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Abdomen > Kidneys > Flashcards

Kidneys Flashcards

0
Q

Bilateral renal agenesis assoc with

A

Oligohydramnios & pulmonary hypoplasia

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1
Q

Branches of renal artery

A

Main renal artery, 5 segmental arteries, interlobar arteries (between pyramids), arcuate arteries (parallel to pyramids), interlobullar arteries (perpendicular to pyramids).

The main renal artery comes off of aorta. At hilum divides into 5 segmental arteries. Those divide into interlobar arteries.

Interlobar arteries are between medullary pyramids. At the base of pyramid, arcuate arteries branch off interlobar. (Arcuate are parallel to renal capsule)

Arcuate arteries branch into interlobullar arteries. (perpendicular to renal capsule)

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2
Q

Unilateral renal agenesis is assoc with

A

Uterine duplication/bicornuate ut, and seminal vesicle agenesis in males.

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3
Q

Crossed renal ectopia

A

Kidney ascends to contralateral side

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4
Q

Crossed fused renal ectopia

A

Kidney goes to contralateral side and fuses with the other kidney

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5
Q

Horseshoe kidney

A

Lower poles fused. U shape. Lower poles at midline.

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6
Q

Ureter duplication

A

Partial or complete

Complete: 2 ureter, 1 is in ectopic location in the bladder. Frequent complication is ureterocele.

Ureterocele distal ureter into bladder with cystic dilatation. Causes obstruction. May cause upper pole to dilate.

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7
Q

MC male urinary obstruction

A

Posterior Ureteral Valve obstruction

Dilated bladder, hydroureter, hydronephrosis, urinoma

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8
Q

Most common cause of abd mass in newborns

A

MCDK

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9
Q

If see renal cell carcinoma, must evaluate ____

A

Renal vein and IVC for lymphadenopathy and liver mets.

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10
Q

Prune Belly Syndrome characteristics

A

Absent Abd wall musculature,
large distended urinary bladder, hydronephrosis/hydroureter,
bilateral cryptorchidism

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11
Q

Pyonephrosis

A

Pus in dilated pelvis secondary to infected hydronephrosis

Dependent echoes in the dilated pelvicaliceal system, debri, gas shadowing from infection.

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12
Q

Transitional cell carcinoma

A

MC cancer in renal pelvis

Squamous cell carcinoma and mucinous adenocarcinoma are also cancers in renal pelvis but not as common.

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13
Q

Bilateral renal masses

A

Malignant lymphoma/Hodgkin’s lymphoma

Mets

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14
Q

Tumors assoc with Von Hippel Lindau

A

RCC, hemangioma, phenochromocytoma, panc cystadenoma, cystadenocarcinoma, Adenoma, islet cell tumors, cyst in organs.

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15
Q

Wilms tumor/ nephroblastoma

A

MC malignant mass in the Abd of children under 8 yrs

Large renal tumor, sharply marginated, compressed renal tissue, focal hemorrhage & necrosis, calcifications, tumor invasion of IVC and RT atrium, tumor may cross midline, hypervascular

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16
Q

MCDK

A

Caused by atresia of uretopelvic junction during metanephric stage of intrauterine development. Week 8-10 GA. Collecting tubules enlarge and turn into cysts.

Assoc with contralateral UPJ obstruction, contralateral renal agenesis or hypoplasia

Cyst of varying shape/size, cyst don’t communicate, absence of sinus and parenchyma. Usually unilateral. Echogenic tissue interfaces between cysts

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17
Q

ARPKD/infantile polycystic kidney

A

Bilateral, infants, spongy large echogenic kidneys. Tiny cysts.

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18
Q

Obstruction from a stone

A

Uretovesical junction:
Ureteropelvic junction: MC
Ureteric obstruction of the level of pelvic inlet

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19
Q

Renal artery stenosis

A

Kidneys < 9cm L
Peak main renal artery vel > 100 cm/s
Renal artery / aorta ratio > 3.5
Pulsus tardus waveform of segmental renal artery

Peak systolic vel of Main renal artery compared to PSV of aorta. Renal artery to aortic ratio > or = 3.5 indicate a hemodynamically significant stenosis

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20
Q

Ureterocele

A

Round cystic structure that projects into the bladder lumen at the uretovesical junction

May obstruct & cause UTIs.

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21
Q

Structure that connects the apex of the bladder to the umbilicus

A

The median umbilical ligament (urachus)

Cystic dilatation of urachus = urachal cyst. Extends from umbilicus to bladder dome.

