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Vascular > Chapter 25: The Renal Vasculature > Flashcards

Chapter 25: The Renal Vasculature Flashcards

1
Q

the slop of the systolic upstroke (kHz/s) divided by the transmitted frequency

A

acceleration index

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2
Q

the time interval between the onset of systole and the initial compliance peak

A

acceleration time

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3
Q

A Doppler spectral waveform recorded immediately distal to a flow-reducing stenosis. The waveform exhibits decreased peak systolic velocity and disordered flow during systolic deceleration and diastole as a result of the pressure-flow gradient associated with the lesion

A

poststenotic signal

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4
Q

The highest peak systolic renal artery velocity divided by the peak systolic aortic velocity recorded at the level of the celiac and/or superior mesenteric arteries. The ratio is used to identify flow limiting renal artery stenosis

A

reanl-aortic velocity ratio

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5
Q

narrowing of the renal artery most commonly as a result of atherosclerotic disease or medial fibromuscular dysplasia

A

renal artery stenosis

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6
Q

a tiny tube inserted into a stenotic renal artery at the time of arterial dilation (angioplasty). The stent, usually a metallic mesh structure, help to hold the artery open

A

renal artery stent

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7
Q

the outermost area of the kidney tissue lying just beneath the renal capsule, the fibrous covering of the kidney

A

renal cortex

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8
Q

the area through which the renal artery, vein, and ureter enter the kidney

A

renal hilum

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9
Q

the middle area of the kidney lying between the sinus and the cortex. The medullary tissue contains the renal pyramids

A

renal medulla

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10
Q

the opening of the renal artery from the aortic wall

A

renal ostium

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11
Q

a medical disorder affecting the tissue function of the kidneys

A

renal parenchymal disease

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12
Q

the ratio between the peak systolic velocity recorded in the proximal or midsegment of the renal artery compared to the PSV recorded in the distal segment of the renal artery

A

renal-renal velocity ratio

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13
Q

the central echogenic cavity of the kidney, It contains the renal artery, renal vein, collecting, and lymphatic systems

A

renal sinus

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14
Q

The visible indentation at the base of the neck where the neck joins the sternum

A

suprasternal notch

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15
Q

the prominence of the pelvic bones noted in the lower abdomen

A

symphysis pubis/ pubic bones

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16
Q

usually ostial or proximal; any segment of main renal; parenchymal arteries; acoustically homogenous or heterogenous; smooth or irregular surfaced; high-velocity with poststenotic turbulence if >60% diameter-reducing stenosis; low velocity if stenosis is preocclusive

A

atherosclerosis

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17
Q

mid-to-distal renal artery; parenchymal arteries; segmental narrowing and dilation of the renal artery; alternating regions of forward and reversed flow; high velocity compared to proximal arterial segment

A

medial fibromuscular dysplasia

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18
Q

focal or entire length; intraluminal echoes of varing echogenicity dependent on chronicity; kidney length <8-9cm; absent Doppler signal in imaged artery; low-velocity, low-amplitude signals in the renal parenchyma

A

Occlusion

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19
Q

Renal artery stenosis is the most common cause of:

A

secondary hypertension
chronic renal insufficiency
incident end-stage renal disease

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20
Q

Narrowing of renal artery

A

renal artery stenosis

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21
Q

most commonly the result of atherosclerotic disease or medial fibromuscular dysplasia

A

renal artery stenosis

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22
Q

The kidneys are located _______ in dorsal abdominal cavity between 12th thoracic and 3rd lumbar vertebrae

A

retroperitoneally

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23
Q

Normal kidney length

A

9-13 cm

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24
Q

Most common kidney anomaly

A

horseshoe kidney

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25
Q

Kidneys joined at lower poles by isthmus of tissue which lies anterior to aorta at level of 4th or 5th lumbar vertebrae

A

horseshow kidney

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26
Q

Renal artery supply:

A

distal aorta
common iliac artery
inferior mesenteric artery

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27
Q

most common congenital anomaly of the urinary tract

A

duplication of the renal collecting system

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28
Q

two pelvicalyceal units are present with ureters that insert separately into the bladder

A

complete duplication of the renal collecting system

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29
Q

renal pelvis is bifid with either a single ureter or two ureters that converge along their course to the bladder

A

partial duplication of the renal collecting system

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30
Q

two parts of renal parenchyma

A

medulla
cortex

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31
Q

triangular shaped; carry urine from cortex to renal pelvis

A

renal pyramids

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32
Q

outermost area of kidney; lie just beneath the renal capsule; area where urine is produced

A

renal cortex

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33
Q

cortical tissue; lies between medullay pyramids

A

columns of Bertin

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34
Q

How many medullary pyramids are located in the kidney?

