Chapter 14 Urinary System Flashcards
Carries blood into the glomerulus of the nephron
afferent arteriole
Site of filtration in the kidney; contains water, salts, glucose, urea, and amino acids
Bowman’s capsule
Outer parenchyma of the kidney that contains the renal corpuscle and proximal and distal convoluted tubules of the nephron
cortex
Another term for the renal fascia; the kidnet is covered by the renal capsule, perirenal fat, Gerot’s fascia, and paprenal fat
Gerota’s fascia
Area of the kidney where the vessels, ureter, and lymphatics enter and exit
hilus
Recieves urine from the minor calyces to convey to the penal pelvis
major calyces
Recieves urine from the renal pyramids; forms the border of the renal sinus
minor calyces
Functional unit of the kidney; includes a renal corpuscle and a renal tubule
nephron
Part of the nephron that consists of Bowman’s capsule and the glomerulus
renal corpuscle
Area in the midportion of the kidney that collects urine before entering the ureter
renal pelvis
Space behind the peritoneal lining of the abdominalcavity
retroperitoneum
Small, membranous canal that excretes urine from the urinary bladder.
urethra
Small vessels found at the base of the renal pyramids; appear as echogenic structures
arcuate arteries
Lab measurement of the amount of nitrogenous waste and creatinine in the blood
BUN- blood urea nitrogen
Part of the collecting system adjacent to the pyramid that collects urine and is connected to the major calyx
calyx
A product of metabolism; lab test that measures the ability of the kidney to get rid of waste
creatinine
Small vessel that carries blood from the glomerulus of the nephron and conducts blood to the peritubular capillaries that surround the renal tubule
efferent arteriole
Network of capillaries that are part of the filtration process in the kidney
glomerulus
Maintenance of normal body physiology
homeostasis
Portion of a renal tubule lying between the proximal and distal convoluted portions; reabsorption of fluid, sodium, and chloride occurs here and in the proximal convoluted tubule.
loop of Henle
Inner portion of the renal parenchyma that contains the loop of Henle
medulla
Right posterior subhepatic space located anterior to the kidney and inferior to the liver where fluid may accumulate
Morison’s pouch
One of several conical masses of tissue that form the kidney medulla; each consists of the loops of Henle and the collecting tubules of the nephrons
renal pyramid
Area in the midportion of the kidney where the renal vessels and ureter enter and exit
renal hilum
Central area of the kidney that includes the calyces, renal pelvis, renal vessels, fat, nerves, and lymphatics
renal sinus
Lab test that measures how much dissolved material is present in the urine
specific gravity
Retroperitoneal structures that exit the kidney to carry urine to the urinary bladder
ureters
Muscular retroperitoneal organ that serves as a reservoir for urine
urinary bladder
Bands of cortical tissue that separate the renal pyramids; may mimic a renal mass on US
columns of Bertin
Normal variant that occurs on the left kidney as a bulge on the lateral border
dromedary hump
Located outside the normal position, most often in the pelvic cavity
ectopic kidney
Congenital malformation in which both kidneys are joined together by an isthmus, most commonly at the lower poles
horseshoe kidney
Dilation of the renal collecting system
hydronephrosis
Interruption of the normal development of the kidney resulting in absence of the the kidney; may be unilateral or bilateral
renal agenesis
First layer adjacent to the kidney that forms a tough, fibrous covering
renal capsule
Stone within the urinary system
urolithiasis
The urinary system has 2 principle functions: excreting ___ and regulating the composition of ___.
wastes;blood
The right kidney lies slightly ___ than the left kidney because the large right lobe of the ___ pushes it ___.
lower; liver; inferiorly.
The kidneys move with respiration; on deep respiration, both kidneys move ___ approximately 1 inch.
downward
___ entails herniation of all layers of the bladder wall and is located in the posterior angle of the trigone.
Congenital diverticulum
___ diverticula are herniations of only the two inner layers through the muscle layer.
Acquired
____ is usually secondary to another condition that causes stasis of urine in the bladder.
Cystitis
The majority of bladder tumors in adults are ___ carcinoma.
transitional cell
Within the hilus of the kidney are other ___ structures, a ureter, and the ___.
vascular; lymphatics
A fibrous capsule called the ___ surround the kidney.
true capsule
Outside of this fibrous capsule is a covering of ____.
perinephric fat
The ___ fascia surrounds the perinephric fat and encloses the kidneys and adrenals.
perinephric
The renal fascia, known as ___ fascia, surrounds the true capsule and perinephric fat.
