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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
What is Von Hipple-Linau? finish slide 20
autosomal-dominant genetic presents in the second and third decade of life tumors of the central nervous system and orbits ***retinal angioma
25
What is Tuberous sclerosis?
Genetic multiple renal cysts multiple angiomyolipomas mental retardation seizures/epilepsy cutaneous/skin lesions
26
What is aquired cystic disease of dialysis?
increased incidence of cysts, adenoma, RENAL CARCINOMA bleeding can cause flank pain dialysis causes the cysts in the kidneys
27
What is polycystic disease?
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
What is congenital cystic disease? Finish slide 24-25
ARPKD (infantile) infants often die with complications of renal failure and hepatic disease rare problem with chro
29
What is ADPKD? slides 28-29
finish
30
When you see poly cystic kidney what else do you look at?
liver and spleen
31
What is multicystic dysplastic kidney?
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
What are the issues with multicystic dysplastic kidney
slide 40
33
What are medullary cystic disease and nephronophyhisis (NPH)
qutosomal recessive/dominant forms salt wasting nephropahty bilateral
34
What is medullary cystic disease? finish slide 41
tubular atrophy glomerular sclerosis multiple small cysts
35
what are renal calcifications?
urolithiasis nephrolithiasis finish slide 42
36
What is urolithiasis?
combinations of chemicals in urine kidney stones anywhere in the urinary tract common cause obstruction severe back pain
37
What is nephrolithiasis?
Kidney stones WITHIN the kidney harmonic imaging may enhance shadowing compound imaging my hide shadowing
38
What is sonographic techniques of urolithiasis and nephrolithiasis?
color doppler - *twinkling artifact*** renal stones are echogenic with shadowing may see ureter because of blockage...follow it to find the stone
39
What is a staghorn calculus?
large stones in the central portion of the kidney Nephrolithiasis more common in men
40
How do you treat urolithiasis and nephrolithiasis?
extracoporeal shockwave lithotripsy percutaneous nephrolithotomy ureteroscopic stone removal
41
What is nephrocalcinosis?
accumulation of calcium within the rnal parenchyma medullary or cortical NOT A STONE, a calcium deposit
42
What is the sonographic findings of slide 51
finish
43
What is cortical slide 52
finihs
44
What is medullary sponge kidney?
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
What are the malignant renal tumors?
renal cell carcinoma transitional cell carcinoma squamous cell carcinoma lymphoma metastases Wilm's tumor
46
WHat is your first choice when you see a solid mass on a kidney?
malignant cancer
47
WHat is the most common renal tumor?
Renal Cell Carcinoma
48
What is renal cell carcinoma
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
What is the staging system for RCC? (renal cell carcinoma)
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
If you see RCC where else do you check automatically?
IVC
51
What is the sonographic findings of renal cell carcinoma?
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
What is transitional cell carcinoma?
most common tumor of the COLLECTING SYSTEM often multiple higher in males hypoechoic mass in the renal pelvis ***invasive*** ***OBSTRUCTIVE****
53
What tumor causes pain secondary to obstruction?
transitional cell carcinoma hematuria
54
What is renal lymphoma?
secondary to Non-hodgkins finish slide 68
55
Where do kidney metastases come from?
most common lung and breast
56
What is Wilm's Tumor?
nephroblastomas most common solid renal mass of childhood associated with Bechwith-wiedemann sporadic aniridia (no color in the eye) omphalocele
57
Sonographic findings of Wilm's tumor
palpable abd mass nausea vomiting finish slide 71-72
58
What are the benign solid tumors?
angiomyolipoma adenoma lipoma oncocytoma nephroma fibroma
59
Angiomyolipoma slide 77-78
finish
60
What is an Adenoma? finish
benign renal tumor tubular epithelial incidental finding well defined calcifications renal cortex
61
What is a lipoma?
fat cells more often in females asymptomatic hematuria well defined echogenic mass connective tissue tumor
62
What is oncocytoma?
finish slide 81-82
63
What happens when you have a diffuse renal disease?
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
What is inflammatory kidney diseases?
acute pyelonephritis acute tubular necrosis pyonephrosis glomerulonphitis fungal-candidiasis abscesses
65
If you have an acute disease, how does the kidney appear?
typically acute disease will have a normal looking kidney
66
What is inflammatory cystic disease? finish slide 87
inflammatory or necrotic pain hematruia proteinuria pyuria white blood cells in urine internal echoes
67
When you have a renal infection what do you lose?
loss of ability to distinguish the cortex from the medulla | the corticomedullary junction

abdomen (11 decks)

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