Chapter 7 The Urinary Tract Flashcards
What is the most common location for a urolithiasis to become lodged?
Ureterovesicular junction
a stone that completely fills the renal pelvis is referred to as:
Staghorn calculus
Clinical findings of Glomerulonephritis
- recent throat infection
- smoky urine
- hematuria
- proteinuria
- fever
- Hypertension
- Azotemia
The most common cause of fungal UTI is:
Candida Albicans
The presence of purulent material within the renal collecting system is termed:
Pyonephrosis
_____would be a common finding in a patient undergoing peritoneal dialysis?
Ascites
Suspicion of cortical thinning should occur when the renal cortex measures:
Less than 1cm
Clinical findings of a simple renal cyst
- Asymptomatic
The systemic disorder associated with epilepsy that leads to the development of solid tumors in various organs, including angiomyolipomas of the kidney, is:
Tuberous sclerosis
Describe the sonographic appearance of a kidney affected by ARPKD:
Bilateral enlarged, echogenic kidneys
Infantile polycystic kidney disease may also be referred to as:
ARPKD
_____would most likely present with a clinical finding of hematuria?
Hemorragic renal cyst
______ is considered the most common solid renal mass?
Angiomyolipoma
What is the most likely location of TCC in the kidney?
Renal pelvis
The inherited disorder associated with the development of tumors of the central nervous system and orbits, renal cysts, and adrenal tumors is:
Von Hippel-Lindau syndrome
Renal cysts that project out away from the kidney are termed:
Exophytic
Sonographically, compared to normal kidneys, those affected by CRF will appear:
Smaller in size and more echogenic
What renal cystic disease would be most likely caused by and thus associated with hemodialysis?
Acquired renal cystic disease
______is the most common cause of CRF
Diabetes mellitus
What is the most common location of an ectopic kidney:
Pelvis
A renal scar most likely appears as:
Echogenic area that extends from the renal sinus through the renal parenchyma
The most common congenital anomaly of the urinary tract is:
Duplicated collecting system
A bulge on the lateral border of the kidney is referred to as:
Dromedary hump
Enlargement of the unaffected contralateral kidney with unilateral renal agenesis or compromised renal function is AKA:
Compensatory hypertrophy
The vessel located anterior to the abdominal aorta and posterior to the superior mesenteric artery is the:
Left renal vein
The protective capsule of the kidney is referred to as:
Renal capsule
_____are retroperitoneal organs
Kidneys
What is the functional unit of the kidneys?
Nephron
_______is a childhood, autoimmune disease that results in the development of purple spots on the skin and possible renal failure?
Henoch-schonlein purpura
Sonographic findings of a renal hematoma
- Variable appearance depending on the stage of the blood
- Blood may accumulate under the capsule(subcapsular), in the perinephric area or intramuscular
- Chronic hematomas may calcify and produce acoustic shadowing
Clinical findings of a renal hematoma (5):
- trauma to the kidneys
- flank pain
- abdominal pain
- hematuria
- decreased hematocrit
_____is a primary form of renal cancer, meaning this form of cancer begins in the kidneys, specifically originates from renal tubular epithelium
Renal cell carcinoma
Clinical findings of renal cell carcinoma (7):
- Anorexia
- flank pain
- gross hematuria
- hypertension
- palpable mass
- smoker
- weight loss
Sonographic findings of renal cell carcinoma
- Hypoechoic, isoechoic or hyperechoic solid mass on the kidney
- Can have a complex cystic appearance as well
- check the renal vein and IVC for tumor invasion
______of the kidney is a malignant tumor that is most often found in the area of the renal pelvis
Transitional cell carcinoma
Clinical findings of renal transitional cell carcinoma
- gross hematuria
- pain secondary to renal obstruction
- history of smoking
