Lesson 4B (Part 2)

Question 1

Xanthogranulomatous Pyelonephritis

Answer 1

Chronic suppurative renal infection with a destroyed parenchyma is replaced with lipid-laden macrophages

Question 2

Is xanthogranulomatous pyelonephritis uni or bilatera?

Answer 2

Unilateral

- diffuse, focal or segmental

Question 3

Who does xanthogranulomatous pyelonephritis commonly affect?

Answer 3

Middle aged diabetic women

Question 4

What does xanthogranulomatous pyelonephritis look like on US? (3)

Answer 4

1. Renal enlargement
2. Lack of corticomedullary differentiation
3. Focal masses

Question 5

What does ischemia lead to?

Answer 5

Papillary necrosis

- lose of blood flow that leads to cell death

Question 6

What are causative factors of papillary necrosis? (9)

Answer 6

1. Analgesic abuse
2. Diabetes
3. UTI
4. Renal vein
5. Thrombosis
6. Prolonged urinary tract obstruction
7. Dehydration
8. Sickle cell anemia
9. Hemophilia

Question 7

What does papillary necrosis look like on US? (5)

Answer 7

1. Swollen pyramids
2. Cystic papilla
3. Clubbed calyx
4. Hydronephrosis
5. Debris in collecting system

Question 8

TB

Answer 8

Tuberculosis

Question 9

Who do tuberculosis affect?

Answer 9

The kidneys of 5-10 year olds after initial infection

Question 10

What are the S/S of TB?

Answer 10

Frequency, dysuria, nocturia, urgency, gross or microscopic hematuria

Question 11

What does TB look like on US? (3)

Answer 11

1. Focal renal lesions
2. Variable echotexture and size
3. May involve bladder
   - focal or diffuse wall thickening

Question 12

What is the best way to asses TB? (2)

Answer 12

1. CT

2. Urography

Question 13

What is the most common fungal agent?

Answer 13

Candida Albicans

Question 14

What are the patients who are at risk for fungal infections? (7)

Answer 14

1. Diabetes mellitus
2. Chronic indwelling catheters
3. Malignancy
4. Hematopoietic disorders
5. Chronic antibiotic or steroid therapy
6. Transplantation
7. IV drug abuse

Question 15

What do fungal infections look like on US? (2)

Answer 15

1. Small cortical hypoechoic lesions
   - small abscesses
2. Fungus balls in collecting system
   - echogenic

Question 16

What is the most common agent seen with parasitic infections?

Answer 16

Schistosomiasis

Question 17

Schistosomiasis

Answer 17

Worms penetrate skin to liver via the portals

Question 18

Hematuria

Answer 18

Eggs deposited in venules of bladder wall/ureter

Question 19

Bladder stasis

Answer 19

Increased incidence of ureteral and bladder calculi and repeated infections

Question 20

What is found in 2-5% of patients with hydatid disease?

Answer 20

Echinoccal hydatid Renal disease

Question 21

What does echinoccal hydatid Renal disease affect? (3)

Answer 21

1. Kidneys
2. Ureters
3. Bladder

Question 22

Who do filiariasis affect?

Answer 22

Children between 10-12 years of age

Question 23

How is filiariasis transmitted?

Answer 23

Mosquitos

Question 24

Where do worms enter with filiariasis?

Answer 24

The lymphatic system through the kidneys

Question 25

When do symptoms develop for filiariasis?

Answer 25

5- 20 years after infection

Question 26

Is US the best modality for filiariasis diagnosis?

Answer 26

No - not helpful in diagnosis

Question 27

HIV

Answer 27

An acquired immunodeficiency syndrome

Question 28

What has decreased the incidence of opportunistic infections for HIV?

Answer 28

Antiviral therapy

Question 29

What kind of disease is HIV associated nephropathy?

Answer 29

Chronic renal disease

Question 30

What is US used for with HIV? (3)

Answer 30

1. Exclude obstruction
2. Determine renal size
3. Cortical echogenicity