladder openings for?

A

Urinary bladder is a large muscular bag
Posterior and lateral opening for the ureters
Anterior opening for the urethra

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14
Q

What is the arterial supply to the kidney?

A

Arterial supply to the kidney is provided by the main renal artery
Divides into branches as it enters the hilus of the kidney

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15
Q

Where does the main renal vein drain into?

A

Emerges from the hilus anterior to the renal a. and drains into the lateral wall of the IVC

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16
Q

What kind of blood does renal veins return?

A

Renal vein returns cleansed blood to the general circulation

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17
Q

Where do lymphatic vessels follow?

A

Lymphatic vessels follow renal artery to the lateral aortic lymph nodes near the origin of the renal artery

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18
Q

Physiology of the urinary system?

A

Remove waste from the blood and produce urine

Excretion- the disposal of metabolic waste

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19
Q

Define excretion

A

the disposal of metabolic waste

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20
Q

What kind of products does the urinary system remove?

A

This entails separating and removing substances harmful to the body—metabolic waste products are: water, carbon dioxide, and nitrogenous wastes ( urea, uric acid, and creatinine)

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21
Q

What are some lab tests that are performed?

A 
Lab Tests
Urinalysis
Urine PH
Specific gravity
Blood (Hematuria)
Hematocrit
Hemoglobin 
Protein
Creatinine clearance
Blood Urea Nitrogen (BUN)
Serum Creatinine
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22
Q

Sonographic evaulation can define what?

A

Renal masses
Perirenal fluid collections (hematoma or abscess)
Determine renal size and parenchymal detail
Detect hydronephrosis and dilated ureters
Detect congenital anomalies

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23
Q

if two separate areas of renal sinus are seen, what would you question?

A

If two separate areas of renal sinus are identified then you must question a double collecting system (2 renal pelvis & 2 ureters)

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24
Q

What does the renal parenchyma surrounds?

A

Renal parenchyma surrounds the fatty central renal sinus, which contains the calyces, infundibula, pelvis, vessels, and lymphatics

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25
Q

Kidneys are surrounded by what?

A

Kidneys- smooth outer contours surrounded by reflected echoes of perirenal fat

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26
Q

What are patient positions for a renal exam?

A

Supine or decubitus

Subcostal or intercostal approach (try different windows)

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27
Q

What can obscure the renal detail?

A

Renal detail may be obscured if the patient has hepatocellular disease, gallstones, rib shadow or large habitus

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28
Q

from where to where is the parenchyma from?

A

The parenchyma is from the renal sinus to the renal surface

Cortex is less echogenic than the liver

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29
Q

What vessels are found within the parenchyma?

A

Arcuate arteries and interlobar vessels are found within

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30
Q

What are the two diseases of the parenchyma?

A

Type I- Increase echogenicity of the cortex

Type II- Any mass lesions, including cysts, tumors, abscesses, and hematomas

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31
Q

Where do the renal arteries extend from?

A

Renal arteries extend from the lateral walls of the aorta and enter the central renal sinus
Renal arteries are posterior to the veins

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32
Q

where do the renal veins extend from?

A

Renal veins extend from the central renal sinus and enter the IVC
Both are seen best in transverse as tubular structures

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33
Q

What does the medulla consists of?

A

Consist of hypoechoic pyramids
Should be uniform in distribution and separated by bands of parenchyma
Pyramids are also uniform in size and shape (triangular)

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34
Q

What does the apex and base adjacent to?

A

Apex points to the sinus and the base is adjacent to the renal cortex

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35
Q

Where do the interlobar and arcuate vessels lie?