A

12-18

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35
Q

located halfway between the suprasternal notch and symphysis pubis curring through lower border of first lumbar vertebrae, ninth costal cartilages, and pyloris

A

transpyloric plane

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36
Q

The ______ are located approximately 2 cm below transpyloric plane arising from anterior, lateral, or posterolateral wall of the abdominal aorta

A

renal arteries

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37
Q

The ___ renal artery orginates slightly more cephalad than the ____ renal artery.

A

left
right

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38
Q

courses on a slightly inferior path from the posterolateral aortic wall, passes posterior to the left renal vein, and is crossed by inferior mesenteric cein

A

left renal artery

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39
Q

courses anterolaterally and then moves posterior to IVC and right renal vein

A

right renal artery

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40
Q

arise from aortic wall below main renal artery; course to polar surfaces of kdineys

A

accessory polar renal arteries

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41
Q

At the level of the _____ the renal artery divides into large anterior and small posterior branches

A

renal hilum

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42
Q

The renal arteries give rise to:

A

interlobar, arcuate, and interlobular arteries

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43
Q

courses anteriorly from renal hilum with ureter arising posteriorly; short course from hilum of kidney to IVC

A

right renal vein

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44
Q

courses anteriorly from renal hilum with ureter arising posteriorly; courses anterior to the aorta just below origin of superior mesenteric artery

A

left renal vein

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45
Q

primary cause of renal artery stenosis

A

atherosclerotic disease

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46
Q

Renal artery disease primarily affects ____ and _____.

A

ostium
proximal third of renal artery

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47
Q

second most common curable cause of renovascular disease

A

medial fibromuscular dysplasia

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48
Q

cmoonly affects mid-to-distal segments of renal artery; lesions produce segmental concentric narrowing and dilation, resulting in “string of beads” appearance

A

medial fibromuscular dysplasia

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49
Q

Patient preparation

A

fast for 8-10 hours

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50
Q

extrinsic compression

A

“nutcracker syndrome” or mesenteric compression syndrome

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51
Q

______ arteries enter the renal hilum

A

accessory

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52
Q

_______ course to surface of kidney

A

polar renal arteries

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53
Q

only low-resistance vessels distal to SMA

A

renal arteries

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54
Q

If a difference in renal length greater than 1 cm is found it is suggestive of:

A

compromised flow on side with smaller kidney

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55
Q

Most common predisposing factor to renal vein thrombosis

A

primary renal disease

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56
Q

stabilized gas microbubbles that strong enhance echoes from moving blood cells due to difference in compressability and density

A

contrast-enhanced imaging

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57
Q

Doppler waveform of normal renal artery

A

rapid systolic upstroke
sharp systolic peak
forward diastolic flow

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58
Q

The PSV in the renal artery ranges from ___ to ___ cm/s

A

74 to 127

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59
Q

Distal renal artery PSV

A

70-90 cm/s

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60
Q

renal sinus PSV

A

30-50 cm/s

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61
Q

renal cortex PSV

A

10 - 20 cm/s

62
Q

increase in renal artery PSV approaching 180 cm/s

A

Narrowing of renal artery by 30-60%

63
Q

PSV increases significantly about 180 cm/s

A

Renal artery stenosis >60%

64
Q

If the degree of renal artery narrowing exceeds ___% the systolic upstroke will be delayed, compliance peak is lost, and PSV will decrease distally

A

80

65
Q

PSV ranges in the proximal abdominal aorta

A

60-100 cm/s

66
Q

absense of flow in main renal artery

A

renal artery occlusion

67
Q

PSV in cortex less than ____ cm/s in renal artery occlusion

A

10

68
Q

Increased vascular resistance associated with _____ diastolic flow

A

decreased

69
Q

amount of arterial impedance is dependent on:

A

age
region of renal arterial system

70
Q

RI is normally highest in the _____

A

renal hilum

71
Q

RI is normally lowest in the _____

A

interlobar arteries

72
Q

The normal diastolic to systolic velocity ratio in the kidney is ______

A

less than 0.3

73
Q

The normal acceleration index is less than ____

A

3.78

74
Q

The acceleration index is found by taking the ______ divided by ______

A

slope of systolic upstroke
transmitted frequency

75
Q

time internal between onset of systole and initial compliance peak

A

acceleration time

76
Q

The normal accleration time is greater than ____ ms

A

100

77
Q

ratio of highest renal artery PSV in the aortic PSV at level of mesenteric arteries

