Kidney Pathology Flashcards
what location do the kidneys develop?
in the pelvis within the 5th week of development
at what week does the kidney ascend to the abdomen?
the kidney ascends into the abdomen by the 9th week of development
what are genitourinary tract anomalies?
Bicornuate uterus and seminal vesicle agenesis
what are the most common complications of renal anomalies?
impaired renal function, infection and calculus formation
renal agenesis is also called?
Potter’s syndrome
Bilateral renal agenesis is predominantly in what gender?
males; it is very rare
what are the sonographic signs of renal agenesis
- kidney and bladder not visualized
- low amniotic fluid
- decreased movement and development
with unilateral renal agenesis, which kidney usually does not develop?
the left kidney
what is typically seen in an ultrasound of unilateral renal agenesis?
- enlargement of contralateral kidney
- 70% genital anomaly
- bicornuate uterus
- seminal vesicle agenesis
what is a supernumerary kidney?
where there is the presence of an extra kidney with its own blood supply and ureter
what is an ectopic kidney?
where one kidney fails to ascend from the pelvis to its proper location during development
typically, where is the ectopic kidney located?
in the pelvis as a palpable mass
Pelvic kidney is prone to…
poor drainage, ureteral reflux, and hydronephrosis
what is a dromedary hump?
a single hump of lobulation on the lateral border of the kidney
what is a horseshoe kidney?
a developmental anomaly that occurs when the kidneys fuse together, creating a horseshoe-shaped structure in the lower abdomen.
where does a horseshoe kidney usually occur?
across the midline, anterior to the aorta
what symptoms can occur with horseshoe kidney?
horseshoe kidney is asymptomatic, but increases the risk for complications such as infection, stones, obstruction, and hematuria
how does horseshoe kidney appear on ultrasound?
a palpable mass anterior to the aorta
what is a hypoplastic kidney?
a hypoplastic kidney is a congenitally small kidney that may be normal or often incompletely developed
what is a duplex kidney?
where the developing kidney is divided into upper and lower sections. the lower section is usually larger
what is the most common renal anomaly?
double collecting system/ duplex kidney
define complete double collecting system
two collecting systems and two ureters that both enter the bladder
define incomplete double collecting system
two collecting systems and two ureters that unite distally before entering the bladder
which part of the kidney typically has problems?
the upper section of the kidney usually shows signs of hydronephrosis
which disease processes are associated with duplex kidney?
obstruction and reflux
duplex kidney is associated with ____ in females?
uterus didelphys (double uterus)
how does duplex kidney appear on ultrasound?
the duplex kidney is usually enlarged, and the renal sinus appears as two echogenic regions separated by normal renal tissue
how do you check for two ureters?
you check for two ureters by seeing if there are two ureters exiting the hilum of the kidney
what is an extrarenal pelvis?
an extrarenal pelvis is a renal pelvis that lies outside the renal sinus
how does an extrarenal pelvis appear on an ultrasound?
it appears as a cystic collection medial to the renal hilum
define ARPKD
Autosomal Recessive Polycystic Kidney Disease. this is found in infants and causes a dilation of the renal collecting tubules in the renal cortex. it is life- threatening.
what is the risk factor for a recessive gene?
it can be very likely to occur if both parents carry the gene for the disease.
what does ARPKD look like on ultrasound?
the cysts are too small to be seen on ultrasound. The kidney appears echogenic.
what is the survival rate of ARPKD?
survival rate is very low, most do not survive for very long.
what is ADPKD?
autosomal dominant polycystic kidney disease
what is the survival rate for a patient with ADPKD?
the survival rate is very high, but 50% of patients develop renal failure by 50 yoa
when do symptoms of ADPKD occur?
by the age of 50
what are the clinical signs of ADPKD?
infection, stones, or cystic rupture
how does ADPKD (PKD) appear on ultrasound?
multiple irregular cysts that consume the kidney’s tissue. the kidneys can also become enlarged. ADPKD can also be associated with liver, pancreas, and splenic cysts
Medullary cystic disease is a _____ gene.
dominant
where are medullary cysts located?
in the medulla of the kidney
what is the sonographic appearance of medullary cystic disease?
small echo-dense kidneys due to numerous small cysts under 2cm
multicystic dysplastic kidney disease is ______
nonhereditary
what is the most common cystic pathology of the kidney?
multicystic dysplastic kidney is the most common pathology of the kidney in neonates
what are the symptoms for multicystic dysplastic kidney?
mostly asymptomatic, but can cause polyuria, hypertension, infection, etc.
what are the sonographic signs for multicystic dysplastic kidney disease?
numerous visible cysts under 1cm within the renal parenchyma
define acquired cystic dysplasia
acquired cystic dysplasia is renal cysts that are acquired over time.
when does acquired cystic dysplasia occur?
typically, acquired cystic dysplasia will occur when a patient undergoes dialysis
what is medullary sponge kidney?
a nonhereditary disease where there is cystic dysplastic dilation of te collecting tubules (papillary necrosis)
medullary sponge kidney is associated with what disease?