A

Interlobar arteries lie alongside the pyramids and arcuate vessels lie at the the base

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36
Q

define columns of bertin

A

Prominent invaginations of cortex located at varying depths within medullary substance
Most exaggerated in patients with a complete or partial duplication
Sonographic findings
Echogenicity similar to cortex

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37
Q

define dromedary hump

A

A bulge of cortical tissue on the lateral surface of a kidney (usually left)
May resemble renal neoplasm
Sonographic Findings
Echogenicity identical to cortex

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38
Q

Define junctional parenchyma defect

A

Triangular, echogenic area typically located anteriorly and superiorly
Result of partial fusion of two ranunculi during normal development
Sonographic Findings
Best seen in sagittal

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39
Q

define fetal lobulation

A

Developmental variation that is usually present in children and may be persistent in adults
Surfaces of the kidney are indented between calyces
Giving a lobular appearance

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40
Q

define Sinus Lipomatosis

A

A condition characterized a deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy
Enlargement of the sinus with increased echogenicity
Occasionally a fatty mass is localized in only one area; this is called lipomatosis

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41
Q

define extrarenal pelvis

A

Larger with long major calyces

Seen outside of the renal sinus

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42
Q

sonographic findings of extrarenal pelvis

A

Central cystic area that may be partially or entirely beyond the confines of the renal substance
Transverse is best for viewing continuity with renal sinus
Dilated extrarenal pelvis will usually decompress when the patient is placed in prone

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43
Q

define renal agenesis

A

Renal agenesis- absence of kidney

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44
Q

define renal hypoplasia

A

Renal hypoplasia- incomplete development of the kidney-usually fewer than 5 calyces

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45
Q

define incomplete duplication

A

Incomplete duplication- incomplete, or partial duplication- 2 collecting systems & 2 ureters that join prior to entering the bladder

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46
Q

define complete duplication

A

Complete duplication- rare, 2 collecting systems and 2 ureters that enter the bladder separately

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47
Q

define renal ectopia

A

Renal ectopia- a kidney that is not located in its usual position
Crossed renal ectopia- fused and nonfused—fused both kidneys on the same side

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48
Q

define horseshoe kidney

A

Horseshoe kidney- Most common anomaly, fusion of the lower poles occurs most often

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49
Q

What should you check prior to an exam?

A

Prior to the exam always review patient chart, labs, and look for previous exams

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50
Q

Renal masses are categorized how?

A

Renal masses are categorized as cystic, solid or complex

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51
Q

Define cystic mass

A

Smooth, thin well-defined border, round or oval, sharp interface between the cyst and renal parenchyma, anechoic, and increased posterior enhancement

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52
Q

define solid mass

A

Irregular borders, poorly defined interface between the mass and the kidney, low-level internal echoes, weak posterior border because of attenuation, and poor through-transmission

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53
Q

define complex mass

A

Cystic and solid—necrosis, hemorrhage, abscess, and calcification within the mass

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54
Q

Define lower urinary tract

A

Stricture with ureter
Narrowing due to fibrosis- common form
Other causes as well

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55
Q

define ureterocele

A

Cystlike enlargement of the lower end of the ureter caused by congenital or acquired stenosis of the distal end of the ureter
Usually small and asymptomatic, although they may cause an obstruction

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56
Q

define ectopic ureterocele

A

Ectopic ureterocele
Rare and found more commonly in children and young adults, typically females
Usually associated with complete ureteral duplication

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57
Q

TA sonography will allow visualization of most lesions greater than what?

A

Transabdominal sonography will allow visualization of most lesions greater than 5 mm
The bladder should be distended to evaluate

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58
Q

If outflow obstruction is a concern what should be done?

A

If outflow obstruction is a concern a residual bladder volume is done.
Measured in 3 planes at the largest dimensions
Residue of less than 20 ml of urine is considered normal

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59
Q

define renal cystic disease

A

The disease may be acquired or inherited

May occur in the cortex, medulla, or renal sinus

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60
Q

Define simple renal cyst

A

Most common renal mass lesion is a simple cortical renal cyst
Acquired, unknown origin
Estimated they occur in 50% of the population over 50
Most are asymptomatic
Usually an incidental finding
Solitary or multiple, involving one or both kidneys
Unusual in children

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61
Q

Ultrasound findings of a simple renal cyst

A

Round or oval, posterior enhancement, thin walls

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62
Q

If it does not meet the criteria for a simple cyst then is it what?