A

renal-aortic ratio

78
Q

In >60% diameter reduction the RAR is less than

A

3.5

79
Q

In significant renal artery stenosis the RAR is greater than

A

3.5

80
Q

Renal artery PSV greater than 180 cm/s is an indicator of:

A

renal artery stenosis

81
Q

kidney appears more echogenic

A

renal atrophy

82
Q

vein most often dilated; respirophasic flow absent; kidney usually enlarged

A

acute renal vein thrombosis

83
Q

left renal vein compressed by mesentary or SMA; high velocity signal associated with color bruit noted in vein as crosses anterior to aorta

A

nutcracker syndrome

84
Q

most common cause of renal artery stenosis with lesions occurring most frequently in ostium or proximal segment of renal artery

A

atherosclerotic plaque

85
Q

If a patient has an RI greater than ___ the patient is unlikely to benefit from renal revascularization.

A

0.8

86
Q

associated with renal atrophy; successful revascularization is unlikely if the renal length is less than __ cm

A

9

87
Q

PSV greater than 400 cm/s; cortical EDV 5 cm/s or greater;

A

high risk progression to renal atrophy

88
Q

__% of pediatric hypertension cases occur secondary to another abnormality.

A

85

89
Q

Up to 70% of pediatric cases of renal artery stenosis are caused by:

A

fibromuscular dysplasia

90
Q

second most common type of childhood renal disoder

A

multicystic renal dysplasia

91
Q

In a neonate the pole to pole length of kidney is ____

A

less than 4 cm

92
Q

Which of the following is NOT a limitation of contrast angiography?
a. detailed anatomic information
b. lack of hemodynamic information
c. no identification of functional significance of renal artery disease
d. invasive with possible nephrotoxic contrast

A

b

93
Q

Which of the following is true regarding duplex ultrasound assessment of the renal vasculature?
a. provides anatomic information
b. provides hemodynamic information
c. painless and noninvasive
d. all of the above

A

d

94
Q

What is the normal length measurement of the kidney?

A

9-13 cm

95
Q

What are kidneys that are joined at the lower poles by an isthmus of tissue that lies anterior to the aorta?

A

horseshoe kidneys

96
Q

Why is the renal sinus normally brightly echogenic on a songraphic image?

A

fat and fibrous tissue in the sinus

97
Q

What the triangular shaped structures within the inner portion of the kidney that carry urine from the cortex to the renal pelvis?

A

renal pyramids

98
Q

What is the most common congenital anomaly of the urinary tract?

A

duplication of the renal collecting system

99
Q

The right renal artery usually courses _____ from the aorta, then passes ______ to the inferior vena cava

A

anterolateral, posterior

100
Q

Which vessel courses anterior to the aorta but posterior to the superior mesenteric artery and anterior to both renal arteries?

A

left renal vein

101
Q

In which of the following renal artery segments does atherosclerotic disease in the renal artery typically occur?
a. origin to proximal third
b. distal renal artery just before entering the kidney
c. mid-to-distal segment
d. interlobar arteries within the renal parencyhma

A

a

102
Q

Which of the following patients would be suspected of fibromuscular dysplasia in the renal artery?
a. an 85 year old diabetic male
b. a 66 year old female with a hisotry of well-controlled hypertension and smoking
c. a 25 year old male with chronic asthma
d. a 32 year old female with poorly controlled hypertension

A

d

103
Q

What is the most appropriate transducer for use in the evaluation of the renal arteries?

A

2-5 MHz curved linear

104
Q

At which level is a spectral Doppler waveform with peak systolic velocity needed from the aorta for us in the renal-aortic ratio

A

proximal, at the level of the celiac and superior mesenteric arteries

105
Q

To identify the renal artery ostia from a midline approach, an image is obtained from which location?

A

transverse, slightly inferior to the superior mesenteric artery

106
Q

Which of the following is an ultrasound modality that has a low angle dependence that may be helpful in identifying duplicate renal arteries?
a. color-flow Doppler
b. power Doppler
c. spectral Doppler
d. pulse inversion Doppler

A

b

107
Q

Using which angle of insonation are flow patterns within the kidney parenchyma typically obstained with a spectral Doppler?

