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abdomen > Kidney Pathology > Flashcards

Kidney Pathology Flashcards

0
Q

Where do the arcuate vessels lie?

A

at the base of the renal pyramids

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1
Q

What is confused with the right renal artery?

A

the diaphragmatic crura

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2
Q

What are Bertin’s columns?

A

normal variant

columns are prominent invaginations of the cortex located at the varying depths within the medullary substance of the kidneys

with have the same echogenicity as the normal kidney…cortex comes way down through the pyramids

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3
Q

The dromedary hump is….

A

a cortical bulge that occurs on the lateral border of the kidney, typically more on the left. (like a camel hump)

in some patients it may be so prominent that it looks like a neoplasm

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4
Q

What is a junctional parenchymal defect?

A

a triangular echogenic area in the upper pole of the renal parenchyma that can be seen during normal sonographic scanning

remnant of fusion site

small chunk taken out of the kidney

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5
Q

What are lobulated appearances of the kidney?

A

norma variant

surface of the kidney is indented between the calyces giving the kidney a lobulated appearance

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6
Q

Is an extrarenal pelvis a normal variant?

A

yes

tends to be larger with long major calyces

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7
Q

What is the duplex collecting system?

A

normal variant

central renal sinus appears as two echogenic regions separated by a cleft of moderately echogenic tissue similar in appearance to the normal renal parenchyma

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8
Q

What is a horseshoe kidney?

A

most common fusion anomaly

(renal ectopia is another fusion anomaly)

fusion of the polar regions of the kidneys

rule out masses and prove its a horseshoe kidney

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9
Q

What is sinus lipomatosis?

A

a condition that is characterized by the deposition of a moderate amount of fat in the renal sinus

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10
Q

What is ageneis, dysgenesis and supernumerary?

A

Agenesis: absence or failure of formation

dysgenesis: defective embryonic development
supernumerary: exceeding the normal number

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11
Q

What is a solitary kidney?

A

rate and results from unilateral renal agenesis

look for a small nonfunctioning kidney before making a diagnosis of solitary kidney

renal enlargement occurs with solitary kidney

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12
Q

Where do you scan if you don’t find the kidney in its normal position?

A

scan the retroperitoneum and pelvis

most true ectopic kidneys are located in the bony pelvis and may be malrotated

a pelvic kidney may simulate a solid adnexal mass

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13
Q

What is BUN related to?

A

renal failure

parenchymal disease

renal obstruction

dehydration

diabetes

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14
Q

What causes creatinine to rise?

A

renal failure

chronic nephritis

renal obstruction

diabetes

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15
Q

What are some reasons for renal imaging?

A

ABN lab values

abn urinalysis

pain

difficulty with uriation

repeat UTI

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16
Q

What is a simple renal cyst?

A

most common renal mass

typical cyst criteria

occurring in 50% of adults over 50

not significant unless they distort the calyces or produce pain or hydronephrosis

asymptomatic

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17
Q

What other kinds of renal cysts are they?

A

peripelvic

parapelvic

cortical

exophytic

milk of calcium

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18
Q

What is a peripelvic cyst?

A

small, multiple, bilateral

develop from lymphatic system

originate in renal sinus/pelvis

does not communicate with collecting system

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19
Q

What is a parapelvic cysty?

finish slide 12

A

in the renal hilum (may mimic hydronephrosis)

originate

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20
Q

What is a cortical cyst?

A

small cortical cysts may be difficult to differentiate with pyramid….but out in the cortex

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21
Q

What is an Exophtic cyst?

A

projected out away from the kidney

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22
Q

What is a milk of calcium cyst?

A

very rare

fluid level within the cyst

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23
Q

What diseases and syndromes presenting with cystic areas in the kidneys?

A

slide 19

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24
Q

What is Von Hipple-Linau?

finish slide 20

A

autosomal-dominant genetic presents in the second and third decade of life

tumors of the central nervous system and orbits

***retinal angioma

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25
Q

What is Tuberous sclerosis?

A

Genetic

multiple renal cysts

multiple angiomyolipomas

mental retardation

seizures/epilepsy

cutaneous/skin lesions

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26
Q

What is aquired cystic disease of dialysis?

A

increased incidence of cysts, adenoma, RENAL CARCINOMA

bleeding can cause flank pain

dialysis causes the cysts in the kidneys

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27
Q

What is polycystic disease?

A

infantile polycystic kidney disease (IPKD) or

autosomal recessive polycystic kidney disease (ARPKD) or Potter Type 1

Adult polycystic kidney disease (APKD) or Autosomal Dominant Plycystic kidney disease or Potter type III

28
Q

What is congenital cystic disease?

Finish slide 24-25

A

ARPKD (infantile)

infants often die with complications of renal failure and hepatic disease

rare

problem with chro

29
Q

What is ADPKD?

slides 28-29

A

finish

30
Q

When you see poly cystic kidney what else do you look at?

A

liver and spleen

31
Q

What is multicystic dysplastic kidney?