A

If it does not meet the criteria for a simple cyst then it is complex and considered malignant until proven otherwise
Complex
Thick walls, may contain septation, calcifications, internal echoes, and mural nodularity

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63
Q

ultrasound findings of a complex cyst

A

Ultrasound findings
Thick walls- anything over 1mm—cystic form of renal cell carcinoma often presents this way
Most of the time internal echoes are a result of protein content, hemorrhage, and/or infection
Irregularity at the base of a cyst should be considered malignant growth
Vascularity within the cyst is concerning

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64
Q

define parapelvic cyst

A

Originates from the renal sinus and most likely lymphatic in origin
Does not communicate with the collecting system

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65
Q

Clinical findings of parapelvic cyst

A

Usually asymptomatic but may cause pain, hematuria, hypertension, or obstruction

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66
Q

sonographic findings for parapelvic cyst

A

Sonographic findings
Well-defined anechoic mass
May have irregular borders because it may compress adjacent renal sinus structures
May cause obstruction
Should be able to differentiate from hydro by trying to connect to a dilated central pelvis

67
Q

Define Von Hippel-Lindau

A

Genetic disorder
Several areas of the body may be affected
Retinal angiomas
Cerebellar hemangioblastomas
Variety of abdominal cyst and tumors
Renal cell carcinoma in patients with this disease is multifocal and bilateral
High incidence of renal cyst with VHL

68
Q

define tuberous Sclerosis

A

Genetic disorder characterized by mental retardation, seizures, and adenoma sebaceum
Associated renal lesions include multiple renal cysts or angiomyolipomas
May be difficult to separate from adult polycystic kidney disease

69
Q

define Acquired Cystic Kidney Disease (ACKD)

A

Found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis

70
Q

Patients with ACKD have a increase risk of what?

A

Patients with this condition have shown a slight increase risk in renal cyst, adenomas, and renal carcinoma
Incidence in having these masses increase with time, particularly after the first 3 years of dialysis

71
Q

Ultrasound findings of ACKD

A

Small echogenic kidneys with several small cysts
May have internal echoes within cyst because of hemorrhage
Possible renal carcinoma- mass with internal echoes, nodularity and increased vascularity on color Doppler

72
Q

Define Autosomal Recessive Polycystic Kidney Disease (ARPKD)

A

Infantile polycystic disease
Rare genetic disorder
Dilation of the collecting tubules causes renal failure
Renal function is usually decrease secondary to hepatic problems when it appears later in life

73
Q

Perinatal form is found where? and cause what?

A

Perinatal form is found in utero and usually progresses to renal failure—causing pulmonary hypoplasia and intrauterine demise

74
Q

Define Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A

Adult polycystic kidney disease
Common genetic disease that occurs in both men and women
Bilateral disease and characterized by enlarged kidneys with multiple asymmetrical cyst varying in size and location in the renal cortex and medulla
Progressive and doesn’t usually clinically manifest until the fourth and fifth decades when hypertension or hematuria develops

75
Q

Clinical symptoms of ADPKD

A

Clinical symptoms- pain, hypertension, palpable mass, hematuria, headache, urinary tract infection, and renal insufficiency

76
Q

define Multicystic Dysplastic Kidney (MCDK)

A

Common nonhereditary renal dysplasia that usually occurs unilaterally
Kidney functioning poorly if at all
Most common form of cystic disease in neonates
Dysplastic changes usually involve the entire kidney
Bilateral (MCDK)- incompatible with life

77
Q

If a MCDK kidney is not removed what kind of complications can occur?

A

If not kidney is not removed complications include- hypertension, hematuria, infection and flank pain. Slight increased risk of malignancy

78
Q

Ultrasound findings of MCDK

A

Neonates and children- multicystic, absence of renal parenchyma, sinus and atretic renal artery
Adults- kidneys are small and echogenic (atrophic and calcified), may have ureteral atresia, contralateral ureteropelvic obstruction and a nonfunctioning kidney

79
Q

Most common form of cystic disease in neonates

A

Multicystic Dysplastic Kidney (MCDK)

80
Q

Define medullary sponge kidney (MSK)

A

Development anomaly that occurs in the medullary pyramids
Consist of cystic or fusiform dilation of the distal collecting ducts causing stasis of urine and stone formation
May be unilateral or segmental
Cause is unknown

81
Q

Clinical symptoms of MSK

A

Many patients are asymptomatic, but patients with hematuria, infection, and renal stones should be evaluated for medullary sponge kidney.

82
Q

What can MSK be associated with?