A

0 degrees

108
Q

When comparing renal length from side to side, how much of a difference suggests compromised flow in the smaller kdiney?

A

3 cm

109
Q

Which of the following describe normal spectral Doppler waveform characteristics in the renal artery?
a. high resistance, minimal diastolic flow with velocities in the range of 90 to 120 cm/s
b. low resistance, high diastolic flow with velocities in the range of 90 to 120 cm/s
c. low resistance minimal diastolic flow with velocities in the range of 10 to 120 cm/s
d. high resistance high diastolic flow with velocities in the range of 50 to 70 cm/s

A

b

110
Q

A patient presents to the vascular laboratory for a renal artery duplex evaluation. During the examination, velocities in the right renal artery origin reach 175 cm/s with no evidence of poststenotic turbulence. Velocities on the left were 100 cm/s. What do these findings suggest?

A

right renal artery stenosis less than 60%

111
Q

Which of the following spectral Doppler waveform changes will NOT occur distal to a hemodynamically significant stenosis of the renal artery?
a. delayed systolic upstroke
b. loss of compliance peak
c. decreased peak systolic velocity
d. increased peak systolic velocity

A

d

112
Q

Which of the following findings within the kidney are consistent with renal artery occlusion?
a. kidney length of greater than 10 cm, velocities less than 10 cm/s in the renal cortex
b. kidney length of less than 9 cm, velocities less than 10 cm/s in the renal cortex
c. kidney length greater than 13 cm with no detectable flow within the renal parencyhma
d. kidney length less than 9 cm, velocities greater than 20 cm/s in the renal cortex

A

b

113
Q

A patient presents to the vascular lab with suspected acute tubular necrosis. Which of the following findings on the renal artery duplex examination would be consistent with this condition?
a. renal artery velocities greater than 180 cm/s, EDR of 0.35
b. renal artery velocities greater than 180 cm/s, RI of 0.6
c. renal artery velocities of 70 cm/s, EDR of 0.19
d. renal artery velocities of 70 cm/s, RI of 0.5

A

c

114
Q

What is measured to determine acceleration time?

A

onset of systole to the early systolic peak

115
Q

During a renal artery duplex ultrasound examination, proximal aortic velocities of 100 cm/s, proximal right renal artery velocities of 200 cm/s, and proximal left renal artery velocities of 400 cm/s were found. Which of the following describes these findings?
a. right RAR 2.0 = 2.0, less than 60% stenosis; left RAR = 0.4, less than 60% stenosis
b. right RAR = 0.2, more than 60% stenosis; left RAR = 0.4, more than 60% stenosis
c. right RAR = 2.0, less than 60% stenosis, left RAR = 4.0, more than 60% stenosis
d. right RAR = 0.2, more than 60% stenosis; left RAR = 4.0, less than 60% stenosis

A

c

116
Q

Which of the following may result in misinterpretation of the hilar acceleration time?
a. elevated renovascular resistance
b. systemic arterial stiffness
c. renal artery stenosis in the 60-79% range
d. all of the above

A

d

117
Q

Under which conditions is the renal-to-aortic ratio likely inaccurate?
a. the abdominal aortic velocities are between 75 and 90 cm/s
b. the abdominal aortic velocities are over 100 cm/s or below 40 cm/s
c. the renal artery velocities exceed 300 cm/s
d. the renal artery velocities are below 100 cm/s

A

b

118
Q

During renal duplex evaluation, the left renal vein near the hilum is noted to have continuous, nonphasic low-velocity. What do these findings suggest?

A

proximal renal vein thrombosis

119
Q

A patient presents to the vascular lab for follow up after renal artery stent placement. Velocities within the distal segment of the stent reach 250 cm/s. At other follow ups at 6 and 12 months, velocities in the distal remain 250 cm/s. What are these findings consistent with?

A

increased velocity because of size mismatch from the stent to native vessel

120
Q

Which of the following represents renal duplex findings that demonstrate a high risk for renal atrophy and likely unsuccessful renal vascularization?
a. renal artery PSV less than 400 cm/s and cortical EDV greater than 10 cm/s
b. renal artery PSV greater than 400 cm/s and cortical EDV less than 5 cm/s
c. renal artery PSV greater than 160 cm/s and cortical EDV less than 10 cm/s
d. renal artery PSV greater than 200 cm/s and cortical EDV less than 5 cm/s

A

b

121
Q

Patients with sudden onset of chronic hypertension, azotemia, unexplained renal insufficiency, or pulmonary edema should be evaluated for ______.

