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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
Infantile polycystic kidney disease
Bilateral Enlarged echogenic kidneys Loss of cortical medullary distinction Assoc with renal dysfunction, lung hypoplasia, periportal hepatic fibrosis, oligohydramnios in utero
25
Column of Bertin
Hypertrophied column of Bertin. Invagination between cortex. Should be < 3cm and continuous with no mass effect.
26
Dromedary Hump
Lateral bulge
27
Renal cell carcinoma
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.
28
Angiomyolipoma
Fat tumor, hyperechoic, propagation speed artifact
29
Renal vein thrombosis
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
30
Urachal Cyst
Cystic dilatation of urachus (median umbilical ligament) Cystic structure superior or anterior to bladder
31
Lymphocele
Renal transplant complication or of pelvic surgery Caused by leakage of lymph from a renal transplant or surgical disruption of lymph channels
32
Urinoma
Caused from renal trauma, surgery, or obstructing lesion | MC assoc with renal tx, PUV
33
3 muscles post to kidney from med to lat
Psoas muscle, quadratus lumborum, transverse abdominis
34
Solid renal mass evaluate
Ivc and renal veins for mets
35
Renal tx possible fluid collections
Urinoma Lymphocele Hematoma Abscess
36
Kidneys
Begin form 3rd wk Nephron function 8th wk Pronephros Mesonephros: Epi, vas deferans, ejact duct Metanephros: kidney Paramesonephric ducts/Mullerian duct: uterus, vag,
37
Kidneys migrate from pelvic to abdomen at
5-6yrs
38
Kidney size
9-12cm L 5cm W 2.5 cm AP Concex laterally, concave medically Cortex > 1cm
39
Sinus contains
Calyces, vessels, lymphatics, nerves, fat
40
Layers
1. Inner fibrous capsule 2. Middle adipose capsule 3. Outer renal fascia/ Gerota's Fascia/ Perinephric Fascia
41
Gerota's fascia encloses
Kidney, adipose capsule, adrenal gland
42
Nephron
Functional unit of kidney. > 1,000,000 | Filters blood, makes urine
43
Right kidney
2-8 cm lower than left
44
Function
Controls blood concentration and volume Regulates blood ph Removed wastes from blood
45
Renal agenesis
Bilateral is fatal Unilateral absent kid and ureter. L>R Assoc with contralateral Hypertrophy & genitial anomalies
46
Ureter duplication
Common Complete duplication creates ureterocele that can't enter bladder and backs up. Partial starts as 2 ureters and merge
47
Extrarenal pelvis
Extra cystic area outside medial to kidney
48
Supernumery kidney
Rare 2 kidneys on one side and one on the other. Ipsilateral kidney may be fused.
49
Ectopic kidney
Fail to migrate. In pelvis commonly. Rarely in thorax.
50
Crossed renal ectopia
Both kidneys on one side. | Crossed fused renal ectopia more common.
51
Horseshoe kidney
Fused at upper or lower poles. Lower pole more common. Connected by isthmus.
52
ADPKD
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
ARPKD / IPKD
Autosomal Recessive Polycystic Kidney Disease Infantile Polycystic Kidney Disease Infants, large echogenic spongy kidneys. Non functioning. Tiny cysts. Bilateral. Fatal.
54
MCDK
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
ACKD
Acquired Cystic Kidney Disease 90% of long term dialysis patients. Various cysts. Hyperechoic. Norm to small kidney.
56
Medullary Cystic Disease
Rare Dilated tubules with formation of Ca+ and stones in 10-15% Echogenic pyramids, no posterior shadowing. Usually Bilateral.
57
Cyst with mural calcifications assoc with
Cancer
58
Milk of calcium cyst
Hyperechoic calcium moves within cyst with patient position
59
Para pelvic cyst
In hilum Does not communicate with pelvis May look like hydro
60
Von Hippel Lindau
Multiple organs and CNS tumors. Renal tumors and cysts.