A

MSK may be associated with Beckwith-Wiedemann syndrome, polycystic kidney disease, Caroli’s disease, and congenital hepatic fibrosis

83
Q

define Medullary Cystic Disease (MCKD) and Nephronophthisis (NPH)

A

Inherited disorders that eventually lead to end-stage renal disease
They share many features
Cyst are restricted to the renal medulla or corticomedullary border
Lead to scarring and cyst
Kidneys do not concentrate the urine enough, leading to excessive urine production and loss of sodium and other chemical changes in the blood and urine
(MCKD) occurs in older adults
(NPH) occurs in young children

84
Q

Cysts of MCKD and NPH are restricted to what?

A

Cyst are restricted to the renal medulla or corticomedullary border

85
Q

Ultrasound findings of MCKD and NPH

A

Small echogenic kidneys, with loss of corticomedullary differentiations, and multiple medullary small cyst

86
Q

Define renal cell carcinoma

A

Also called hypernephroma or Grawitz’s tumor
Most common of all renal neoplasms and represents 85% of all kidney tumors
More common in males 2:1
Usually seen in the sixth and seventh decades

87
Q

Clinical symptoms of renal cell carcinoma

A

Hematuria, flank pain, and palpable mass

88
Q

What is renal cell carcinoma associated with?

A

An association with von Hippel-Lindau disease, dialysis patients, and tuberous sclerosis.

89
Q

Sonographic findings of renal cell carcinoma

A

Sonographic findings
Most are isoechoic, but may be hyperechoic
The larger the tumor the more heterogeneous caused by hemorrhage and necrosis
Intratumoral calcifications
Could be cystic
Vascularity is appreciated in 92% of cases
Renal vein and IVC invasion occur in 5%-24% cases at the time of diagnosis

90
Q

define transitional carcinoma (TCC)

A

Account for 90% of all malignancies that involve the renal pelvis, ureter, and bladder and up to 7-10% of all renal tumors
Tumor is often multifocal
Occurs in men 2:1
Peak occurrence in the seventh decade
Most commonly seen in the urinary bladder
Small TCC’s are generally high-grade malignancies and metastasize easily to other tissues and organs

91
Q

clinical symptoms of TCC

A

Clinically

May present with gross or microscopic hematuria and flank pain

92
Q

ultrasound findings of TCC

A

Ultrasound Findings
Typically hypoechoic within collecting system
May invade adjacent renal parenchyma and form an infiltrating mass

93
Q

define Squamous Cell Carcinoma

A

Rare, highly invasive with poor prognosis

94
Q

clinical symptoms of squamous cell carcinoma

A

Gross hematuria, palpable kidney secondary to hydro

95
Q

ultrasound findings of squamous cell carcinoma

A

Large mass in renal pelvis

Obstruction from kidney stones may also be present

96
Q

define renal lymphoma

A

Primary is rare, secondary form is more common
Hematogenous spread spread in 90% of cases, can be direct extension via the retroperitoneal lymph nodes
Lymphoma is more common as a bilateral invasion with multiple nodules

97
Q

Ultrasound findings of renal lymphoma

A

Enlarged hypoechoic kidneys
Highly hypoechoic renal tumors with poorly defined margins without posterior enhancement (can be mistaken for renal cysts)

98
Q

define Nephroblastoma or Wilms’ Tumor

A

Most common abdominal malignancy in children
Most common solid renal tumor in patients 1-8 years old
Peak incidence is seen at 2.5 to 3 years old
2-8 times more common in patients with horseshoe kidney

99
Q

Most common abdominal malignancy in children

A

Wilms’ Tumor

100
Q

Most common solid renal tumor in patients 1-8 years old

A

Wilms’ Tumor

101
Q

Clinical symptoms of Wilms’ Tumor

A

Abdominal flank mass, hematuria, fever, anorexia

102
Q

Sonographic findings of Wilms’ Tumor

A

Determine cystic or solid and confirm if it is renal in origin
Mass varies from hypoechoic to moderately echogenic
5-10% bilateral
Up to 40% have renal vein thrombosis and/or vena cava or atrial thrombus by the time of diagnosis
Venous obstruction may result in leg edema, varicocele, or Budd-Chiari syndrome

