Chapter 7: The Urinary Tract Flashcards
a cystic disease of the kidney that is often the result of chronic hemodialysis
acquired renal cystic disease
an inflammation of the kidney or kidneys
acute pyelonephritis
damage to the tubule cells within the kidneys that results in renal failure
acute tubular necrosis
an excess of urea or other nitrogenous compounds in the blood
azotemia
a measure of the amount of nitrogen in the blood in the form of urea
blood urea nitrogen (BUN)
a chronic inflammation of the kidney or kidneys
chronic pyelonephritis
an extension of the renal cortex located between the renal pyramids
columns of Bertin
the dilation of the renal collecting system at birth
congenital hydronephrosis
the accumulation of calcium within the cortex of the kidney
cortical nephrocalcinosis
the muscle that controls the appropriate emptying of the urinary bladder
detrusor muscle
the formation of air within the kidney parenchyma secondary to bacterial infiltration
emphysematous pyelonephritis
the fibrous envelope of tissue that surrounds the kidney and adrenal gland
Gerota fascia
the dilation of the renal collecting system resulting from the obstruction of the flow of urine from the kidney(s) to the bladder; also referred to as pelvocaliectasis
hydronephrosis
abnormally high levels of potassium in the blood
hyperkalemia
carcinoma of the kidney; also referred to as renal cell carcinoma
hypernephroma
an inherited renal disease that results in bilateral enlargement of the fetal kidneys and microscopic renal cysts; also referred to as autosomal recessive polycystic kidney disease
infantile polycystic kidney disease
an enzyme found within the blood that may be used to monitor renal function; may also be used as a tumor marker for some ovarian tumors
lactate dehydrogenase
the accumulation of calcium within the medulla of the renal parenchyma
medullary nephrocalcinosis
a congenital disorder characterized by the accumulation of calcium within the abnormally dilated collecting ducts located within the medulla
medullary sponge kidney
a renal disease thought to be caused by an early renal obstruction; leads to the development of multiple noncommunicating cysts of various sizes in the renal fossa
multicystic dysplastic kidney disease
the most common solid malignant pediatric abdominal mass; a malignant renal mass that may also be referred to as a Wilms tumor
nephroblastoma
an accumulation of calcium within the renal parenchyma
nephrocalcinosis
the functional unit of the kidney
nephron
a kidney disorder caused by damage to the glomeruli, which results in excess amounts of protein in the urine and the swelling of the ankles, face, and feet due to accumulation of excess water
nephrotic syndrome
a bladder that is poorly functioning secondary to any type of neurological disorder
neurogenic bladder
a scant or decreased urine output
oliguria
a benign renal tumor that is often found in men in their 60s
oncocytoma
a benign, solid adrenal tumor associated with uncontrollable hypertension
pheochromocytoma
the condition of having pus within the collecting system of the kidney
pyonephrosis
pus within the urine
pyuria
a benign renal mass
renal cell adenoma
the carcinoma of the kidney; also referred to as hypernephroma
renal cell carcinoma
a sharp pain in the lower back that radiates into the groin and is typically associated with the passage of a urinary stone through the ureter
renal colic
the outer part of the renal parenchyma that is responsible for filtration
renal cortex
a benign renal mass that consists of blood vessels
renal hemangioma
a collection of blood on or around the kidney typically associated with some form of trauma
renal hematoma
a fatty tumor on the kidney
renal lipoma
the inner part of the renal parenchyma that is responsible for absorption
renal medulla
cone-shaped structures located within the renal medulla that contains part of the nephron
renal pyramids
the portion of the kidney containing the minor calices, major calices, renal pelvis, and infundibulum
renal sinus
a disease characterized by the buildup of fibrous tissue within the retroperitoneum; this mass may involve the abdominal aorta, IVC, ureters, and sacrum
retroperitoneal fibrosis
the combination of slow systolic upstroke and a decreased systolic velocity
tardus-parvus
muscular bundles
trabeculae
a malignant tumor of the urinary tract that is often found within the urinary bladder or within the renal pelvis
transitional cell carcinoma
the area within the urinary bladder where the two ureteral orifices and urethral orifice are located
trigone of the urinary bladder
a systemic disorder that leads to the development of tumors within various organs
tuberous sclerosis
an abnormality in which the distal ureter projects into the urinary bladder
ureterocele
a localized collection of urine
urinoma
a urinary stone
urolithiasis
the retrograde flow of urine from the urinary bladder into the ureter
vesicoureteral reflux
a radiographic examination that involves the assessment of the urinary bladder and distal ureter for urinary reflux and other abnormalities
voiding cystourethrogram
an inherited disorder characterized by tumors of the central nervous system and the development of cysts within the kidneys, renal cell carcinoma, and pheochromocytoma
von Hippel-Lindau syndrome
a rare chronic form of pyelonephritis that is typically the result of a chronic obstructive mass
xanthogranulomatous pyelonephritis
the functional unit of the kidney
nephron
the kidneys initially develop within the pelvis and ascend into their normal position by _ weeks gestation
9
most common location of an ectopic kidney
pelvis
4 coverings of the kidney
pararenal fat layer
Gerota’s fascia
perirenal fat layer
renal capsule
2 parts of the kidney
renal parenchyma
renal sinus
2 parts of the renal parenchyma
renal medulla
renal cortex
the renal medulla is responsible for __________ and includes the ____________
absorption
renal pyramids
the renal cortex is responsible for __________
filtration of the blood
4 components of the renal collecting system contained in the renal sinus
minor calices
major calices
renal pelvis
infundibula
the renal arteries are branches of the ____________ that are located just below the level of the _____________
abdominal aorta
SMA
which renal vein is longer?