A

renal artery stenosis

122
Q

In most patients, renal artery disease is correctable with treatment planning providing _____ for hypertension and stabilization of renal function in patients with chronic renal failure.

A

control or cure

123
Q

Because of the ______ of the contrast agents, computed tomography angiography is often reserved for use as secondary confirmatory study.

A

nephrotoxicity

124
Q

The kidneys are located ______ in the dorsal abdominal cavity between the 12th thoracic and third lumbar vertebrae. The kidney

A

retroperitoneally

125
Q

For the purpose of sonographic examination of the kidney, it is divided into ___ main areas.

A

4

126
Q

The renal arteries can be identifited approximately ___ below the ______ plane, with the left renal artery slightly more cephalad than the right.

A

2cm
transpyloric

127
Q

Duplicate main renal arteries that enter the kidney through the renal hilum or accessory polar renal arteries are present in ____ of patients.

A

12-22%

128
Q

Owing to the location of the inferior vena cava, the right renal vein has a ____ course, and the left renal vein typically courses ____ to the aorta.

A

short
anterior

129
Q

The second most common curable cause of renovascular disease is ______, which occurs most commonly in women aged 25 to 50 years.

A

medial fibromuscular dysplasia

130
Q

Elevating the examination table, keeping the patient close to the sonographer’s side, and not overextending the arm are all ways to maintain _____ positioning.

A

correct ergonomic

131
Q

Extrinsic compression of the left renal vein may result in ______ syndrome.

A

mesenteric compression/nutcracker

132
Q

_____ imaging, derived from grayscale, B-mode imaging, utilizes shorter pulses and provides visualization of moving vascular reflectors, independent of insonation angle and does not depend on Doppler shift.

A

B-flow

133
Q

A useful approach to identify the ostia of the renal arteries that involves having the patient in a decubitus position and imaging the aorta in a longitudinal plane to view the renal arteries from the lateral aortic walls is termed the _____ approach.

A

banana-peel

134
Q

_____ Doppler is valuable in identifying duplicate renal arteries because of its lower angle dependence and sensitivity to low flow states.

A

power

135
Q

An alternate position to access the distal segments of the renal arteries is in the ____ position, with the patient’s midsection flexed over a pillow.

A

prone

136
Q

In addition to evaluation of the renal vasculature, the ____ should be examined for cortical thinning, renal calculi, masses, cysts, or hydronephrosis.

A

kidney

137
Q

Accuracy of renal length is enhanced by averaging ____ separate measurements

A

3

138
Q

In the presence of renal vein _____, renal artery waveforms demonstrate retrograde, blunted diastolic flow components.

A

thrombosis

139
Q

Improved diagnostic accuracy has been shown in the kidneys, liver, mesenteric, and peripheral vessels with the use of _____.

A

CEUS

140
Q

The proximal aorta demonstrates rapid systolic upstroke and ____ flow during diastole, whereas the distal abdominal aorta demonstrates a _____ flow pattern that reflects the elevated vascular resistance of the lower extremities/

A

forward
multiphasic

141
Q

An early _____ peak is often seen on the upstroke to systole in a normal renal artery/

A

systolic

142
Q

When the degree of renal artery narrowing exceeds __%, the systolic upstroke is delayed, the compliance peak is lost, and the PSV will decrease distally/

A

80

143
Q

With chronic renal artery occlusion, the PSV in the cortex will be less than ___ cm/s, and pole-to-pole length of the kidney will be less than ___ cm

A

10
9

144
Q

When parenchymal disease is present, increased renovascular ______ is demonstrated throughout the kidney, characterized by ______ diastolic flow.

A

resistance
decreased

145
Q

Indirect renal hilar evaluations use ______ index or time to provide assessment of renal artery stenosis.

A

acceleration

146
Q

Current diagnostic criteria for identification of renal artery stenosis are based on the _______ ratio greater than ____

A

Renal-aortic
3.5

147
Q

With nutcracker syndrome, a ______ signal with associated color bruit is noted int he left renal vein as it crosses anterior to the aorta.

A

high-velocity

148
Q

When evaluating a stented renal artery, velocity _____ are typically identified, making identification of stenosis difficult.

A

increases

149
Q

When evaluating pediatric patients for renal artery disease, it is important to note that the _____ is normally higher in children than in adults.

A

velocity

150
Q

The most common cause of renal artery stenosis in the pediatric patient is ______.

A

fibromuscular dysplasia

151
Q
A

Vascular (33 decks)

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