Sonographic findings of renal transitional cell carcinoma (2):
- hypoechoic or isoechoic mass in renal sinus
- Hydronephrosis may be present
Renal adenoma typically measure:
Less than 1cm
_____is a benign mass that appears sonographically similar to its malignant counterpart, the RCC
Renal adenoma
Sonographic findings of renal adenoma
- Hyperechoic, vascular mass with internal calcifications
- May produce acoustic shadowing
Clinical findings of renal adenoma
- Asymptomatic
- May complain of hematuria
Sonographic findings of other renal malignancies
- Bilateral, hypoechoic masses with lymphoma
- Lymphoma or leukemia can manifest as an enlarged kidney
- Metastases have varying sono findings but most often solid tumors are hypoechoic or hyperechoic
Clinical findings of other renal malignancies
- History of primary cancer (often lung or breast)
- Hematuria
- fever
- weight loss
Compression or entrapment of the left renal vein as it passes between the SMA and abdominal aorta is termed:
Nutcracker syndrome
Clinical findings in nutcracker syndrome (4):
- Hematuria
- Proteinuria
- Possible left-sided abdominal or flank pain
- Left-sided testicular pain
Sonographic findings of nutcracker syndrome (2):
- Compression of the left renal vein
- Elevated pressure within the left renal vein
Sonographic findings of renal vein thrombosis
- heterogeneous renal echotexture
- enlarged renal vein
- absent renal vein doppler signals
- thrombus may not be seen
Clinical findings of renal artery stenosis
- Smoker
- high BP
- high cholesterol
- diabetes
- Hypertension that does not respond to treatment
____is a blood clot within the renal vein
Renal vein thrombosis
Clinical findings of renal vein thrombosis
- pain
- hematuria
Sonographically renal lipomas are:
- Well-circumscribed, hyperechoic mass
- Measures less than 5mm in diameter
Clinical findings of a renal lipoma
- Asymptomatic
Clinical findings of a renal hemangioma
- Asymptomatic
- Hemorrhage of the mass can lead to pain and hematuria
Sonographic findings of a renal hemangioma
- Small, hyperechoic mass
_____ is a benign renal tumor that is often found in men in their 60s and is the second most common renal mass after the angiomyolipoma
Oncocytoma
Sonographic findings of an oncocytoma
- Isoechoic, hyperechoic, or hypoechoic mass
- May also contain a hypoechoic central scar
Clinical findings of an oncocytoma
- Asymptomatic
- May produce pain or hematuria
______is the most common benign renal tumor
Angiomyolipoma
Clinical findings of angiomyolipoma (3):
- Asymptomatic in most individuals
- Patient may have a history of tuberous sclerosis
- Pain, hematuria and hypertension can occur with hemorrhage of the mass
Sonographic findings of angiomyolipoma (3):
- Solid, hyperechoic mass
- acoustic shadowing
- multiple and bilateral with tuberous sclerosis
Sonographically, cortical nephrocalcinosis appears as:
Small calculi within the cortex
Medullary sponge kidney appears sonographically as:
Highly echogenic renal pyramids that may shadow
Nephrocalcinosis that occurs within the cortex is termed:
Cortical nephrocalcinosis
Two forms of nephrocalcinosis
- Medullary nephrocalcinosis
- Cortical Nephrocalcinosis
______is the accumulation of calcium within abnormally dilated collecting ducts located within the medulla
Medullary sponge kidney
_____is an accumulation of calcium within the renal parenchyma
Nephrocalcinosis
Sonographic findings of nephrocalcinosis
- Medullary nephrocalcinosis (echogenic renal pyramids, medullary sponge kidney)
- Cortical nephrocalcinosis (echogenic foci within the cortex)
Clinical findings of nephrocalcinosis
- hypercalcemia
- hyperparathyroidism
- UTI
- history of urinary calculi
Sonographic findings of urolithiasis
- echogenic focus that produces acoustic shadowing
- “twinkle sign” seen posterior to the stone with the use of color doppler
- Hydronephrosis and dilation or ureter may be present
A stone that completely fills and takes on the shape of the renal pelvis is called
