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Abdomen > Kidneys > Flashcards

Kidneys Flashcards

0
Q

What is the anatomical location of kidneys?

A

Retroperitoneal

Flank area

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1
Q

Renal Embryology

A

Kidneys usually develop by 15 weeks gest age in pelvis and then ascend to lumbar region.
Migration is not complete until 5-6 years old

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2
Q

Which muscles are posterior to the kidneys?

A

Psoas muscle, and Quadrates Lumbordum muscles.

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3
Q

What covers the kidneys?

A

Gerota’s Fascia

Which also covers the peritoneal fat, renal capsule and adrenal glands

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4
Q

What is the normal adult kidney measurement?

A

9-12 cm in length
4-6 cm in diameter
2.5-4 cm in depth (AP)

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5
Q

Neonatal kidney measurements?

A

3.5-5 cm in length
2-3 cm in diameter
1.5-2.5 cm in depth

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6
Q

What are the 3 distinct regions of the renal parenchyma?

A

Cortex, medulla (medullary pyramids) and renal pelvis

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7
Q

What is the pathway of urine through the collecting system?

A

Urinary sinus- minor calyces- major calyces- renal pelvis- ureter- bladder

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8
Q

What is the echogenicity of a normal kidney?

A

Renal cortex is homogenous and either isoechoic or hypoechoic to liver or spleen
Medullary pyramids are usually hypoechoic to anechoic in appearance.
Collecting system/ sinus appears highly echogenic due to fat and only becomes hypoechoic or anechoic when there is blockage

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9
Q

What is the anatomical relationship of the renal artery in respect to the IVC?

A

Right renal artery passes posterior to IVC

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10
Q

What is the anatomical relationship of the renal veins?

A

Right renal vein is shorter than left
Left renal vein courses anterior to aorta but posterior to SMA

*renal veins are inferior to renal arteries

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11
Q

What does the renal arterial vasculature consist of?

A

Renal artery, segmental artery, interlobar artery, arcuate artery, interlobular artery

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12
Q

What is the pathway of blood through the kidney?

A

Segmental arteries- interlobar a.- arcuate a.- interlobular a.- afferent arteriole- glomerular filtration- efferent arteriole- peritubular capillaries- interlobular v.- arcuate v.- interlobar v.- renal v.- IVC

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13
Q

What is the functional unit of the kidney?

A

Nephron

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14
Q

What is the excretory function of the kidney?

A

Removal of waste from blood by the glomerulus

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15
Q

What is the regulatory function of the kidney?

A

Balances fluid and electrolyte contents of blood through re-absorption and secretion by the renal tubules

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16
Q

Which components of blood are too large to pass through the nephron’s membrane?

A

Blood cells such as RBC, WBC, Platelets, and plasma proteins such as albumin and globulin.

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17
Q

What is Aldosterone?

A

Hormone secreted by adrenal glands.
Increases tubule permeability to increase reabsorption of sodium.
Adjusts fluid uptake in the event of dehydration and hemorrhage

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18
Q

Which is the most specific indicating lab function test for kidney dysfunction?

A

Serum Creatinine

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19
Q

What other lab function test are there for renal evaluation?

A

BUN- also rises with renal dysfunction

Uric Acid level- increases with renal failure and causes gout

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20
Q

Why do RBC increase when renal dysfunction is present?

A

Kidney secretes erythropoietin to stimulate RBC production from bone marrow in the presence of hypernephroma, RCC and renal cysts

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21
Q

What is the most common anomaly of the genitourinary tract?

A

Duplicate collecting system
1 in 157 adults
Most common in women

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22
Q

What types of duplicate collecting systems are there?

A

Incomplete: 2 pelvis, 1 ureter
Complete: 2 pelvis, 2 ureter * may become obstructed due to ureterocele

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23
Q

What is the sonographic appearance of duplicate collecting system?

A

Complete separation of normal renal sinus echodensities
Cause of isolated hydronephrosis
Can mimic cyst but cyst usually in cortex

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24
Q

What is prominent or hypertrophic column of Bertin?