103
Q

Define lipomas

A

Consist of fat cells
More common in females
Has been reported to cause hematuria

104
Q

ultrasound findings of lipomas

A

Well-defined echogenic mases

105
Q

Define lupus nephritis

A

Kidneys are involved in more than 50% of patients with lupus

Females are affected more often and peak incidence is between 20-40 years of age

106
Q

Clinical symptoms of lupus nephritis

A

Hematuria, proteinuria, hypertension, renal vein thrombosis, and renal insufficiency

107
Q

ultrasound findings of lupus nephritis

A

Renal atrophy and increased echogenicity of the cortex

108
Q

define Hypertensive Nephropathy

A

Uncontrolled hypertension can lead to progressive renal damage and azotemia

109
Q

Ultrasound findings of hypertensive nephropathy

A

Small kidneys

Scaring may be seen

110
Q

define renal atrophy

A

Results from numerous disease processes

Renal sinus lipomatosis occurs secondary to renal atrophy

111
Q

ultrasound findings of renal atrophy

A

Kidneys appear enlarged

Echogenic, enlarged sinus and a thin cortex

112
Q

where can Acute Renal Failure occur?

A

May occur in prerenal, renal, or postrenal failure stages

113
Q

What are the causes of acute renal failure?

A 
Prerenal:
Hypoperfusion of the kidney
Renal:
Parenchymal diseases
Renal vein thrombosis or renal artery occlusion
Postrenal:
Result of outflow obstruction
Increased in patients with malignancy of bladder, prostate, uterus, ovaries or rectum
114
Q

Ultrasound findings of acute renal failure

A

The cause can be determined—urinary outflow obstruction vs. parenchymal disease
Size- normal to enlarged
May be hypoechoic with parenchymal diseases
Most important issue is the presence or absence of urinary tract dilatation
Sonographer should try to determine the level of obstruction
A normal sonogram does not totally exclude a urinary obstruction

115
Q

define Acute Tubular Necrosis (ATN)

A

Most common medical renal disease to produce acute renal failure—can be reversible

116
Q

ultrasound findings of acute tubular necrosis (ATN)

A

Bilaterally enlarged kidneys
Hyperechoic pyramids
Can revert to a normal appearance
Differential- nephrocalcinosis- too much calcium deposited in the kidneys (similar ultrasound appearance)

117
Q

Define Chronic Renal Disease

A

The loss of renal function, most commonly a result of parenchymal disease

118
Q

what are the 3 primary types of chronic renal failure?

A

Nephron, vascular, and interstitial

119
Q

What diseases can lead to renal failure?

A

Glomerulonephritis, chronic pyelonephritis, renal vascular disease, and diabetes are a few diseases that lead to renal failure

120
Q

ultrasound findings of chronic renal failure?

A

Diffusely echogenic kidney
If chronic renal disease is bilateral, small kidneys are identified
May result from hypertension, chronic inflammation, or chronic ischemia

121
Q

Define hydronephrosis

A

Dilatation of the pelvocalyceal system is called hydronephrosis

122
Q

What are the grades of hydronephrosis?

A

Grade 1-Small amount of fluid in the renal pelvis
Grade 2- dilatation of some but not all calyces
Grade 3- complete pelvocaliectasis; echogenic line separating collecting system from renal parenchyma can be seen
Grade 4- prominent dilatation of the collecting system, thinning of renal parenchyma and no differentiation between collecting system and the parenchyma

123
Q

With hydro, what should you always look for?

A

Always look for Ureteral Jets– complete vs. partial obstruction can be evaluated—patients who have recently voided may not see jets

124
Q

ultrasound findings of hydronephrosis

A

Whenever the renal collecting system is dilated, scan the ureters and bladder to locate the level of obstruction
Ureteropelvic junction obstruction- collecting system dilated without dilation of the ureter
Ureterovesical junction obstruction- hydronephrosis with dilated ureter
Posterior urethra obstruction- hydroureteronephrosis with a dilated bladder- posterior urethral valves
A mildly distended pelvis can be caused by overhydration
You should always take post-void images after your exam is complete if a patient has hydro

125
Q

define ureteropelvic junction obstruction

A

collecting system dilated without dilation of the ureter

126
Q

define Ureterovesical junction obstruction

A

hydronephrosis with dilated ureter

127
Q

define Posterior urethra obstruction

A

Posterior urethra obstruction- hydroureteronephrosis with a dilated bladder- posterior urethral valves

128
Q

define Nonobstructive Hydronephrosis

A

Dilation of the renal pelvis without obstruction

129
Q

causes of nonobstructive hydronephrosis

A

Dilation of the renal pelvis without obstruction
Reflux
Infection
Large extrarenal pelvis
Distended bladder
Pregnancy (more often on the right in 3rd trimester)

130
Q

What are the renal infections?