left
which renal artery is longer?
right
what 3 things may be utilized in blood tests for renal function?
blood urea nitrogen (BUN)
creatinine
lactate dehydrogenase (LDH)
an elevation in either BUN or creatinine indicates some form of what?
renal disease
typical measurements for kidneys
8-13 cm in length
2-3 cm in AP
4-5 cm in width
most common cause of acute renal failure
acute tubular necrosis
Clinical findings: elevated BUN and creatinine oliguria hypertension leukocytosis hematuria edema hypovolemia
acute renal failure
Sonographic findings:
normal kidneys
may appear more echogenic
acute renal failure
most common cause of chronic renal failure
diabetes mellitus
Clinical findings: diabetes mellitus malaise elevated BUN and creatinine fatigue hypertension hyperkalemia
chronic renal failure
Sonographic findings:
small, echogenic kidneys
loss of normal corticomedullary differentiation
renal cysts may be seen as well
chronic renal failure
most common renal mass
simple cyst
4 locations of renal cysts
peripelvic - originate from the renal sinus
parapelvic - originates in the renal parenchyma and protrudes into the renal sinus
cortical - located within the cortex
exophytic - project out away from the kidney
Clinical findings:
asymptomatic
may have pain
simple renal cyst
Sonographic findings: spherical anechoic mass smooth walls posterior acoustic enhancement no internal echoes
simple renal cyst
if a cyst does not meet all of the criteria for a simple renal cyst, it is a __________
complex renal cyst
autosomal dominant polycystic kidney disease usually shows up in what decades of life?
third or fourth
Clinical findings: asymptomatic until the third or fourth decade of life decreased renal function urinary tract infections renal calculi flank pain hematuria palpable abdominal mass
autosomal dominant polycystic kidney disease
Sonographic findings:
bilateral enlarged kidneys that contain numerous cortical renal cysts
possible cysts identified in the pancreas, liver, and/or spleen
autosomal dominant polycystic kidney disease
autosomal recessive polycystic kidney disease is characterized by dilation of the _______________
renal collecting tubules
Clinical findings:
may be found in the fetus
clinical findings of renal failure
hepatic disease
autosomal recessive polycystic kidney disease
Sonographic findings:
bilateral, enlarged echogenic kidneys
loss of corticomedullary differentiation
autosomal recessive polycystic kidney disease
multicystic dysplastic kidney is thought to be caused by what?
an early, first trimester obstruction in the ureter
if bilateral, it is fatal
Clinical findings:
asymptomatic
normal renal function
multicystic dysplastic kidney disease
Sonographic findings:
unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossa
compensatory hypertrophy of the contralateral kidney
multicystic dysplastic kidney disease
acquired renal cystic disease is often the result of what?
chronic hemodialysis
patients with a history of dialysis and who have acquired renal cystic disease are at an increased risk of developing _________
RCC
Clinical findings:
clinical findings of renal failure
history of hemodialysis
acquired renal cystic disease
Sonographic findings:
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
acquired renal cystic disease
patients with von Hippel-Lindau syndrome have the propensity to develop what other 3 things?