Gerota’s
The medullary substance consists of a series of striated conical masses, called the renal ___.
pyramids
A nephron consists of two main structures; a renal ___ and a renal ___.
corpuscle; tubule
Nephrons ____ the blood and produce ___.
filter; urine
The renal corpuscle consists of a network of capillaries, called the ___, which is surrounded by a cuplike structure known as ___.
glomerulus; Bowman’s capsule
Blood flows into the glomerulus through a small ___ arteriole and leaves the glomerulus through a ___ arteriole.
afferent;efferent
There are 3 constrictions along the ureters course:
where the ureter leaves the renal pelvis; where it kinks as it crosses the pelvic brim; where it pierces the bladder wall
The main renal artery is a lateral branch of the aorta and arises just inferior to the ___ artery.
superior mesenteric
The renal vein drains into the ___ of the IVC.
lateral walls
The urinary system is located posterior to the peritoneum lining the abdominal cavity in an area called the ___.
retroperitoneum
The kidneys adjust the amounts of ___ and ___ leaving the body so that these equal the amounts of substances entering the body.
water; electrolytes
The principle metabolic waste products are ___, ___, and nitrogenous wastes.
water; carbon dioxide
Both urea and uric acid are carried away from the liver into the kidneys by the ___ system.
vascular
The presence of an acute infection causes ___, which is ___ in the urine; pyuria means there is ___ in the urine.
hematuria; RBC’s;pus
The pH refers to the strength of the urine as a partly ___ or __ solution.
acidic, alkaline
The ___ is the measurement of the kidney’s ability to concentrate urine.
specific gravity
The specific gravity is especially __ in cases of renal failure, glomerular nephritis, and pyelonephritis.
low
A decreased ___ occurs with acute hemmorhagic processes secondary to disease or blunt trauma.
hematocrit
Impairment of renal function and increased protein catabolism result in BUN ___ that is relative to the degree of renal impairment and rate of urea nitrogen excreted by the kidneys.
elevation
The renal parenchyma surrounds the fatty central renal sinus, which contains what 5 structures?
calyces, infundibula, pelvis, vessels, lymphatics
Dilation of the collecting system has been noted in ___ patients, especially the right kidney.
pregnant
The ___ is the area from the renal sinus to the outer renal surface.
parenchyma
The ____ and ___ arteries are best demonstrated as intense specular echoes in cross section or oblique section at the corticomedullary junction.
arcuate arteries, interlobar
The ___ generally is echo producing, whereas the medullary pyramids are ___.
cortex; hypoechoic
The cortex and medullary pyramids are separated from each other by bands of cortical tissue called ___, that extend inward to the renal sinus.
columns of Bertin
The ___ lie posterior to the renal arteries and should be identified by their lack of pulsations and absence of Doppler flow.
crura
The ___ of the pyramid points toward the sinus, and the ___ lies adjacent to the renal cortex.
apex;base
The ___ is a cortical bulge that occurs on the lateral border of the kidney, typically more on the left side.
dromedary hump
A ___ is a triangular, echogenic area in the upper pole of the renal parenchyma that can be seen during normal scanning.
junctional parenchymal defect
In a patient with a ___ there is fusion of the kidneys during fetal development that almost invariably involves the ___ poles.
horseshoe kidney; lower
A cystic mass presents sonographically with what characteristics?
smooth, thin, well defined border; round or oval shape; sharp interface between the cyst and renal parenchyma, anechoic, increased posterior acoustic enhancement
Sonographically, it is difficult to differentiate between a ___ cyst and a small adjacent cortical cyst.
septated
The parapelvic cyst is found in the ___ but does not communicate with the renal collecting system.
renal hilum
Name the 4 forms of autosomal polycystic kidney disease.
perinatal, neonatal, infantile, juvenile
Discuss the characteristics of autosomal dominant polycystic kidney disease.