A

Pyonephrosis- pus is within the collecting system- requires urgent IV antibiotics and/or percutaneous drainage
Ultrasound- low level echoes with a fluid-debris level
Emphysematous Plyelonephritis- air is seen in the parenchyma (diffuse gas-forming parenchymal infection)—may cause for emergency nephrectomy
Ultrasound- enlarged kidneys appear hypoechoic and inflamed
Xanthogranulomatous Pyelonephritis- uncommon, associated with chronic obstruction and infection. Parenchyma destruction occurs, more common in females and poorly understood

131
Q

Define Pyonephrosis

A

pus is within the collecting system- requires urgent IV antibiotics and/or percutaneous drainage

132
Q

define Emphysematous Plyelonephritis

A

air is seen in the parenchyma (diffuse gas-forming parenchymal infection)—may cause for emergency nephrectomy

133
Q

define Xanthogranulomatous Pyelonephritis

A

uncommon, associated with chronic obstruction and infection.

134
Q

Ultrasound findings of renal infections

A

Ultrasound- Bright echogenicity from staghorn calculus, renal parenchyma is replaced by cystic spaces. Increased renal size

135
Q

Define renal calcifications

A

Localized parenchymal calcifications- scar tissue caused by bacterial infection, renal abscess, infected hematoma, urinoma, lymphocele, tuberculosis (TB), infarction, or post percutaneous procedures
Malignant solid and/or cystic lesions often have calcifications
Benign renal masses may also calcify
Linear vascular calcifications are associated with renal artery atherosclerosis or vascular malformation
Most intraluminal calcifications are renal calculi

136
Q

Define nephrocalcinosis

A

Parenchymal calcification is usually located in the medulla but can be seen in the renal cortex
Disorder where too much calcium is deposited in the kidney
Both kidneys are affected
Medullary nephrocalcinosis occurs with many disorders- hyperparathyroidism (40%)

137
Q

what does ultrasound evaluate for nephrocalcinosis?

A

Ultrasound- Cortical & medullary
Cortical- increased echogenicity of the cortex with spared pyramids
Medullary- pyramids are more echogenic than cortex
Corticomedullary form exist as well

138
Q

Define Renal Artery Stenosis

A

Most common correctable cause of hypertension

139
Q

Most common causes of renal artery stenosis (RAS) is

A

atherosclerosis and fibromuscular dysplasia

140
Q

What is associated with hypertension?

A

Atherosclerosis is associated with hypertension, more common in older adults–1/3 of cases of RAS

141
Q

What is associated with renal artery stenosis that involved 2/3 cases?

A

Fibromuscular dysplasia- 2/3 of cases of RAS, in younger patients.
May involve in layer of the renal artery wall- medial layer involvement is seen most often
Replacement of smooth muscle with ridges occurs and causes stenosis “string of beads” on CT angiography
Progressive and may involve other vessels

142
Q

ultrasound findings of renal artery stenosis

A

Ultrasound Findings
Selective renal arteriography is the gold standard for visualizing RAS
With sonography accuracy depends on operator, patient habitus, and adequacy of technique
Color Doppler and PW are used in sonography
Evaluation of MRA (Direct) and arcuate and intralobar renal arteries (indirect)
MRA increased velocity > 150 to 190 cm/sec and turbulence distal to narrowing
RI > .70- abnormal
Tardus-parvus has been used to describe a waveform with a decreased acceleration time and decreased peak Fig. 14-86 D
Review RAS pages 404-405 and images

143
Q

What RI is considered abnormal for RAS?