A

non hereditary

renal dysplasia - the tubules aren’t working correctly (not really cysts)

unilaterally

most common palpable mass and cystic disease in neonates*

may lead to infection, hypertension, hematuria, flank pain

more common than IPKD

32
Q

What are the issues with multicystic dysplastic kidney

A

slide 40

33
Q

What are medullary cystic disease and nephronophyhisis (NPH)

A

qutosomal recessive/dominant forms

salt wasting nephropahty

bilateral

34
Q

What is medullary cystic disease?

finish slide 41

A

tubular atrophy

glomerular sclerosis

multiple small cysts

35
Q

what are renal calcifications?

A

urolithiasis

nephrolithiasis

finish slide 42

36
Q

What is urolithiasis?

A

combinations of chemicals in urine

kidney stones anywhere in the urinary tract

common

cause obstruction

severe back pain

37
Q

What is nephrolithiasis?

A

Kidney stones WITHIN the kidney

harmonic imaging may enhance shadowing

compound imaging my hide shadowing

38
Q

What is sonographic techniques of urolithiasis and nephrolithiasis?

A

color doppler - twinkling artifact**

renal stones are echogenic with shadowing

may see ureter because of blockage…follow it to find the stone

39
Q

What is a staghorn calculus?

A

large stones in the central portion of the kidney

Nephrolithiasis more common in men

40
Q

How do you treat urolithiasis and nephrolithiasis?

A

extracoporeal shockwave lithotripsy

percutaneous nephrolithotomy

ureteroscopic stone removal

41
Q

What is nephrocalcinosis?

A

accumulation of calcium within the rnal parenchyma

medullary or cortical

NOT A STONE, a calcium deposit

42
Q

What is the sonographic findings of slide 51

A

finish

43
Q

What is cortical

slide 52

A

finihs

44
Q

What is medullary sponge kidney?

A

RARE

birth defect

benign

calcium stones

dysplastic dilatation of tubules

abnormal function because calcium in the tubules

be able to recognize from the picture

45
Q

What are the malignant renal tumors?

A

renal cell carcinoma

transitional cell carcinoma

squamous cell carcinoma

lymphoma

metastases

Wilm’s tumor

46
Q

WHat is your first choice when you see a solid mass on a kidney?

A

malignant cancer

47
Q

WHat is the most common renal tumor?

A

Renal Cell Carcinoma

48
Q

What is renal cell carcinoma

A

most common renal tumor

twice as common in females as in males

sixth to seventh decade of life

clincal:

hematuria

flank pain

palpable mass

unexplained weight loss

better prognosis - can be removed

49
Q

What is the staging system for RCC? (renal cell carcinoma)

A

Robson System

  1. confined to kidney
  2. spread to perinphric fat but within gerota
  3. perinephric involvement with spread to RENAL VEIN and/or IVC
  4. lymph node enlargement
  5. venous and lymph
  6. invasion of adjacent structures
50
Q

If you see RCC where else do you check automatically?

A

IVC

51
Q

What is the sonographic findings of renal cell carcinoma?

A

AKA: hypernephroma/adenocarcinoma

solid parenchymal mass

areas of hemorrhage and necrosis

erythrocytosis

leukocytoisis

“basket sign” with color doppler - demonstrates peripheral vascularity of the tumor

52
Q

What is transitional cell carcinoma?

A

most common tumor of the COLLECTING SYSTEM

often multiple

higher in males

hypoechoic mass in the renal pelvis

invasive

OBSTRUCTIVE*

53
Q

What tumor causes pain secondary to obstruction?

A

transitional cell carcinoma

hematuria

54
Q

What is renal lymphoma?

A

secondary to Non-hodgkins

finish slide 68

55
Q

Where do kidney metastases come from?

A

most common lung and breast

56
Q

What is Wilm’s Tumor?

A

nephroblastomas

most common solid renal mass of childhood

associated with Bechwith-wiedemann

sporadic aniridia (no color in the eye)

omphalocele

57
Q

Sonographic findings of Wilm’s tumor

A

palpable abd mass

nausea vomiting

finish slide 71-72

58
Q

What are the benign solid tumors?

A

angiomyolipoma

adenoma

lipoma

oncocytoma

nephroma

fibroma

59
Q

Angiomyolipoma slide 77-78

A

finish

60
Q

What is an Adenoma?

finish

A

benign renal tumor

tubular epithelial

incidental finding

well defined

calcifications

renal cortex

61
Q

What is a lipoma?

A

fat cells

more often in females

asymptomatic

hematuria

well defined echogenic mass

connective tissue tumor

62
Q

What is oncocytoma?

A

finish slide 81-82

63
Q

What happens when you have a diffuse renal disease?

A

examine the renal parenchyma because the entire look of the kidney will change when there is disease.

inspect the edges - disease begins here…inferior, superior pole

64
Q

What is inflammatory kidney diseases?

A

acute pyelonephritis

acute tubular necrosis

pyonephrosis

glomerulonphitis

fungal-candidiasis

abscesses

65
Q

If you have an acute disease, how does the kidney appear?

A

typically acute disease will have a normal looking kidney

66
Q

What is inflammatory cystic disease?

finish slide 87

A

inflammatory or necrotic

pain

hematruia

proteinuria

pyuria

white blood cells in urine

internal echoes

67
Q

When you have a renal infection what do you lose?

A

loss of ability to distinguish the cortex from the medulla

the corticomedullary junction

abdomen (11 decks)

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