Kidneys Flashcards
What is the layer of fibrous tissue that surrounds the kidney and adrenal gland?
Gerota’s fascia
What vessel is more anterior, Renal veins or renal arteries?
LRV followed by LRA then ureter is posterior
What abnormality is cause when the LRV is squished between the Ao and SMA?
Nutcracker phenomenon
Cortical extensions between renal pyramids are known as?
Columns or bertin
What is the fat containing area of the kidney?
Sinus
What is a normal kidney size?
10-12cm
Cortical thickness should be what measurement?
Greater than 1cm
What is known as a lateral cortical bulge of kidney tissue of the same echogenicity as the rest of the tissue?
Dromedary hump
What kidney variant = remnant due to incomplete fusion of the upper and lower poles?
Junctional defect - is triangular / wedge shaped and typically HYPERECHOIC
What is known as fatty infiltration of the kidney in the 6-7th decade in Obese patients?
A) Nephrocalcinosis
B) Medullary sponge kidney
C) Renal sinus lipomatosis
D) Nephrolithiasis
Renal sinus lipomatosis
If you suspect an extra renal pelvis, what steps should you take to prove vs dilated ureter?
- Image in SAG and TRV and measure
- Show with color
- Elongate to show it DOES NOT extend into the kidney
Where should you search for an ectopic kidney?
Pelvis
In horseshoe kidney, do the ureters pass anterior or posterior to the fused renal parenchyma?
Anterior
What are S/S of horseshoe kidney?
Palpable pulsatile abdominal mass
Hydro in pregnancy is quite common, in what kidney does this typically occur?
Rt side
If you see hydro in the kidney, what additional structure do you need to include in the exam?
Bladder and jets (rule out obstruction) - get patient to go pee and re-check kidneys to see if its due to hydration or not
Explain different grades of hydro:
Grade 1 (mild) - minimal separation of sinus echoes
Grade 2 (mild) - dilation of renal pelvis with some but not all calyces/medulla dilation
Grade 3 (moderate) - complete pelvocaliectasis
Grade 4 (severe) - Gross dilation of pelvis with cortical thinning <1cm
Symptoms of pyonephritis?
Hematuria and renal insufficiency
What type of Lithiasis is associated with UTI’s?
A) Calcium oxalate
B) Staghorn
C) Magnesium ammonium
D) Uric acid
Staghorn calculus - look for DENSE shadow posteriorly
Symptoms of nephrolithiasis?
Renal colic
N/V
Fever
Chills
Hematuria
How to look for kidney stones?
Take off cross beam
Look for posterior shadow
Use twinkle on CD
On ultrasound, you see many small echogenic foci in bilateral kidney throughout cortex with no shadowing. What is the most plausible diagnosis?
Cortical nephrocalcinosis - excess calcium deposits in cortex
What population are kidney stones most common?
Men aged 20-50
What pathology is described as echogenic renal pyramids with shadowing?
A)Kidney stones
B) Urolithiasis
C) Medullay nephrocalcinosis
D) Cortical nephrocalcinosis
Medullary nephrocalcinosis - associated with medullary sponge kidney
How to decipher parapelvic cyst VS hydro?
- Parapelvic cyst is well defined and round
- It does NOT extend into the renal pelvis when you turn on it
- It does not extend outside of the kidney
In a septated kidney cyst, what are clues of malignancy?
Septations >1cm WITH vascularity
Calcified walls
Papillary projections
What kind of cysts “originate from renal parenchyma and protrude into the sinus”?
Parapelvic cysts - no communication with collecting system - typically solitary and large
Symptoms of ADPKD?
Presents in 40’s - hematuria, abdominal discomfort, kidney failure
What pathology is described as “multiple cystic dilatations of collecting ducts in the medulla” ?
Medullary Sponge Kidney
What is medullary sponge kidney associated with?
Caroli’s disease
What is tuberous sclerosis associated with (2) ?
Renal cysts and BILATERAL AML’s
What kidney disease is associated with the following symptoms: mental retardation, seizures, and cutaneous lesions?
A) TB
B) Lupus
C) Tuberous sclerosis
D) Acute tubular necrosis
Tuberous sclerosis
What kidney pathology may be seen in Von hippel Lindau?
