Kidneys Flashcards
Fetal lobulation vs scarring
Lobulation: Renal surface indentation overlie the space between the pyramids.
Scarring: Renal surface indentation overlie the medullary pyramids.
Dromedary hump affects which side?
Left side.
Re Renal agenesis:
Unilateral vs bilateral:
Unilateral: Female: Gynae anomaly eg unicornuate uterus
Male: Agenesis of epididymus/ VD/ SV cyst
Bilateral: Potter sequence
Define Potter sequence:
Insult (eg ACE I’s) –> Renal agenesis–> Pulmonary hypoplasia
Define Mayer Rokitansky Kuster Hauser
Mullerian duct anomalies including the absence or atresia of the uterus.
Associated with unilateral renal agenesis.
What sign is used to differentiate surgical absent vs congenital absence of adrenals.
Pancake adrenal sign or lying down adrenal.
What are the complications of horseshoe kidney?
- Injury
- UPJ obstruction
- Recurrent infection
- Recurrent stones
- Wilm’s tumour- 8x more common
- TCC from all those UTI’s
- Renal carcinoid
What syndrome are associated with horseshoe kidney:
Turner syndrome and renal carcinoid.
What type of bone metastases in RCC?
ALWAYS Lytic bone mets
RF for RCC:
Smoking
Syndromes like VHL
Chronic dialysis > 3 years
Family history
What sort of liver mets RCC produce?
Hypervascular mets
What makes a lesion highly suspicious for RCC?
- Contrast enhancement >15 HU
2. Calcification in a fatty mass lesion. - CLEAR CELL type, can produce fatty liver metastases.
What are the 4 subtypes of RCC?
- Clear cell
- Papillary
- Medullary
- Chromophobe
Which subtype of RCC is associated with Sickle cell trait?
Medullary
Which subtype of RCC is associated with Birt Hogg Dube?
Chromophobe
Which subtype of RCC is associated with VHL:
Clear cell
What is the DDx for T2 dark renal mass/cystic lesions?
- Papillary RCC
- Haemorrhagic cysts- likely T1 bright
- Lipid poor AML. Think of tuberous sclerosis
Describe RCC Staging:
- Limited to kidney and < 7cm
- Limited to kidney and > 7cm
- Still inside Gerota’s fascia
3A: RV invasion
3B: IVC below diaphragm
3C: IVC above diaphragm - Outside Gerota’s fascia, ipsilateral adrenal.
What is papillary RCC is associated with ?
Hereditary papillary renal carcinoma
Re Renal lymphoma
- Appearance? Unilateral or bilateral?
Most commonly bilateral, enlarged kidneys with small low attenuation cortically based solid nodules or masses.
A solitary mass is seen in 25%.
Out of all the renal masses what is the most likely to preserve the normal reniform shape?
Lymphoma
What is the most common visceral organ involved in leukaemia?
Kidneys
Typically the kidneys are smooth and enlarged. Hypodense lesions are cortically based only.
Re Oncocytoma:
- DDx
- On USS and PET
- Solid mass with central scar- no malignant features such as vessel invasion.
- DDx RCC, till proven otherwise
- USS: spoke wheel vascular pattern
- PET: hotter than surrounding renal cortex.
Name a syndrome associated with bilateral oncocytomas:
BHD- Birt Hogg Dube