A

Considered a variant
Double thickness of cortical tissue between 2 pyramids
can create or mimic a pseudocyst

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25
Q

Sonographic findings with column of Bertin

A

Renal sinus is clearly defined
Largest dimension is less than 3 cm
It is continuous or contiguous with the renal cortex
Echogenicity is close to that of the cortex

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26
Q

What is Dromedary Hump?

A

A variant
Bulging of the mid section of left kidney
Same echogenicity as cortex

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27
Q

What is horseshoe kidney?

A

Anomaly
Lower pole of kidneys are fused at the midline of body
1 in 400
IVP and CT are good for identification of horseshoe kidney in adjunct to ultrasound

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28
Q

What Is pelvic kidney?

A

Anomaly
Non-visualization of a kidney in renal fossa
Ectopic kidney. Failed to ascend to upper quadrant.

Note: transplanted kidneys are in the pelvis

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29
Q

What is Renal Agenesis?

A

Anomaly
No kidney formation.
Will have unilateral large kidney due to contra-lateral compensation

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30
Q

What is another name for Junctional Parenchymal Defect?

A

Fetal Lobation

Typically occurs on the anterior surface of the upper pole of kidney

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31
Q

What is Supernumerary Kidney?

A

Anomaly
Very rare
Complete duplication of kidney
Extra kidney with its own blood supply. Usually ectopically placed and shares ureter

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32
Q

What is crossed renal ectopia?

A

When a kidney ascends to the contralateral side.
You will see 2 kidneys on one side of abdomen and none on the other
One ureter crosses midline to enter other side of bladder

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33
Q

What is crossed fused renal ectopia?

A

Unilateral fused kidney
The developing kidneys fuse while in the pelvis and one kidney ascends to its normal position, carrying the other one with it across the midline

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34
Q

What is extrarenal pelvis?

A

An extra renal pelvis that lies outside the renal sinus.

Sonographically appears as a cystic collection medial to the renal hilum

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35
Q

What is posterior urethral valve?

A 
Common cause of urinary obstruction in a male infant due to a flap of mucosa that has a slit-like opening in the opening of the area of the prostatic urethra.
You will see a large bladder 
Hydroureter
Hydronephrosis
Possible urinoma
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36
Q

What is Renal Sinus Lipomatosis?

A

Excessive fatty infiltration of the renal pelvis associated with obesity, or Parenchymal atrophy

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37
Q

What are the indications for a Renal Ultrasound?

A 
Hematuria
Oligouria (scanty urine)
Flank pain
Increased serum creatinine 
Palpable mass in lumbar region
Chronic UTI 
Obstruction of the GU tract such as nephrolithiasis
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38
Q

How does renal infection develop?

A

Secondary to respiratory infection, its prevalence can cause mortality. Usually originates from bladder and spreads to kidneys.
E-colimis the most common bacteria responsible for 85% UTI
Women are more susceptible due to shorter urethra.
Urinary stasis from voiding interference enhances bacterial growth (pregnancy, urolithiasis, benign prostatic hypertrophy- BPH)

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39
Q

Where can renal infection originate from?

A

Urethra, lymphatics, vascular.

Skin, bone and heart infections can disseminate to the nephron’s via blood

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40
Q

Who is more susceptible to renal infection and why?

A

Women due to shorter urethra
Women with increased sexual activity
Pregnancy due to increased pressure on bladder and ureters

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41
Q

What is Acute Pyelonephritis (APN), and what is its etiology?

A

Sudden Renal Plevis inflammation

Abrupt onset.
Usually caused by gram-negative bacilli from intestinal tract
Causes suppuration (puss)
Unilateral or bilat
Focal or diffused infection
Can lead to micro abcess formations in kidney
Associated with UTI

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42
Q

What are the clinical findings of APN?

A 
Flank pain
Fever and chills
Urinary frequency
Elevated WBC 
Dysuria (painful/difficult urination)
Pyuria (puss in urine)
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43
Q

What are the sonographic findings of APN?

A

Kidneys may have normal appearance in early stages.

As infection progresses, the kidneys may show abnormal echopatterns (focal or diffused)

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44
Q

What is the focal appearance of APN?

A

Enlarged, hypoechoic kidney with absence of sinus echoes

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45
Q

What is the diffused appearance of APN?