Renal cysts, possibly RCC.
Pheochromocytoma in adrenal gland
What is the m/c benign renal tumor?
Adenoma- hyperechoic lesion <3cm
SF and presentation of renal adenoma?
Round, hyperechoic, 1-3cm
Presents in 60-70’s and more male dominant
Can be associated with RCC/adenocarcinoma
SF and presentation of AML’s?
Round, hyperechoic, vascular, cortical
Presents in 40-60’s and more female dominant
More commonly affects Rt side
What kind of tumor secretes renin?
Juxtaglomerular Tumor/reninoma
If you see a possible malignancy, what other structures should you pay more attention to? Hint: vessels
IVC and renal vein and the rest of the abdomen for potential METS
Renal vein waveform: continuous with mild pulsatility
IVC waveform: Pulsatility due to how close the right atrium is of the heart
What are the other names for RCC?
Adenocarcinoma and hypernephroma
What is the most common symptom of RCC?
Gross hematuria
SF of RCC?
Hyperechoic but may be iso or hypoechoic
Very vascular and potential calcifications
Assess IVC and RV for tumor extension
What is the most common urothelial carcinoma?
TCC
If there is a TCC, where will the tumor in the kidney be located?
Solid mass seen in renal SINUS
What are lymphomas in the kidney typically caused by?
METS from the blood system
METS in kidney typically come from where?
Lung, breast, or contralateral kidney
What may be seen in the kidney when a patient presents with decreased hematocrit?
A) Hematoma
B) Lipoma
C) Tubular necrosis
D) Infarction
Renal hematoma - always avascular
What pathology is known as the “loss of blood supply due to the obstruction of blood by occlusion or
stenosis”?
Renal infarction - wedge shaped area in cortex
What pathology is “acute suppurative bacterial inflammation of renal tubulointerstitial tissues”?
Acute pyelonephritis - associated with ascending UTI - most common in women aged 15-35
What is acute pyelonephritis usually caused by?
E coli
Difference between acute pyelonephritis and emphysematous?
Emphysematous is a medical emergency due to gas within the body, appears as echogenic foci with dirty shadowing or ring-down due to gas within kidney, need to send to ER
Xanthogranulomatous pyelonephritis occurs when macrophages take over parenchyma. What SF will you NOT see with this pathology?
A) Staghorn calculi typically
B) Renal enlargement >12cm
C) Decreased renal function
D) Renal atrophy
Renal atrophy
Whats are the classic kidney features of a patient with TB?
Putty kidney - small, calcified, non-functioning kidney, increased echogenicity due to calcification
“Putty kidney” is associated with what abnormality?
TB
What types of patients typically present with Lupus?
Females ages 20-40
Patients present with increased BUN and creatinine. What might this imply?
A) Liver failure
B) Dehydration
C) Muscle dystrophy
D) AKI
Acute kidney injury
What is the most common renal disease to develop into acute kidney injury?
A) Tuberous sclerosis
B) Acute tubular necrosis
C) Papillary necrosis
D) Lupus
Acute Tubular necrosis
SF of ATN?
Echogenic kidneys with bilateral enlargement
Patient presents with hypertension and decreased GFR. On ultrasound you see an atrophied echogenic kidney. Whats the most likely diagnosis?
A) AKI
B) Chronic kidney disease
C) ATN
D) Tuberous sclerosis
Chronic kidney disease
What week GA do the kidneys begin to function?
8 weeks
Which of the following pathologies does NOT have an increased risk of RCC?
A) medullary sponge kidney
B) Von hippel-lindau
C) Tuberous sclerosis
D) ADPKD
Medullary sponge kidney is NOT associated with RCC
What portion of the renal arteries course alongside the renal pyramids?
A) Interlobar
B) Interlobular
C) Arcuate
D) Segmental
A
What portion of the renal arteries course on top of the renal pyramids?
A) Interlobar
B) Interlobular
C) Arcuate
D) Segmental
C
During ultrasound evaluation of the kidney, you detect a muscle posteromedial in relation to the kidney. What structure is being imaged?
A) Quadratus lumborum
B) Rectus sheath
C) Psoas
D) Iliacus
E) Piriformis
A