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22
Q

AIDs US findings

A

Hepatosplenomegaly, lymphadenopathy, hyper liver, hyper renal, liver abscess, Mets kaposi sarcoma, acute cholecystitis

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23
Q

3 parts of retroperitoneal

A

Perirenal, ant and post pararenal

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24
Q

Infantile polycystic kidney disease

A

Bilateral
Enlarged echogenic kidneys
Loss of cortical medullary distinction

Assoc with renal dysfunction, lung hypoplasia, periportal hepatic fibrosis, oligohydramnios in utero

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25
Q

Column of Bertin

A

Hypertrophied column of Bertin. Invagination between cortex. Should be < 3cm and continuous with no mass effect.

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26
Q

Dromedary Hump

A

Lateral bulge

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27
Q

Renal cell carcinoma

A

Solid hypo mass

Assoc with adult polycystic kidney disease, acquired cystic disease, Von Hippel Lindau, and Tuberous Sclerosis

Evaluate ipsilateral renal vein and IVC for mets, contralateral renal vein, Retroperitoneum for lymphadenopathy, and liver for mets.

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28
Q

Angiomyolipoma

A

Fat tumor, hyperechoic, propagation speed artifact

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29
Q

Renal vein thrombosis

A

Cause: IVC or renal vein extrinsic compression, nephrotic syndrome, renal tumors, renal allografts, trauma

Dilated clotted renal vein, absence venous flow in kidney, enlg hypo kidney, high resistive artery

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30
Q

Urachal Cyst

A

Cystic dilatation of urachus (median umbilical ligament)

Cystic structure superior or anterior to bladder

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31
Q

Lymphocele

A

Renal transplant complication or of pelvic surgery

Caused by leakage of lymph from a renal transplant or surgical disruption of lymph channels

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32
Q

Urinoma

A

Caused from renal trauma, surgery, or obstructing lesion

MC assoc with renal tx, PUV

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33
Q

3 muscles post to kidney from med to lat

A

Psoas muscle, quadratus lumborum, transverse abdominis

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34
Q

Solid renal mass evaluate

A

Ivc and renal veins for mets

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35
Q

Renal tx possible fluid collections

A

Urinoma
Lymphocele
Hematoma
Abscess

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36
Q

Kidneys

A

Begin form 3rd wk
Nephron function 8th wk

Pronephros
Mesonephros: Epi, vas deferans, ejact duct
Metanephros: kidney
Paramesonephric ducts/Mullerian duct: uterus, vag,

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37
Q

Kidneys migrate from pelvic to abdomen at

A

5-6yrs

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38
Q

Kidney size

A

9-12cm L
5cm W
2.5 cm AP

Concex laterally, concave medically

Cortex > 1cm

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39
Q

Sinus contains

A

Calyces, vessels, lymphatics, nerves, fat

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40
Q

Layers

A
  1. Inner fibrous capsule
  2. Middle adipose capsule
  3. Outer renal fascia/ Gerota’s Fascia/ Perinephric Fascia
41
Q

Gerota’s fascia encloses

A

Kidney, adipose capsule, adrenal gland

42
Q

Nephron

A

Functional unit of kidney. > 1,000,000

Filters blood, makes urine

43
Q

Right kidney

A

2-8 cm lower than left

44
Q

Function

A

Controls blood concentration and volume
Regulates blood ph
Removed wastes from blood

45
Q

Renal agenesis

A

Bilateral is fatal

Unilateral absent kid and ureter. L>R
Assoc with contralateral Hypertrophy & genitial anomalies

46
Q

Ureter duplication

A

Common
Complete duplication creates ureterocele that can’t enter bladder and backs up.
Partial starts as 2 ureters and merge

47
Q

Extrarenal pelvis

A

Extra cystic area outside medial to kidney

48
Q

Supernumery kidney

A

Rare
2 kidneys on one side and one on the other.
Ipsilateral kidney may be fused.

49
Q

Ectopic kidney

A

Fail to migrate. In pelvis commonly. Rarely in thorax.

50
Q

Crossed renal ectopia

A

Both kidneys on one side.

Crossed fused renal ectopia more common.

51
Q

Horseshoe kidney

A

Fused at upper or lower poles. Lower pole more common. Connected by isthmus.