A

Enlarged echogenic kidney due to multiple abscess
Cortex also becomes echogenic if there is abscess formation
The sinus will blend with the parenchyma

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46
Q

What is Acute Focal Bacterial Nephritis?

A

Focal wedge-shaped area or a hypoechoic renal lobe without renal enlargement

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47
Q

What is Emphysematous Pyelonephritis?

A

Emphysema- presence of air on tissue
Intrarenal gas accumulates causing a dirty ringdown reverberation artifact
Common in diabetes, immune-suppressed patients and those with UTI

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48
Q

What is Chronic Pyelonephritis (CPN)

And what causes it?

A

A silent, insidious, progressive disorder
From recurrent infections like UTI, obstructive lesions or vesico-ureteral reflux
Inflammation leads to scarring which can contribute to tubular dysfunction and parenchymal atrophy.

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49
Q

What is the clinical presentation of CPN?

A 
Flank pain
Oliguria
HTN 
Foul smelling urine
Slight increase in WBC
Mild fever and chills
Proteinuria (urine will be smoky)
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50
Q

What are the lab findings for CPN?

A

Poor renal function (decreased GFR)
Proteinuria
Increased blood creatinine
Increased BUN

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51
Q

What are the sonographic findings of CPN?

A

Kidneys will atrophy as the disease progresses (<8 cm)
Increased parenchymal echoes due to fibrosis
Echogenic Zone extends beyond normal areas of the sinus

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52
Q

What are other names for Renal Abscess?

A

Carbuncle

Perinephric Abscess

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53
Q

How does a Carbuncle occur?

A

Bacterial infections such as staph. Aureus or Gram Negative Bacilli spread to kidneys via blood or the ascending route from bladder.
Abscess results in flank pain, Fever and chills

54
Q

What are the sonographic findings of a renal abscess?

A 
Echogenic Renal mass
Thick wall
Irregular margins
Reverberation or shadow artifact from gas-producing organisms
Septations
Possible acoustic enhancement
55
Q

What is Xanthogranulomatous Pyelonephritis?

A

Due to chronic infection and obstruction of the uretero-pelvic junction from a staghorn calculus (blocking renal pelvis)

56
Q

What will you find with Xanthogranulomatous pyelonephritis?

A 
Renal enlargement
Parenchymal abcess
Staghorn calculus
Papillary necrosis
Possible hydronephrosis
57
Q

What is Pyonephrosis?

A

Purple to material in the collecting system
Associated with renal obstruction
Percutaneous or surgical drainage is required
Echogenic debris in a dilated renal collecting system is seen on ultrasound

58
Q

Etiology of Acute and Chronic Glomerulonephritis?

A

An antigen-antibody inflammatory response (autoimmune reaction) in the glomerulus, secondary to streptococcal infection
Leads to increased peritubular capillary permeability and cell proliferation resulting in leakage of proteins and RBC into the filtrate (ends up in tubules which congest area and slow down filtration process
Decreases GFR
Fluid and waste retention occurs, leading to ARF if prolonged
Chronic conditions can lead to CRF

59
Q

What is the clinical presentation of Glomerulonephritis?

A

Flank pain
Hematuria
Edema (beginning at face)
HTN leading to headache, nausea, fatigue and stroke

60
Q

What are the lab findings of Glomerulonephritis?

A

Increased creatinine
Increased BUN
Azotemia (abnormally high levels of nitrogen-containing compounds in the blood such as urea, creatinine)
RBC in urine

61
Q

What are the sonographic findings of Glomerulonephritis?

A

Enlarged Echogenic kidney
Cortex will have equal echogenicity to sinus followed by increased cortical echogenicity
Post treatment of primary streptococcal infection will return the kidney’s size and echogenicity back to normal

62
Q

What causes ARF?

A 
Prinmary cause is Acute Tubular Necrosis (ATN)
Decreased GFR 
Acute Glomerulonephritis 
Prolonged circulatory shock or trauma
Septicemia
Burns
Interstitial nephritis
Urinary tract obstruction 
Bilat renal artery occlusion or DVT
Heart failure and Hypotension
Tumors
63
Q

What are the 2 phases of ARF?