Staghorn calculus
_____are kidney stones located anywhere within the urinary tract
urolithiasis
Clinical findings of urolithiasis (4):
- hematuria
- renal colic
- oliguria
- UTI
Abnormalities that are located outside the urinary tract that leads to renal obstruction are referred to as:
Extrinsic causes of hydronephrosis
Irregularities that lead to renal obstruction that are located inside the urinary tract are called:
intrinsic causes of hydronephrosis
____is dilation of the calices, infundibula and renal pelvis
Hydronephrosis
sonographic findings of renal artery stenosis
- thickening and calcification of the renal artery may not be noted
- renal to aorta ratio that is greater than 3.5
- possibly a tardus-parvus spectral waveform downstream from the stenosis
Sonographic findings of hydronephrosis
- anechoic fluid filling all or part of the renal collecting system
- can also alter the renal artery resistive index within the arcuate or interlobar vessels
Dilation of the urinary tract occurs:
proximal to the level of obstruction
Sonographic findings of chronic glomerulonephritis
- Small, echogenic kidneys
Clinical findings of renal fungal disease
- immunocompromised person
- diabetes mellitus intravenous drug abuse or long-standing indwelling catheter
- infant with an indwelling catheter
- flank pain
- fever
- chills
Clinical findings of glomerulonephritis (7):
- recent throat infection (acute)
- smoky urine
- hematuria
- proteinuria
- fever
- hypertension
- Azotemia
A stellate (star-shaped) central scar may be noted within an:
oncocytoma
______is a hereditary disorder that may also be referred to as infantile polycystic kidney disease
Autosomal recessive polycystic kidney disease
Clinical findings of ARPKD (2):
- Clinical findings of renal failure
- Abnormal LFTs
Sonographic findings of ADPRD
- Bilateral enlarged kidneys that contain numerous cortical renal cysts
- Possible cyst identified in the pancreas, liver and/or spleen
Clinical findings of ADPKD
- Asymptomatic until 3rd or 4th decade of life
- Decreased renal function
- UTI
- Renal calculi
- Flank pain
- Hematuria
- Palpable abdominal mass
_______are located within the cortex and maybe difficult to differentiate from prominent renal pyramids, especially if solitary
Small cortical cysts
_____ is one that originates in the renal parenchyma and protrudes into the renal sinus
Parapelvic cyst
Renal cysts that appear to be projecting out away from the kidney may be termed:
Exophytic
Sonographic findings of a simple renal cyst
- Anechoic mass
- Smooth walls
- Posterior acoustic enhancement
Clinical findings of a simple renal cyst
- Asymptomatic
_____is the most common renal mass
Simple cyst
____uses a solution that is instilled into the abdominal via a catheter
Peritoneal dialysis
Both ______utilize a machine that essentially acts as a kidney whereby it extracts the patient’s blood, filters it and returns the filtered blood
Hemodialysis and hemofiltration
Dialysis may be either in the form of:
- Hemodialysis
- Hemofiltration
- Peritoneal dialysis
_____is used to remove the accumulated urea, other wasted materials and excess water from patient whose kidney function is inadequate
Dialysis
The most common cause of chronic renal failure is
Diabetes mellitus
Kidneys that fail to function normally will lead to:
End-stage renal disease
The gradual decrease in renal function over time, typically months or years is referred to as:
Chronic renal failure
Clinical findings of chronic renal failure
- Diabetes mellitus
- Malaise
- Elevated BUN and creatinine
- fatigue
- Hypertension
- Hyperkalemia
Sonographic findings of chronic renal failure (4):
- Small, echogenic kidneys
- Cortical thinning
- Loss of normal corticomedullary differentiation
- Renal cysts
_____ is the cystic dilation of the ureter as it enters the bladder
ureterocele
Urinary jets typically occur at least:
once every minute
Enlarged and distended with urine, the ureters will appear as:
*anechoic