61
Tuberous Sclerosis
Mental retard, seizures, cutaneous lesions, renal cysts, Angiomyolipomas 80% multiple bilateral angiomyolipomas
62
Uremic Medullary Cystic Disease / Nephronophthesis
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
Angiomyolipomas / Renal Hamartoma
Blood vessel muscle fat | Echogenic well defined, solitary
64
Adenoma
MC benign tumor | Well defined iso hyper hypo, < 1 cm, in cortex
65
Oncocytoma / Oxyphilic Adenoma
Large vascular Adenoma Males Solitary, hypoechoic, stellate scar / spokes wheel
66
Hypernephroma / Renal Cell Carcinoma
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
Renal cancer mets to
Lungs MC, bone, contralateral kidney, nodes, liver, adrenal, brain
68
Transitional Cell Carcinoma
90% of primary pelvis tumors Males > females Carcinogen exposure Near trigone usually Hematuria, frequency, dysuria, suprapubic pain
69
Squamous Cell Carcinoma
10% of primary renal pelvis tumors Hematuria, hydronephrosis, hypo-iso mass that splits central echo complex/sinus.
70
Renal Lymphoma
Usually NonHodgkins spread through blood | Hypo cortex, cystic/hypo mass with no enhancement, multiple, bilateral, enlargement.
71
Mets to kidneys
MC melanoma Contralateral kidney, lymphoma, lung, breast, stomach, cervix, colon, pancreas Multiple small bilateral hypo lesions
72
Wilms tumor / nephroblastoma
MC renal tumor in children Usually before 3 yrs Palp mass, pain, anorexia, n/v, fever, hematuria, malaise, htn Large unilateral
73
Acute Renal Failure
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
Chronic Renal Failure
Months-years Irreversible End stage renal disease Small Echogenic kidneys Need transplant or dialysis
75
Acute Tubular Necrosis
2nd to ischemia or toxic insult Enlg hyperechoic kidneys
76
AIDs
Pneumocystis Carinii: diffuse Ca+
77
Sickle Cell Nephropathy
Glomerulonephritis, RV thrombus, papillary necrosis | Hematuria
78
Hypertensive Nephropathy
Uncontrolled htn leads to renal damage | Small kidneys Echogenic
79
Renal Atrophy
Thin cortex | Small
80
Acute Pyelonephritis
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
Chronic pyelonephritis
Small Echogenic thin parenchyma | Recurrent UTIs
82
Emphysematous Pyelonephritis
``` Gas forming bacterial Immunosuppressed, females with UTIs E. coli Life threatening Emergency nephrectomy Gas in sinus/cortex ```
83
Xanthogranulomatous Pyelonephritis
``` Rare. Chronic. Replacement of normal parenchyma Staghorn Calculi: big obstruction huge stone thing Hydro Diabetic females diffuse/segmental ```
84
Acute Glomerulonephritis
Inflammation necrosis of glomeruli | Echogenic cortex
85
Acute interstitial nephritis
Scarlet fever assoc, diphtheria, drug allergies Enlg Echogenic mottled splotchy kidney
86
Renal/Perirenal Abscess/ renal carbuncle
Staph Aureus bacteria Pain fever chills tender Focal collection of inflammatory necrotic debri Diabetics Complex fluid collection. Gas. Shadow. Debri.
87
Pyonephrosis
Pus in dilated collecting system Fever. Flank pain. Dilated anechoic to hypo ureter. Fluid debri. Air.
88
Tuberculosis
From lungs to kidney via blood | Ca+
89
Candidiasis
MC cause of urinary tract fungal infection ``` Renal fungus balls Candida Immunosuppressed patients Fever chills flank pain Large kid. Echogenic fungus balls ```
90
Hydronephrosis
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
Nephrolithiasis
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
Urolithiasis
Stone in urinary collecting system
93
Nephrocalcinosis
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
Infiltrative disease/ renal medical disease
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
Renal transplant.
Renal artery stenosis, MC correctable cause of hypertension. 1/3 due to atherosclerosis 2/3 due to fibromuscular dysplasia
96
Metanephros develops into
Ureteric bud & metanephric blastema
97
Lymphocele
Transplant complication | Fluid collection with septations & internal debri adj to kidney
97
Right renal artery courses
Post to ivc
98
Left renal vein courses
Ant to aorta. Post to SMA

Abdomen (15 decks)

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