cysts within the kidneys
RCC
pheochromocytomas
Clinical findings:
symptoms of a brain and/or eye tumors
von Hippel-Lindau syndrome
Sonographic findings: multiple renal cysts cysts may be complex and have mural nodules (sign of RCC) cysts within the pancreas pheochromocytoma may be present
von Hippel-Lindau syndrome
Clinical findings:
epilepsy
skin lesions of the face
tuberous sclerosis
Sonographic findings:
bilateral renal cysts
bilateral angiomyolipomas
tuberous sclerosis
Clinical findings: flank pain bacteriuria pyuria leukocytosis dysuria urinary frequency
acute pyelonephritis
Sonographic findings: kidneys may appear normal renal enlargement focal areas of altered echotexture compression of the renal sinus
acute pyelonephritis
Clinical findings: pyuria bacteriuria fever flank pain leukocytosis
pyonephrosis
Sonographic findings:
hydronephrosis
pus and debris appear as internal, layering, and low-level echoes within the dilated collecting system
pyonephrosis
Clinical findings: symptoms of pyelonephritis high fever flank pain leukocytosis
renal or perinephric abscess
Sonographic findings:
can appear anechoic, hypoechoic, or complex, depending on its contents
gas shadows or dirty shadowing may be present within the mass
renal or perinephric abscess
a rare and life-threatning complication of pyelonephritis found more often in patients who have diabetes or who are immunocompromised
emphysematous pyelonephritis
which bacteria most commonly causes emphysematous pyelonephritis?
Escherichia coli
Clinical findings: diabetes mellitus immunocompromised patient fever flank pain leukocytosis
emphysematous pyelonephritis
Sonographic findings:
gas or air within the renal parenchyma
dirty shadowing (reverberation artifact) coming from the renal parenchyma
emphysematous pyelonephritis
Clinical findings: flank pain bacteriuria pyuria leukocytosis dysuria urinary frequency
chronic pyelonephritis
Sonographic findings:
small, echogenic kidneys that have lobulated borders
chronic pyelonephritis
most common cause of fungal urinary tract infections
Candida albicans
Clinical findings: immunocompromised person diabetes mellitus, IV drug abuse or long-standing indwelling catheter infant with an indwelling catheter flank pain fever chills
renal fungal disease
Sonographic findings:
fungal balls appear as hyperechoic, nonshadowing, mobile structures within the renal collecting system
renal fungal disease
Clinical findings: recent throat infection (acute) smoky urine hematuria proteinuria fever hypertension azotemia
glomerulonephritis
Sonographic findings:
enlarged kidney(s) of varying echogenicities
prominent renal pyramids
acute glomerulonephritis
Sonographic findings:
small, echogenic kidneys
chronic glomerulonephritis
dilation of the calices
caliectasis
dilation of the renal pelvis
pelviectasis
dilation of the calices and renal pelvis
pelvocaliectasis
dilation of the urinary tract occurs ________ to the level of obstruction
proximal
the dilation of the renal collecting system secondary to the obstruction of normal urine flow
hydronephrosis
6 intrinsic causes of hydronephrosis
urolithiasis
congenital abnormality (vesicoureteral reflux, posterior urethral valves, and ureterovesicular junction)
hematoma (blood clot)
neoplasm
ureteropelvic junction obstruction or ureteral stricture
uereterocele
8 extrinsic causes of hydronephrosis
benign prostatic hypertrophy neurogenic bladder pelvic masses (uterine leiomyoma, ovarian masses, tubo-ovarian abscess, and bowel masses) pregnancy retroperitoneal fibrosis surgery trauma urethritis
4 sources of false-positive hydronephrosis
overdistention of the urinary bladder
parapelvic cysts
prominent renal vein
extrarenal pelvis
what are kidney stones most often made of?
calcium oxalate
most common location for a stone to become lodged in the urinary tract
the ureterovesicular junction
Clinical findings:
hematuria
renal colic
oliguria
urolithiasis
Sonographic findings:
echogenic focus that produces acoustic shadowing
“twinkle sign” seen posterior to the stone
hydronephrosis and dilatation of a ureter may be present
urolithiasis
most common cause of medullary nephrocalcinosis
medullary sponge kidney
Clinical findings: hypercalcemia hyperparathyroidism urinary tract infection history of urinary calculi
nephrocalcinosis
Sonographic findings:
medullary - echogenic renal pyramids - medullary sponge kidney
cortical - echogenic foci within the cortex
nephrocalcinosis
a benign mass that appears sonographically similar to its malignant counterpart
renal cell adenoma
renal cell adenomas typically measure less than ___
1 cm
Clinical findings:
asymptomatic
may complain of hematuria
renal adenoma
Sonographic findings:
hyperechoic, vascular mass with internal calcifications
may produce acoustic shadowing
renal adenoma
benign renal tumor that is often found in men in their 60s
oncocytoma
Sonographic findings:
isoechoic, hyperechoic, or hypoechoic mass
may also contain a hypoechoic central scar
oncocytoma
a renal hamartoma is also called an:
angiomyolipoma
patients with tuberous sclerosis tend to have multiple and bilateral ______________
angiomyolipomas
Clinical findings:
asymptomatic
tuberous sclerosis
hematuria, pain, and/or hypertension secondary to hemorrhage
angiomyolipoma
Sonographic findings:
solid, hyperechoic mass
may produce acoustic shadowing
tend to be multiple and bilateral with tuberous sclerosis
angiomyolipoma
Sonographic findings:
small, hyperechoic renal mass encountered in the third or fourth decade of life
renal hemangioma
Sonographic findings:
well-circumscribed, hyperechoic mass usually measuring less than 5 mm in diameter
most often found in women
renal lipoma
Clinical findings: anorexia flank pain gross hematuria hypertension palpable mass smoker weight loss
renal cell carcinoma
Sonographic findings:
hypoechoic or isoechoic solid mass on the kidney
check the renal vein and IVC for tumor invasion
renal cell carcinoma
where is transitional cell carcinoma of the kidney usually found?