*tubular structures
The point at which the ureter meets the urinary bladder is referred to as:
Ureterovesicular junction
Patent urachus will appear as an:
Anechoic tube that extends from the umbilicus to the apex of the urinary bladder
Urachal cyst and urachal diverticulum will appear as a:
Cystic structure between the bladder and the umbilicus
Urachal sinus will appear as a:
Linear fluid-filled structure that is continuous with the umbilicus
______ is a remnant of embryonic development
Urachus
_____is the most common solid malignant pediatric abdominal mass
Wilms tumor
_______, is the retrograde flow of urine from the bladder to the ureter, is a widespread malady in the pediatric population
VUR
_____are folds of excessive urethral tissue found exclusively in males
Posterior urethral valves
The most common cause of congenital hydronephrosis in infants and children is a:
Ureteropelvic junction obstruction
_____cause dilation of the bladder, both ureters and both renal collecting systems
Posterior urethral valves
_____is typically by megacystis, a massively dilated urinary bladder
Prune belly syndrome
_____describes the result of the abdominal wall musculature being stretched by the extremely enlarged urinary bladder
Prune belly syndrome
The most common congenital anomaly of the urinary tract is the:
Duplex or duplicated collecting systems
A sudden decrease in renal function, typically over the course of days or weeks, is termed
Acute renal failure (ARF)
_____is an autoimmune, inflammatory vascular disease that mostly affects children and can permanently damage the kidneys
Henoch-schonlein purpura
The most common cause of ARF is:
Acute tubular necrosis
Clinical findings of a ureterocele
- Asymptomatic
- Signs of a UTI
Sonographic findings of a ureterocele
- Anechoic, balloon-like structure within the urinary bladder near the ureterovesicular junction
Clinical findings of megaureter and hydroureter
- Asymptomatic
- UTI
Sonographic findings of megaureter and hydroureter
- Large, anechoic tubular structure that extends from the kidney to the urinary bladder, only a section may be enlarged
The _____ marks the single urethral opening and bilateral ureteral openings
Trigone
The _____ controls the appropriate emptying of the urinary bladder
Detrusor muscle
The four layers of the bladder wall
*Mucosa
*Submucosa
*Muscularis
*Serosa
When the bladder wall is thickened, its diameter will exceed _______in a distended state
4mm
______elevates as a result of cell death
LDH
The _____can be used to evaluate the overall function of the kidney
GFR
An elevation in either BUN or creatinine indicates
Some form of renal disease
______Measures the amount of creatinine phosphate found in the skeletal muscles
Creatinine
______measures the amount of urea nitrogen, a byproduct of protein metabolism that occurs within the liver and is excreted by kidneys
BUN
The left renal vein has to travel across the abdomen, between the:
SMA and Abdominal aorta
The renal veins exit the kidneys at their respective renal hilums and connect to the:
Lateral aspects of the IVC
The right renal artery travels _____ and is therefore longer than the left renal artery
Posterior to the IVC
The renal medullary, the inner part of the parenchyma id responsible for:
Absorption
Neurogenic bladder may be caused by:
*Brain or spinal trauma
*Congenital spinal abnormalities
*Diabetes
_______is poorly functioning secondary to any type of neurologic disorder
neurogenic bladder
Sonographic findings of a neurogenic bladder
- Urinary bladder wall thickening
- Trabeculae of the bladder wall
- Postvoid images will show excessive urinary retention
- The patient may have a distended bladder but does not feel the need to urinate
- Bladder stones may be present
Clinical findings of a neurogenic bladder
- Past history of brain or spinal trauma, congenital spinal abnormalities or diabetes
- Unnecessary urgency to void
- Rarely feel the need to urinate