A

Oliguria:
Decreased urine output
Tissue breakdown

Diuretic phase:
Few days to 6 weeks after onset
Increased urine output
Indicates nephron recovery

64
Q

What are the clinical findings of ARF?

A 
Oliguria
Hypertension 
Muscle fatigue
GI bleed
Infections
65
Q

What are the sonographic findings of ARF?

A

May be normal in early stages
Kidneys may also enlarge bilat
Homogenous echogenic pattern
Increased RI with hypoperfusion

66
Q

What is the etiology of CRF?

A 
Decrease in GFR 
Hypotension
Diseases such as:
AGN (acute glomerulonephritis)
CPN (chronic pyelonephritis)
Renal vascular disease
Diabetes
Toxins 
Polycystic disease
67
Q

Clinical presentation of CRF

A 
Early stage:
Polyuria
Nausea
HTN 
Increased BUN & Creatinine
Later stage:
Oliguria
Dry skin
Impotence
Encephalopathy
CHF
68
Q

What is the sonographic appearance of CRF?

A

Small, shrunken, echogenic kidney which is definitive of end stage renal failure
Kidney measures < 8 cm in length
Cortical thinning < 1 cm

69
Q

What is Mycetoma?

A

Fungal ball
Candidiasis is another name
Most common renal fungal disease as a result from hematogenous seeding or ascend from bladder
Usually seen in immune suppressed patients such as AIDS
fungal balls appear as hyperechoic, non shadowing masses

70
Q

When performing renal biopsy where should the needle be directed?

A

Lateral aspect of lower pole

10 degree cephalad angulation

71
Q

What is the RI used for and what is its formula?

A

Used to evaluate renal transplants, access suspected hydronephrosis, medical renal disease and suspected renal neoplasm

RI= PSV-EDV/PSV

72
Q

Where is a simple renal cyst found?

A 
Commonly encountered in patients over 40 years old
Found in 50% of patients over 50
Origin is usually unknown 
Serous fluid filled
Usually solitary
73
Q

What are the sonographic findings of a simple cyst?

A

Normal characteristics of a simple cyst
Range in size
98% accuracy with ultrasound
Mural growth may indicate malignancy

74
Q

What types of simple cysts are there?

A 
Cortical/single
Cortical/multiple
Pyelogenic cyst
Parapelvic
Peripelvic
75
Q

Where does a pyelogenic cyst arise from?

A

Renal pelvis, infundibulum or calyces (calyceal diverticulum)
Show appearance of a simple cyst in ultrasound

76
Q

What is a parapelvic cyst?

A

Cysts that bulge into the central sinus of the kidney which may cause symptoms and can be mistaken for hydronephrosis

77
Q

What is a Peripelvic cyst?

A

Lymphatic cysts in the central sinus. Identical ultrasound appearance of parapelvic cysts

78
Q

Note on renal cysts

A

Cortical cysts: originate from uriniferous tubules
Pyelogenic cysts: calyceal diverticula
Parapelvic cysts: parenchymal cysts
Peripelvic cysts: lymphatic cysts

79
Q

Are hemorrhagic cysts associated with neoplasm?

A

Yes 31%

They can also be associated with trauma

80
Q

Clinical symptoms of hemorrhagic cyst

A

Abdominal pain
Back and flank pain
Hematuria

81
Q

What is MOC (Milk of Calcium)

A

Low grade inflammation and partial or complete blockage of a calyceal diverticulum
Quite common and represents calcium carbonate crystals

82
Q

Sonographic appearance of MOC

A

Anechoic area near calyx
Echogenic mobile foci or gravity dependent wall
Acoustic shadowing

83
Q

What is Medullary Sponge Kidney?

A 
Congenital autosomal recessive defect
Common/innocuous 
Localized to medullary collecting ducts
Dysplastic cystic dilation of pyramids
Bilateral, multiple cystic dilation
Occurs in adults
84
Q

What are complications of Medullary Sponge Kidney?