in the renal pelvis
Clinical findings:
hematuria
pain secondary to renal obstruction
transitional cell carcinoma of the kidney
Sonographic findings:
hypoechoic or isoechoic mass within the renal sinus
hydronephrosis may be present
transitional cell carcinoma of the kidney
2 places cancer most often metastasizes to the kidneys from:
lungs
breast
Clinical findings: history of primary cancer (often lung or breast) hematuria fever weight loss
metastases of the kidney
Sonographic findings:
bilateral, hypoechoic or hyperechoic masses
lymphoma or leukemia can manifest as an enlarged hypoechoic kidney
metastases of the kidney
Clinical findings: smoker high blood pressure high cholesterol diabetes hypertension that does not respond to treatment
renal artery stenosis
Sonographic findings:
thickening and calcification of the renal artery may be noted
renal/aorta ratio that is greater than 3.5
possibly a tardus-parvus spectral waveform downstream from the stenosis
renal artery stenosis
Clinical findings:
pain
hematuria
(may be caused by renal tumors, trauma, renal infection, or be seen after a kidney transplant)
renal vein thrombosis
Sonographic findings: heterogeneous renal echotexture enlarged renal vein absent renal vein Doppler signals thrombus may not be seen
renal vein thrombosis
4 causes of congenital hydronephrosis
ureteropelvic junction obstruction
vesicoureteral reflux
posterior urethral valves
prune belly syndrome
most common cause of congenital hydronephrosis in infants and children
ureteropelvic junction obstruction
folds of excessive urethral tissue found exclusively in males
posterior urethral valves
Clinical findings: may be asymptomatic most commonly found in young females bacteriuria fever
vesicoureteral reflux
most common solid malignant pediatric mass
Wilms tumor (nephroblastoma)
when is a Wilms tumor most often discovered?
before age 5, with a mean age of 3
Clinical findings: palpable abdominal mass in pediatric patient abdominal pain hematuria fever hypertension
Wilms tumor
Sonographic findings:
large, solid, mostly echogenic masses that may contain anechoic or hypoechoic areas
evaluate IVC and renal vein for tumor invasion
Wilms tumor
3 pediatric urachal anomalies
patent urachus
urachal cyst
urachal sinus
Clinical findings: history of some form of trauma to the kidney(s) (blunt trauma, stab wound, biopsy, and lithotripsy) flank pain abdominal pain hematuria decreased hematocrit
renal hematoma
Sonographic findings:
variable appearance depending on the stage of the blood and location
blood may accumulate under the capsule (subcapsular), in the perinephric area (in Gerota’s fascia), pararenal area (anterior or posterior), or intramuscular (in the psoas muscle)
if chronic, may calcify and produce acoustic shadowing
renal hematoma
where are transplanted kidneys placed?
in the right or left lower quadrant
4 things a postrenal transplant fluid collection could be:
lymphocele
urinoma
hematoma
abscess
Sonographic findings:
echogenic focus within the ureter that produces acoustic shadowing
dilatation of the ureter proximal to the obstruction
ureteral stone
ureteroceles are often associated with what?
duplicated collecting systems
Sonographic findings:
anechoic, balloonlike structure within the lumen of the urinary bladder near the ureterovesicular junction
can be ectopic in location
ureterocele
Sonographic findings:
large, anechoic tubular structure that extends from the kidney to the urinary bladder; only a section may be enlarged however
megaureter and hydroureter
4 layers of the bladder, from inner to outer
mucosa
submucosa
muscularis
serosa
what muscle controls the appropriate emptying of the urinary bladder?