52
Q

ADPKD

A

Autosomal Dominant Polycystic Kidney Disease

Adult
Multiple cysts varying sizes
75% with HTN

2 cyst < 30yrs
2 cyst/ kidney 30-59
4 cyst / kidney > 60

50% liver cyst assoc. also panc, spleen, and berry aneurysm

53
Q

ARPKD / IPKD

A

Autosomal Recessive Polycystic Kidney Disease
Infantile Polycystic Kidney Disease

Infants, large echogenic spongy kidneys. Non functioning. Tiny cysts. Bilateral. Fatal.

54
Q

MCDK

A

Multi Cystic Dysplastic Kidney

MC cause Abd mass in newborns. Neonates. Large cysts, loss of sinus, cyst don’t communicate.

Usually unilateral. Bilateral fatal.
Assoc with contralateral abnl UPJ

Potters syndrome assoc with bilateral MCDK

55
Q

ACKD

A

Acquired Cystic Kidney Disease

90% of long term dialysis patients.
Various cysts. Hyperechoic. Norm to small kidney.

56
Q

Medullary Cystic Disease

A

Rare
Dilated tubules with formation of Ca+ and stones in 10-15%

Echogenic pyramids, no posterior shadowing. Usually Bilateral.

57
Q

Cyst with mural calcifications assoc with

A

Cancer

58
Q

Milk of calcium cyst

A

Hyperechoic calcium moves within cyst with patient position

59
Q

Para pelvic cyst

A

In hilum
Does not communicate with pelvis
May look like hydro

60
Q

Von Hippel Lindau

A

Multiple organs and CNS tumors. Renal tumors and cysts.

61
Q

Tuberous Sclerosis

A

Mental retard, seizures, cutaneous lesions, renal cysts, Angiomyolipomas

80% multiple bilateral angiomyolipomas

62
Q

Uremic Medullary Cystic Disease / Nephronophthesis

A

Rare, progressive.
Uremic medullary cystic disease: adult
Nephronophthesis: child

Azotemia (inc nitrogen), anemia, salt wasting, polyuria

Sm cyst in medulla, echogenic pyramid, hyper cortex, normal to small kidneys

63
Q

Angiomyolipomas / Renal Hamartoma

A

Blood vessel muscle fat

Echogenic well defined, solitary

64
Q

Adenoma

A

MC benign tumor

Well defined iso hyper hypo, < 1 cm, in cortex

65
Q

Oncocytoma / Oxyphilic Adenoma

A

Large vascular Adenoma
Males
Solitary, hypoechoic, stellate scar / spokes wheel

66
Q

Hypernephroma / Renal Cell Carcinoma

A

MC renal cancer 85%
Males > females

Assoc with Tuberous Sclerosis, Von Hippel Lindau, dialysis, cystic diseases

Stage 1: kidney

2: Gerota’s fascia
3: renal vein, ivc, regional nodes
4: adj organs, distant mets, distant nodes

Pain, palp mass, hematuria, weight loss, fever, htn

Hypo usually, calcifications, complex with necrosis,
Color pseudocapsule / basket sign

67
Q

Renal cancer mets to

A

Lungs MC, bone, contralateral kidney, nodes, liver, adrenal, brain

68
Q

Transitional Cell Carcinoma

A

90% of primary pelvis tumors
Males > females

Carcinogen exposure
Near trigone usually

Hematuria, frequency, dysuria, suprapubic pain

69
Q

Squamous Cell Carcinoma

A

10% of primary renal pelvis tumors

Hematuria, hydronephrosis, hypo-iso mass that splits central echo complex/sinus.

70
Q

Renal Lymphoma

A

Usually NonHodgkins spread through blood

Hypo cortex, cystic/hypo mass with no enhancement, multiple, bilateral, enlargement.

71
Q

Mets to kidneys

A

MC melanoma
Contralateral kidney, lymphoma, lung, breast, stomach, cervix, colon, pancreas

Multiple small bilateral hypo lesions

72
Q

Wilms tumor / nephroblastoma

A

MC renal tumor in children
Usually before 3 yrs

Palp mass, pain, anorexia, n/v, fever, hematuria, malaise, htn

Large unilateral

73
Q

Acute Renal Failure

A

Impaired kidney function over days-wks
Reversible with early tx

MC cause ATN Acute Tubular Necrosis
Other causes: cystic diseases, inflammations, toxin exposure, obstruction, diabetes, htn