A

Calcifications in dilated cysts
Infection
Urinary calculi

85
Q

Sonographic appearance of Medullary Sponge Kidney

A

Hyperechoic medullary pyramids bilaterally
Ectastatic collecting tubules
No shadowing

86
Q

Acquired cystic disease

A

Patients on chronic hemodialysis develop bilat renal cysts
Hemorrhage often occurs into acquired cysts, resulting in pain, Hematuria and echogenic collections of cysts
Higher incidence of renal cell carcinoma

87
Q

What is Tuberous Sclerosis?

A

Multi-systemic disorder associated with renal cyst formation and multiple angiomyolipomas (sebaceous cysts)
Patients present clinically with mental retardation, seizure and cutaneous lesions

88
Q

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A 
Cause is unknown
Inherited Autosomal Dominant defect
Potter III disease
Latent until 3-4th decade
Bilat disease
Cystic origin: convulated tubules, bowman's capsule 
Incidence: 1-1000-2000
Leads to renal failure and requires transplant
89
Q

Clinical findings of ADPKD

A

Flank pain
Back pain
HTN
Hematuria

90
Q

Lab findings of ADPKD

A

Increased BUN
Increased creatinine
Hematuria
Proteinuria

91
Q

Complications of ADPKD

A

Destruction of residual tissue
Advanced stages lead to renal failure and HTN
Associated with Berry’s Aneurysm: cerebral arterial/circle of Willis

92
Q

What is the treatment for ADPKD?

A

Transplant

93
Q

Autosomal Recessive Polycystic Kidney Disease (ARPKD)

A

Unknown cause
Theory states dilation of collecting tubules due to hyperplasia of interstitial portions
Inherited Autosomal Recessive defect
Potter I
Common in infants
Bilateral kidney involvement
Associated with renal dysfunction and hepatic fibrosis

94
Q

Clinical findings of ARPKD

A

Oligohydramnios in utero

Cannot produce urine due to a,punt of cysts

95
Q

Ultrasound appearance of ARPKD

A

BEEK: Bilateral, Echogenic, Enlarged Kidneys
Absence of renal parenchyma
Abscess of renal sinus

96
Q

Multicystic Dysplastic Kidney

A

Cause by atresia of uretero-pelvic junction during fetal development
Most common cause of abdominal mass in newborn
It can be unilateral or bilat
Bilateral case can be fatal within 24 hrs of delivery

Potter II

97
Q

Clinical findings of MDK

A

Oliguria

Anuria if bilat

98
Q

Sonographic appearance of MDK

A

Cysts of varying shapes and size
Absence of communication between cysts
Absence of renal sinus and parenchyma
Renal architecture is gone

99
Q

Renal Adenoma etiology

A 
Most prevalent benign renal tumor 
From tubular epithelium
Can only be distinguished from malignancy by histology
Treated as malignant 
3:1 ratio male over female
Occurs usually in 6-7th decade
100
Q

Clinical presentation of Renal Adenoma

A

Painless Hematuria

101
Q

Ultrasound appearance of renal Adenoma

A 
Similar to RCC 
Variable echogenicity
Highly vascular
May have internal echoes
1 cm in size mostly
Rarely >3 cm
102
Q

Angiomyolipomas (Renal Hematoma)

A

Fat, blood vessels and smooth muscle
Cortical lesions
More common in women
40-60 years old

103
Q

Clinical findings of angiomyolipomas

A

May be asymptomatic
May have flank pain
Hematuria
HTN

104
Q

Sonographic appearance of angiomyolipomas

A

Echogenicity is greater than or equal to renal sinus fat
Solitary
Posterior displacement of structures behind these masses may be seen as a result of the slower acoustic velocity in these fatty Tumors (propagation speed artifact)
Multiple associated with tubular sclerosis

105
Q

Other names for Renal Cell Carcinoma

A

Hypernephroma

106
Q

Etiology of RCC

A 
Most common solid renal mass in adult
80-85% of adult renal tumor
Unilateral
Most common in men and African American 
5-7th decade
107
Q

Clinical findings of RCC

A

Pain
Hematuria
Palpable mass

108
Q

Sonographic appearance of RCC

A

Unilateral, encapsulated solid mass
Hyperechoic in cortex relative to adjacent normal tissue
Multilocular cyst and hemorrhagic components may be present due to necrosis and hemorrhage
Calcifications are common
METS to liver, lymph nodes, adrenals and contralateral kidney

109
Q

Stages of RCC

A

1: inside kidney
2: outside of kidney
3: goes to IVC
4: goes to lymph nodes and other organs

110
Q

What is the treatment for RCC?