detrusor muscle (located within the muscularis portion of the wall)
when the bladder wall is thickened, its diameter will exceed ____ in a distended state
4 mm
bladder volume formula
L x W x H x 0.56
Clinical findings:
past history of brain or spinal trauma, congenital spinal abnormalities, or diabetes
unnecessary urgency to void
rarely feel the need to urinate
neurogenic bladder
Sonographic findings:
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
neurogenic bladder
Sonographic findings:
anechoic outpouching of the bladder wall
bladder diverticulum
Clinical findings: dysuria urinary frequency lower abdominal pain nocturia hematuria
cystitis
Sonographic findings:
bladder wall may appear focally or diffusely thickened, measuring greater than 4 mm in thickness
bladder may contain echogenic, layering material within its lumen
cystitis
Sonographic findings:
echogenic, mobile, shadowing foci within the lumen of the urinary bladder
bladder stones
Sonographic findings:
echogenic, nonshadowing mass that may be mobile or adhered to the wall of the bladder
blood clots in the bladder
the most malignant tumor of the bladder
transitional cell carcinoma (TCC)
Clinical findings:
gross hematuria
may urinate blood clots
transitional cell carcinoma of the bladder
Sonographic findings:
smooth or papillary hypoechoic mass that projects into the lumen of the bladder
a solid tumor will not be mobile and will often demonstrate vascularity
transitional cell carcinoma of the bladder
What is the functional unit of the kidney? A. nephron B. medulla C. cortex D. Bowman's capsule
nephron
The protective capsule of the kidney is referred to as: A. Glisson capsule B. perirenal capsule C. renal capsule D. renal cortex
renal capsule
The vessel located anterior to the abdominal aorta and posterior to the superior mesenteric artery is the: A. celiac artery B. left renal artery C. right renal vein D. left renal vein
left renal vein
All of the following are clinical findings of acute renal failure except: A. hematuria B. hypertension C. oliguria D. decreased BUN and creatinine
decreased BUN and creatinine
Which of the following is the most common cause of chronic renal failure?
A. hypertension
B. diabetes mellitus
C. autosomal recessive polycystic kidney disease
D. acute tubular necrosis
diabetes mellitus
The inherited disorder associated with the development of tumors of the central nervous system and orbits, renal cysts, and adrenal tumors is: A. tuberous sclerosis B. tuberculosis C. von Hippel-Lindau syndrome D. multicystic dysplastic kidney disease
von Hippel-Lindau syndrome
Which of the following is the most common cause of acute renal failure?
A. hypertension
B. diabetes mellitus
C. autosomal recessive polycystic kidney disease
D. acute tubular necrosis
acute tubular necrosis
All of the following are characteristics of a complex cyst except: A. internal echoes B. smooth walls C. mural nodules D. septations
smooth walls
Which of the following best describes the sonographic appearance of a kidney affected by autosomal recessive polycystic kidney disease?
A. bilateral enlarged, echogenic kidneys
B. unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossa
C. small, echogenic kidneys
D. numerous large, complex renal cysts
bilateral enlarged, echogenic kidneys
The systemic disorder associated with epilepsy that leads to the development of solid tumors in various organs including angiomyolipomas of the kidneys is: A. tuberous sclerosis B. tuberculosis C. von Hippel-Lindau syndrome D. multicystic dysplastic kidney disease
tuberous sclerosis
The presence of purulent material within the renal collecting system is termed: A. pylotosis B. pyelonephritis C. pyonephrosis D. emphysematous pyelonephritis
pyonephrosis
Clinical findings of glomerulonephritis include all of the following except: A. proteinuria B. throat infection C. azotemia D. hypercalcemia
hypercalcemia
Which of the following is not considered an intrinsic cause of hydronephrosis? A. ureterocele B. urethritis C. urolithiasis D. ureteropelvic junction obstruction
urethritis
Clinical findings of nephrocalcinosis include all of the following except: A. urinary tract infections B. urinary calculi C. hyperparathyroidism D. weight loss
weight loss
Which of the following renal conditions is associated with the development of cysts within the pancreas and liver?
A. autosomal recessive polycystic kidney disease
B. autosomal dominant polycystic kidney disease
C. multicystic dysplastic kidney disease
D. acquired renal cystic disease
autosomal dominant polycystic kidney disease
Which of the following locations is the most common location for a urolithiasis to become lodged? A. ureteropelvic junction B. midureter C. urethra D. ureterovesicular junction
ureterovesicular junction (UVJ)