A

RI > .70- abnormal

144
Q

define renal infarction

A

Occurs when part of the tissue undergoes necrosis—usually a result of arterial occlusion
Renal function is usually normal

145
Q

What can renal infarction result from?

A

May result from: thrombus, tumor infiltration or obstruction, or be iatrogenic.

146
Q

Ultrasound findings of renal infarction

A

Ultrasound Findings
Infarcts within the parenchyma- irregular areas, somewhat triangular along the periphery of the renal border
Irregular area may be slightly more echogenic than parenchyma

147
Q

Why is renal transplant used?

A

Renal transplantation and dialysis are currently used to treat chronic renal failure and end-stage renal disease

148
Q

What is the most frequent complication of renal transplant?

A

Most frequent complication is rejection

149
Q

Sonographic evaluation of renal transplants

A

Sonographic Evaluation
Size, parenchyma, presence of abnormal fluid collections and Doppler assessment should be done
Baseline scan is done 48 hours after surgery to determine—renal size, calyceal pattern, and extra renal fluid collections
Serial scans may be done at 3 to 6 month intervals to detect fluid collections at an early, asymptomatic stage

150
Q

What is the method used to determine renal rejection?

A

Renal biopsy is the only method to accurately determine whether or not there is rejection

151
Q

What are the types of rejections?

A

4 types of rejection
Hyperacute-within hours of transplant
Acute- within days to months after transplant
Immunologic-causes: pre-formed antibodies, immune complexes, and cell-mediated responses
Chronic-can occur months after a transplant with gradual onset

152
Q

Define kidney stones

A

One of the most common kidney problems that occur
May cause obstruction which can be extremely painful
Most stones are small and can pass through the urinary system without treatment. Stones that are large and fill the collecting system are called staghorn calculi
More common in men, once someone develops a kidney stone they are at an increased risk of developing them in the future

153
Q

Clinical symptoms for kidney stones

A

Clinically- initially extreme pain, cramping on the side with the stone, N/V, pain may subside as it travels down the ureter

154
Q

What are the treatments for kidney stones?

A

Treatment- lithotripsy (shock waves) or surgery if a stone is obstructing and cannot pass

155
Q

Ultrasound findings for kidney stones

A

Echogenic with posterior shadowing
Stones less than 3 mm may not shadow, the use of harmonics can be helpful in appreciating an acoustic shadow
Color and Power Doppler have an increased sensitivity and can show a “twinkling sign” posterior to the stone—rapidly changing mixture of red and blue colors posterior to the stone
If a stone is causing an obstruction hydro and possibly dilated ureter can be appreciated depending on the level of obstruction

156
Q

Define twinkling sign and what is it used for?

A

Color and Power Doppler have an increased sensitivity and can show a “twinkling sign” posterior to the stone—rapidly changing mixture of red and blue colors posterior to the stone

157
Q

Define bladder diverticulum

A

Herniation of the bladder wall. These outpouchings may be singular or multiple
Congenital or acquired

158
Q

ultrasound findings of bladder diverticulum

A

A neck of varying size connect the adjacent fluid-filled structure to the bladder
Diverticulum may still be filled with fluid after the patient empties their bladder
Urine stasis leads to recurrent infections and stone formation

159
Q

define Cystitis

A

inflammation of the bladder

Usually secondary to another condition that causes stasis of urine in the bladder

160
Q

Causes of cystitis

A 
Urethral stricture
Benign and malignant neoplasms
Bladder calculi
Trauma
Tuberculosis
Pregnancy
Neurogenic bladder
Radiation therapy
161
Q

ultrasound findings of cystitis

A

Wall may appear normal in early stages
Diffuse or nondiffuse hypoechoic thickening of the wall over time
As the inflammatory process progresses the bladder wall becomes fibrotic and scarred becoming echogenic

162
Q

define bladder tumors

A

95% in adults are transitional cell carcinoma (TCC)
Usually not detected until they become advanced
Patients present with gross hematuria, dysuria, urinary frequency, or urinary urgency
Biopsy is necessary to determine benign vs. malignant

163
Q

ultrasound findings of bladder tumors

A

Appearance varies
Sonography, CT, or MRI may be used for staging
All primary bladder tumors have the same appearance-irregular echogenic mass that projects into the lumen

SON130 (3 decks)

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