A

Nephrectomy

111
Q

Associated findings with RCC

A 
Von Hipple-Lindau syndrome
Acquired cystic kidney disease
ADPKD 
Tuberous Sclerosis
Other syndromes associated with multiple cysts in kidneys
112
Q

When RCC suspected, what other areas should be investigated?

A 
Ipsilateral renal vein
IVC 
Contralateral kidney and renal vein
Retroperitoneum 
Liver for METS
113
Q

Transitional Cell Carcinoma

A

Over 90% of TCC malignancies involve the renal pelvis and ureter
Majority of TCC arises in the bladder
Avg age diagnosis 61 yrs old

114
Q

Clinical findings of TCC

A

Painless Hematuria
Hydronephrosis
Central filling defect on excretory urogram

115
Q

Sonographic findings of TCC

A

Irregular hypoechoic mass in the renal sinus
Usually too small for US detection
Clot or fungal ball pattern
Hypoechoic to isoechoic collecting system mass
Secondary calyectasis
Multiple and bilat

116
Q

Are papillomas bening but have high risk of developing to to TCC?

A

Yes

117
Q

Renal lymphoma

A

Non-Hodgkin lymphoma is the most common type

Bilat enlarged hypoechoic renal masses

118
Q

What is Wilm’s tumor?

A 
Nephroblastoma
Most common tumor in babies
Malignant
Arising from immature renal cells
Less than 3 years old
Large asymptomatic mass
Mets is common to lungs, liver, bones, lymph nodes, adrenals and retroperitoneum IVC and renal veins should be evaluated for tumor extension
Must be differentiated from adrenal neuroblastomas
119
Q

Other names for kidney stones

A

Nephrolithiasis
Urolithiasis
Calculi

120
Q

What causes nephrolithiasis?

A

Hot climates that promote dehydration, leading to concentrated urine and increases isolated precipitates of dissolved salts such as calcium oxylate, calcium phosphate

121
Q

Risk factors for urolithiasis

A 
Hereditary
Renal dysfunction 
Bacteria 
Calyceal scarring
Calyceal obstruction of collecting system
Urine stasis
122
Q

Clinical features of renal stones

A 
Hematuria
Oliguria
Renal colic
Nausea 
Vomiting 
Fever
Pyuria 
Anuria
Abdominal distention
123
Q

Sonographic appearance of renal calculi

A

Echogenic foci
Posterior acoustic shadowing
Possible hydronephrosis
Hydroureter

124
Q

What is nephrocalcinosis?

A

Calcifications of the kidney

125
Q

What kind of nephrocalcinosis are there?

A

Cortical nephrocalcinosis and

Medullary nephrocalcinosis

126
Q

Cortical Nephrocalcinosis Predispositions?

A 
Hyperparathyroidism
Vitamin D intoxication
Chronic glomerulonephritis 
AIDS
Malignancies
Acute cortical necrosis
127
Q

What is pelvocaliectasis?

A

Non-obstructive dilation of the collecting system

128
Q

Where should RI be?

A

0.7

129
Q

Grades of hydronephrosis

A 
Grade 1
Mild hydro
Dilated renal pelvis
Grade 2
Moderate hydro
Dilated calyces 
Grade 3
Severe hydro
Dilated pelvis, calyces and cortical thinning or loss of renal parenchyma
130
Q

What causes ureteric obstruction?

A 
Pregnancy
Fibroids
Bening prostatic hypertrophy BPH
Tumors 
Mass effect
131
Q

What is Ureteropelvic Junction (UPJ) obstruction?

A

Common congenital anomaly.

Associated with a contralateral multicystic Dysplastic kidney

132
Q

Where is the most common site of renal obstruction in an adult?

A

Ureterovesicle junction (ureter/bladder junction)

133
Q

What causes UVJ obstruction?

A

Renal calculi
Pelvic tumors
Trauma
Infection

Abdomen (10 decks)

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