______is an outpouching in the bladder wall
Bladder diverticulum
Clinical findings of a bladder diverticulum
- Can be asymptomatic
- UTI
Sonographic findings of a bladder diverticulum
- Anechoic outpouching of the bladder wall
- A visible neck connecting the diverticulum to the bladder
Inflammation of the urinary bladder is referred to as _______
Cystitis
Clinical findings of cystitis
- Dysuria
- Urinary frequency
- Lower abdominal pain
- Nocturia
- Hematuria
Sonographic findings of cystitis
- Hypoechoic bladder wall that may appear focally or diffusely thickened, measuring greater than 4mm in thickness
- Bladder may contain echogenic layering material echogenic layering material within its lumen
Sonographic appearance of bilateral stones
- Echogenic, mobile, shadowing foci within the lumen of the urinary bladder
Sonographic appearance of blood clots in the bladder
- Echogenic, nonshadowing mass that may be mobile or adhered to the wall of the bladder
The most common malignant tumor of the bladder is:
Transitional cell carcinoma
Clinical findings of transitional cell carcinoma of the bladder
- Gross hematuria
- May urinate blood clots
Sonographic findings of transitional cell carcinoma of the bladder
- Smooth or papillary hypoechoic or hyperechoic mass that projects into the lumen of the bladder
- A solid tumor will not be mobile and will often demonstrate vascularity
The _____begins at the trigone of the urinary bladder and ends at the urethral orifice
Uretha
The kidneys also work to regulate blood pressure by producing the enzyme ______
Renin
The nephron begins to function by the _____of gestation and urine production begins between 11 and 13 weeks
9th
The functioning unit of the kidney is the:
Nephron
Sonographic findings of acute glomerulonephritis
- Enlarged kidney(s) with increased echogenicity
- Prominent renal pyramids
Sonographic findings of renal fungal disease
- Fungal balls appear as hyperechoic nonshadowing, mobile structures within the renal collecting system
“Xantho” means
Yellow
Clinical findings of xanthogranulomatous pyelonephitis
- Dull or persistent flank pain
- Pyuria
- Hematuria
- fever
- Leukocytosis
Sonographic findings of Xanthogranulomatous pyelonephritis
- Hydronephrosis
- Staghorn calculus
- Perinephric fluid collection
A rare and yet life threatening, complication of pyelonephritis is
Emphysematous pyelonephritis
Sonographic findings of emphysematous pyelonephritis
- Gas or air within the renal parenchyma
- Dirty shadowing or reverberation artifact coming from the renal parenchyma
Clinical findings of emphysematous pyelonephritis
- Diabetes mellitus
- Immunocompromised patient
- Fever
- Flank pain
- Leukocytosis
Sonographic findings of a renal or perinephric abscess (3):
- Anechoic, hypoechoic or complex
- Gas shadows/dirty shadowing
- Reverberation artifact
_____is a collection of purulent material that has leaked through the capsule into the tissue surrounding the kidney
Perinephric abscess
Clinical findings of a renal or perinephric abscess
- Symptoms of pyelonephritis
- fever
- Flank pain
- Leukocytosis
_____can lead to xanthogranulomatous pyelonephritis and end-stage renal disease
Chronic pyelonephritis
Clinical findings of chronic pyelonephritis
- flank pain
- bacteriuria
- pyuria
- leukocytosis
- dysuria
- urinary frequency
- history of VUR
_____describes the condition of having pus within the collecting system of the kidneys
Pyonephrosis (purulent material)
Sonographic findings of pyonephrosis
- hydronephrosis
- pus and debris appear as internal, layering and low-level echoes within the dilated collecting systems
Clinical findings of pyonephrosis
- pyuria
- bacteriuria
- fever
- flank pain
- leukocytosis
_____is an inflammation of the kidney or kidneys
Acute pyelonephritis
Sonographic findings of acute pyelonephritis
- May appear normal
- Renal enlargement
- Focal areas of altered echotexture
- Compression of the renal sinus
Clinical findings of acute pyelonephritis
- Flank pain
- bacteriuria