Caroli’s disease
what is the sonographic appearance of medullary sponge kidney?
the medullary pyramids appear echogenic and sponge-like
what do 80% of medullary sponge kidney patients have by the age of 40?
tubular ectasia and calcium stones
what is pyelonephritis
an upper UTI
what age group does pyelonephritis affect?
women in early child-bearing age
what are the clinical symptoms for pyelonephritis?
fever, flank pain, frequency, hematuria, and dysuria.
what does a kidney with an infection look like on utrasound?
it can look enlarged
acute renal failure is caused by…
decreased renal function, usually caused by acute tubular necrosis
what are the clinical symptoms for acute renal failure?
elevated creatine, hematuria, hypertension, sepsis, and severe dehydration
what is the sonographic appearance of acute renal failure?
normal or elarged kidney, hydronephrosis, and an abnormal resistive index (RI)
define chronic renal failure
chronic renal failure develops over a long period of time where there is a decreased amount of renal function
what are the clinical symptoms of chronic renal failure?
anemia, headaches, hypertension, weight loss, N/V, pruritis, polyuria, nocturia, and chronic UTIs
what is the sonographic appearance of chronic renal failure?
chronic renal failure appears as a small kidney with a loss of cortical (cortex) thickness <2cm, and a hyperechoic cortex (loss of normal anatomy)
list the pre-existing conditions for renal failure
- hypertension
- hypotension
- CHF
what are the renal causes for renal failure?
- infection
- nephrotoxicity
- renal artery occlusion
- renal mass or cyst
what are other causes of renal failure?
- lower urinary tract obstruction
- retroperitoneal obstruction
what are the 3 types of chronic renal failure?
- nephron
- vascular
- interstitial
how common are renal cysts?
50% of the population over 50 have renal cysts
what are the two types of renal cysts
cortical and peripelvic cysts
where are perapelvic cysts located?
located in the hilum but do not project into the renal pelvis
what are the medical terms for kidney stones?
nephrolithiasis, renal calculi, and nephrocalcinosis
what are kidney stones made of?
calcium or uric acid
what might cause kidney stones?
change in pH or uric acid, hereditary, bacteria, or high calcium levels
who is commonly affected by kidney stones?
white men from the age of 20-50
what are the clinical symptoms of kidney stones?
hematuria, oliguria, flank pain, and pyuria
what is the sonographic appearance of kidney stones?
kidney stones appear as echogenic foci with strong shadow posterior to the stone
what is hydronephrosis?
where the renal pelvis and calyces become dilated due to obstructed outflow of urine
what are some common causes of hydronephrosis?
stones, prostate hypertrophy, prostate CA, or pelvic malignancy
what percentage of women present with hydronephrosis?
65% to 85%
what is mild or grade 1 for hydronephrosis?
slight separation of the collecting system
what is moderate or grade 2 for hydronephrosis?
dilation of some but not all calyces
what is severe or grade 3 for hydronephrosis?
dilation of all calyces
what is severe or grade 4 for hydronephrosis?
prominent dilation or thinning cortex
where is a transplanted kidney placed?
in the pelvis/ iliac fossa
in a transplant, where is the renal artery relocated?
the common iliac artery
what are the clinical signs of a transplant rejection?
fever, pain, decreased output, and elevated creatine levels
what are the sonographic signs of rejection?
fluid, swollen with loss of internal structures, hydronephrosis, etc.
what is the most correctable cause of hypertension?
renal artery stenosis
what is the most common cause of renal artery stenosis?
ateriosclerosis
what are the clinical signs of renal artery stenosis?
rapid onset of hypertension, elevated BUN, elevated creatine, and flank pain
what are the doppler signs of renal stenosis?
RI = >.7
RAR (renal artery ratio) is 3.5x greater than that of the aorta.
tardus parvus waveform may be present with stones
when you have decreased blood flow to the kidneys, the kidney will be ____
enlarged
what is the most common cause of renal failure?
acute tubular necrosis (ATN)
what are the causes of ATN?
surgery, sepsis, hypotenstion, pregnancy complication, obstetric jaundice
what is the sonographic appearance of ATN?
bilateral enlarged kidney and increased RI
renal vein thrombosis is most common in _____
children
renal vein thrombosis is associated with ______
trauma or tumor
what are the clinical symptoms of renal thrombosis?
massive proteinuria, epigastric pain, hematuria, and dehydration
what are the sonographic signs of renal thrombus?
- size increase in acute phase and cortex decreases
- later stages-kidney decreases
- enlarged renal vein with no flow
- renal artery will have retrograde and diastolic flow
what is artery occlusion?
the absence of blood flow in the main renal artery
what are the clinical symptoms of renal artery occlusion?
sudden hypertension, flank pain, elevated BUN, and elevated creatine
what is the sonographic appearance of renal artery occlusion?
small kidney that is less than 1.5cm shorter than the other
what is a renal infarction?
where part of the renal tissue undergoes necrosis from an arterial occlusion
what are the causes of a renal infarction?
thrombosis, tumor, or occlusion
what is the sonographic appearance of a renal infarction?
renal infarction appears as a triangular, echogenic mass in the renal parenchyma