common; severity depends on genotype; most common is PKD1 (located on the short arm of the 16th chromosome) which is more severe than PKD2 (long arm of 4th chromosome), may be a spontaneous mutation, bilateral mutiple cysts in cortex and medulla; 50% of patients by age 60 have ESRD
Usually a ___ renal contour is the first finding that a mass may be present and requires further investigation.
abnormal
Define the characteristics of renal cell carcinoma.
most common of all renal tumors; accounts for 85% of tumors; 2X more common in males; hematuria, flank pain, palpable mass; increased incidence in patients with Hippel Landau disease and in dialysis patients
One of the most common benign renal tumors is called ___.
adenoma
An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is ____.
angiomyolipoma
A ___ appears as a well defined echogenic mass, found more often in females.
lipoma
Sonographic findings include one or more fluid spaces at the ___ junction that corresponds to the distribution of the renal pyramids.
corticomedullary
Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with uniform loss of renal tissue in patients with ___.
renal atrophy
The most common medical renal disease that produces acute renal failure is _____.
acute tubular necrosis
Chronic renal disease is loss of renal ____ as a result of disease, most commonly parenchymal disease.
function
Name the 3 primary types of chronic renal failure.
nephron, vascular, and interstitial abnormalities
___ is when the dilated pyelocalyceal system appears as separation of the renal sinus echoes by fluid filled areas that conform anatomically to the infundibula, calyces, and renal pelvis.
Hydronephrosis
A localized hydronephrosis occurs as a result of ___, calculi, ___, or the ___.
strictures; focal masses; duplex collecting system
Hydronephrosis with a dilated ureter and bladder indicated obstruction of the ___junction or of the ___.
ureterovesical; urethra
If hydronephrosis is suspected, the sonographer should evaluate the ___.
bladder
Name 3 conditions that might mimic hydronephrosis.
parapelvic cyst, renal vessels in the parapelvic area, extrarenal pelvis
Describe the sonographic findings in acute obstruction.
resistive index of the intrarenal vessels greater than .70 for 48-72 hours after obstruction; RI then returns to normal; No ureteral jet will be seen on the affected side, or flow will be decreased if the obstruction is partial
Ureteral jets are best visualized by ___ imaging.
color Doppler
When pus is found within the obstructed renal system, the condition is called ___.
pyonephrosis
___ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently can also be seen in the renal cortex.
Nephrocalcinosis
A renal __ occurs when part of the tissue undergoes necrosis after the cessation of the blood supply, usually as a result of artery occlusion.
infarction
The major problem encountered with renal transplantation is ___.
graft rejection
Early after surgery, a baseline sonographic exam is performed to determine ___, ___, and ___.
renal size, calyceal pattern, extrarenal fluid collections
Perirenal fluid collections, such as ___,___,___ or ___ can be diagnosed reliably and differentiated from acute rejection.
hematoma, abscess, lymphocele, urinoma
___ rejection occurs within hours of transplantation and is caused by vasculitis leading to thrombosis and usually loss of the graft.
Hyperacute
___ rejection occurs within days to months after transplant.
Acute
___ rejection causes include preformed antibodies, immune complexes, and cell mediated responses.
Immunologic
___ rejection can occur months after transplantation with gradual onset.
Chronic
When using US to diagnose rejection, what things must be evaluated?
kidney size and shape; appearance of pyramids, cortex, parenchyma; presence of any fluid
The incidence of acute tubular necrosis is usually higher in ___ transplants than in __ transplants.
cadaveric; donor relative
Early signs of obstruction are ___ or severe ___ in a patient with satisfactory renal volumes.
anuria; oliguria
Renal artery stenosis exhibits a _____ jet with distal disturbance.
high velocity
___ Doppler is not angle dependent and has a greater sensitivity to detect blood flow.
Power
The initial clinical sign of a kidney stone is extreme ___, typically followed by cramping on the side where the stone is located; nausea and vomiting may also occur.
pain
Renal stones have very ___ foci with posterior acoustic shadowing.
echogenic
If the stone causes obstruction, there will be ___ and, depending on the location of the stone, the ureter may be dilated ___ to the level of the obstruction.
hydronephrosis; superior