Htn, weak muscles, GI bleed, infection

Enlg hypo kidneys

74
Q

Chronic Renal Failure

A

Months-years
Irreversible
End stage renal disease

Small Echogenic kidneys
Need transplant or dialysis

75
Q

Acute Tubular Necrosis

A

2nd to ischemia or toxic insult

Enlg hyperechoic kidneys

76
Q

AIDs

A

Pneumocystis Carinii: diffuse Ca+

77
Q

Sickle Cell Nephropathy

A

Glomerulonephritis, RV thrombus, papillary necrosis

Hematuria

78
Q

Hypertensive Nephropathy

A

Uncontrolled htn leads to renal damage

Small kidneys Echogenic

79
Q

Renal Atrophy

A

Thin cortex

Small

80
Q

Acute Pyelonephritis

A

E. coli, infection
Enlg
Bld irritation fever chills headache back pain malaise

Normal kidney
Enlg, compressed renal sinus, hypo/hyper, loss of corticomedullary differentiation, poorly marginated mass, gas within parenchyma.

81
Q

Chronic pyelonephritis

A

Small Echogenic thin parenchyma

Recurrent UTIs

82
Q

Emphysematous Pyelonephritis

A 
Gas forming bacterial
Immunosuppressed, females with UTIs
E. coli 
Life threatening 
Emergency nephrectomy 
Gas in sinus/cortex
83
Q

Xanthogranulomatous Pyelonephritis

A 
Rare. Chronic. 
Replacement of normal parenchyma
Staghorn Calculi: big obstruction huge stone thing
Hydro
Diabetic females diffuse/segmental
84
Q

Acute Glomerulonephritis

A

Inflammation necrosis of glomeruli

Echogenic cortex

85
Q

Acute interstitial nephritis

A

Scarlet fever assoc, diphtheria, drug allergies

Enlg Echogenic mottled splotchy kidney

86
Q

Renal/Perirenal Abscess/ renal carbuncle

A

Staph Aureus bacteria
Pain fever chills tender
Focal collection of inflammatory necrotic debri
Diabetics

Complex fluid collection. Gas. Shadow. Debri.

87
Q

Pyonephrosis

A

Pus in dilated collecting system
Fever. Flank pain.
Dilated anechoic to hypo ureter. Fluid debri. Air.

88
Q

Tuberculosis

A

From lungs to kidney via blood

Ca+

89
Q

Candidiasis

A

MC cause of urinary tract fungal infection

Renal fungus balls
Candida
Immunosuppressed patients 
Fever chills flank pain
Large kid. Echogenic fungus balls
90
Q

Hydronephrosis

A

Dilation of renal collecting system
May lead to atrophy

Complete obstruction, serious damage after 3 wkd
Partial obstruction, serious damage after 3 months

False positive with overly distended bladder, large pelvis, prominent vessels, para pelvic cysts.

91
Q

Nephrolithiasis

A

Kidney stones
Calcium, Uric acid, cysteine

Hot climates, fam hx,

Hematuria, oliguria, renal colic/cramp, n/v fever chills, pyuria, anuria

Echogenic foci, shadow, candle sign (little flow in jets), twinkle artifact.

92
Q

Urolithiasis

A

Stone in urinary collecting system

93
Q

Nephrocalcinosis

A

Ca+ in renal cortex. Variable etiology. Bilateral. Diffuse.
Cortical/medullary Echogenic

Highly Echogenic pyramids with or without shadowing

Assoc Hyperparathyroidism, vit D toxication, Hypercalcemia, medullary sponge kidney, Cushing’s syndrome, Alport syndrome, fanconi’s syndrome

94
Q

Infiltrative disease/ renal medical disease

A

Renal cortical disease: Echogenic cortex. No differentiating sinus and cortex. Small.

Renal medullary disease: Echogenic pyramids.

Renal Papillary Necrosis: no differentiating cortex and sinus. Echogenic pyramids. Diabetes, obstruction, sickle cell, pyelonephritis, alcohol abuse. Multiple round/triangular cystic spaces in medulla. Echogenic pyramid with shadowing.

Renal Sinus Disease / renal sinus lipomatosis / fibrolipomatosis: fatty renal pelvis. Inc size sinus. Thin cortex. Fatty sinus.

95
Q

Renal transplant.

A

Renal artery stenosis, MC correctable cause of hypertension.
1/3 due to atherosclerosis
2/3 due to fibromuscular dysplasia

96
Q

Metanephros develops into

A

Ureteric bud & metanephric blastema

97
Q

Lymphocele

A

Transplant complication

Fluid collection with septations & internal debri adj to kidney

97
Q

Right renal artery courses

A

Post to ivc

98
Q

Left renal vein courses

A

Ant to aorta. Post to SMA

Abdomen (15 decks)

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