- pyuria
- leukocytosis
- dysuria
- urinary frequency
_____is a systemic disorder that leads to the development of tumors within various organs
tuberous sclerosis
Sonographic findings of tuberous sclerosis
- Bilateral renal cysts
- Bilateral angiomyolipomas
Clinical findings of tuberous sclerosis
- Epilepsy
- Skin lesions of the face
Sonographic findings of chronic pyelonephritis
- Small, echogenic kidneys that have lobulated boarders
- Renal scar appears as an echogenic area within the kidney that extends from the renal sinus through the renal parenchyma
Sonographic findings of Von hippel-lindau syndrome
- Multiple renal cysts
- Cysts may be complex and have mural nodules
- Cysts within the pancreas
- Pheochromocytoma present
Clinical findings of Von hipple- Lindau syndrome
- Symptoms of a brain and/or an eye tumor
_____is an inherited disorder characterized by tumors of the central nervous system and orbits
von hippel-lindau syndrome
Acquired renal cystic disease is often the result of
Chronic hemodialysis
Sonographic findings of acquired renal cystic disease
- The kidney will appear small initially during end-stage renal disease with some small cysts
- With time, the kidneys may enlarge and have numerous small cysts noted throughout the renal parenchyma
Clinical findings of acquired renal cystic disease
- clinical findings of CRF
- History of hemodialysis
MCDK is thought to be caused by
An early, first trimester obstruction of the ureter
Sonographic findings of MCDK
- Unilateral, smooth-walled noncommunicating cysts of varying sizes located within the renal fossa
- Compensatory hypertrophy of the contralateral kidney
Clinical findings of multicystic dysplastic kidney disease
- Asymptomatic
- Normal renal function
Sonographic findings of the ARPKD
- Bilateral, enlarged echogenic kidneys
- Loss of corticomedullary differentiation
Sonographic findings of parasitic UTI
- Schistosomiasis (bladder wall thickening
- Hydatid cyst (depends on the stage of its maturation as it may appear completely anechoic, contain a daughter cyst with internal debris or complex mass
Clinical findings of parasitic UTI
- Hematuria
- Flank pain
- Pyuria
- Dysuria
- Possible recent travel out of the country (hydatid cyst)
Clinical findings of acute renal failure
- Elevated BUN & creatinine
- Oliguria
- Hypertension
- Leukocytosis
- Hematuria
- Edema
- Hypovolemia
Sonographic findings of acute renal failure
- Normal kidneys
- May appear more echogenic
- Hydronephrosis may be present
Sonographic findings of vesicoureteral reflux
- Patients with minimal reflux may have normal appearing kidneys
- hydronephrosis and/or hydroureter may be present in the bladder
- Bladder debris may be seen
VUR is the most commonly caused by an abnormal
Angle of insertion of the distal ureter into the bladder at the ureterovesicular junction, resulting in a faulty valve
Urine-containing bacterium that travels from the bladder, up the ureter and into the kidney, can result in
Kidney infection with subsequent scarring and permanent damage to the renal parenchyma
Clinical findings of vesicoureteral reflux
- May be asymptomatic
- unexplained fever
- irritability
- flank pain
- leukocytosis
- Bacteriuria
- Hematuria
- Dysuria
- Urgency to void
Clinical findings of Wilms tumor
- Palpable abdominal mass
- Abdominal pain
- Hematuria
- Fever
- Hypertension
Sonographic findings of Wilms tumor
- Large, solid, mostly echogenic masses that may contain anechoic or hypoechoic areas
Clinical findings of urachal anomalies (2):
- signs of UTI
- Palpable abdominal mass between the umbilicus and urinary bladder
The most common place for a urinary stone to become lodged is
Ureterovesicular junction
Clinical findings of a ureteral stone
- Renal colic
- Pain in the groin, labia, or testicle on the side of the stone
- possible hematuria
Sonographic findings of a ureteral stone (2):
- Echogenic foci within the ureter that shadows
- Dilation of the ureter proximal to the stone