Metabolic Diseases: Urinary Tract Flashcards
What is urolithiasis?
Stones in the urinary system
Nephrolithiasis is what?
Stones in the renal collecting system
What is nephrocalcinosis?
Calcifications in the renal parenchyma
How common is Nephrolithiasis?
Very common
Which demographic is affected most commonly with Nephrolithiasis? 2
- Caucasian males
- Increased age
What is the etiology of Nephrolithiasis?
Unknown
What is the risk factors of Nephrolithiasis? 4
- Hereditary
- Limited water intake
- Diets high in animal protein
- Urinary stasis
Can stones move through the collecting system?
Yes
Stones may lodge in natural narrowing s of the ureter, where? 3
- PST UPJ
- At iliac vessel
- UVH
For stones to pass, what is the range they can be?
<5mm
What is the clinical presentation of Nephrolithiasis? 3 (s/s)
- Often asymptomatic
- Hematuria
- Flank pain
How does hematuria present/look with Nephrolithiasis? 2
- Microscopic
- Gross or frank (visualized in urine)
What is a twinkling artifact? 2
- Tiny stones difficult to identify
- Color or power doppler
What might lead to false positives in Nephrolithiasis? 4
- Internal gas
- Renal artery calcification
- Calcified slough papilla
- Ureteric stent
What does Nephrolithiasis stones look like on U/S? 2
- Echogenic focus
- Posterior shadowing
In terms of location and stones in the ureter, what does it cause?
Imaging challenges
Where does stones lodge normally?
Narrowest point
To look for a stone what do we look for? 2
- Dilated tube
- Try to identify an echogenic focus with shadowing at distal end
In terms of stones in the ureters, what should we always do?
Check for jets
How many bladder calculi do we normally have?
Single usually
Is bladder calculi asymptomatic or symptomatic?
Asymptomatic
What is a bladder calculi?
Migration of stone from kidney or result of urinary stasis
What are some S/S for bladder calculi? 2
- Hematuria
- Pain
What do we check for in terms of bladder calculi besides jets?
Mobility to dependent portion of bladder Change patient position
What is hydronephrosis?
Dilation of renal collecting system
What kind of finding of hydronephrosis?
Incidental and asymptomatic
What kind of obstruction is hydronephrosis?
obstructive and non obstructive
Hydronephrosis may lead to what?
Renal Atrophy
What is obstructive hydronephrosis caused by?
Intrinsic/ extrinsic obstruction of urine flow
In terms of Obstructive hydronephrosis, what should we look for?
Ureteral jets
What is non obstructive hydronephrosis caused by? 3
- Reflux
- Infection
- Polyuria
What is the classifications of hydro? 3
- Grade 1 - mild
- Grade 2 - Moderate
- Grade 3 - Sevee
Based on sonographic appearence
What is grade 1 hydro?
Slight separation (splaying) of sinus echoes
What is grade 2 hydro look like? 3
- Separation of entire central sinus
- Pelvis, minor and major calyceal system dilated
- Clubbed calyces
What is grade 3 hydro look like? 3
- Cortical thinning
- Extensive enlargement of renal sinus and calyces
- Loss of individual calyx definition
What is the prognosis for grade 3 hydro?
Severe
What can lead to false positives of hydro? 4
- Over distended bladder
- Extra- renal pelvis
- Multiple parapelvic cyst
- AV malformation
In terms of false positives of hydro, what must we always do?
Post void assessment
What are renal parenchymal calcium deposits examples? 3
- Nephrocalcinosis
- Bilateral and diffuse
- Cortical or medulla
What is renal parenchymal calcium deposits caused by? 3
- Ischemia
- Necrosis
- Hypercalcemic states
What does renal parenchymal calcium deposits look like on U/S ? 3
- Increased cortical echogenicity
- Echogenic pyramids/ walls of pyramids
- Possible shadowing
What is Anderson-car kidney’s 2
- Theory of stone progression
- High concentration of calcium fluid around tubules
In terms of Anderson-car kidney’s, excess results of calcium in fluid and around results in what?
Deposits of calcium in margins of medulla
What does this image represent?
Nephrolithiasis
What does this image represent?
Nephrolithiasis and Twinkling artifact
What does this image represent?
Staghorn Calculi or calcifications filling the collecting system
What is this?
Staghorn Calculi
What does this represent?
Stone in the ureter
What does this represent?
Grade 1 Hydro (2mm separations needed)
What does this represent?
Grade 2 hydro
What does this represent?
Grade 3 hydro
What does Anderson- Car kidneys look like on U/S?
Non-shadowing echogenic rims of the pyramids
If a patient presents with increased levels of creatinine and they are sent for ultrasound as an initial screen, what would be the purpose of ultrasound? 2
- To determine if there is a mechanical obstruction
- No obstruction indicates a renal parenchymal abnormalities
What are medical renal diseases?
Broad term to describe renal disorders
Medical renal disease are usually diseases affecting what?
The renal parenchyma diffusely and bilaterally
What does medical renal disease describes?
poor functioning but unobstructed kidneys
In terms of medical renal disease, what is usually needed for specific diagnosis?
Renal biopsy
Is medical renal disease treatable?
Initially treatable by medication rather than surgery, but can lead to renal failure
What do we asssess for in terms of medical renal disease on u/s? 6
- Renal size
- Contour
- Echogenicity
- CM junction (Distinct or indistinct)
- Pyramid size
- Renal sinus (poor seen or well?)
What does acute medical renal disease look like? 3
- Diffuse increase in cortical echogenicity
- Prominent CM junction
- Enlarged kidneys
What is the exception to a prominent CM junction with acute medical renal disease?
If the pyramids are affected than the CM junction is not defined
In the acute stage of medical renal disease, the kidneys may appear how?
May appear normal
What is the sonographic appearance of chronic medically kidney disease? 2
- Small
- Echogenic
What is the most common cause of reversible ARF?
Acute tubular necrosis
What is seen with acute tubular necrosis?
Deposits of debris in collecting tubules
What can cause acute tubular necrosis?
Can be the result of toxic or Ischemic results
What might be something we can see as a result of Acute tubular necrosis? (S/S)
Hematuria
What does Acute tubular necrosis look like on u/s? 2
- Most often normal
- May be bilaterally enlarged with echogenic pyramids
What is the RI of acute tubular necrosis?
> 0.75
How common is acute cortical necrosis?
Rare
What is acute cortical necrosis?
Necrosis of the cortex with sparing of the pyramids
What causes acute cortical necrosis? 4
- Sepsis
- Burns
- Severe dehydration
- Pregnancy induced hypertension
What does acute cortical necrosis look like on u/s? What does it lead to? 3
- Normal size initially
- Hypoechoic cortex, loss of CM junction
- Leads to atrophy and calcification
What kind of reaction is acute glomerulonephritis?
Autoimmune reaction
What clinical signs does patients with Acute glomerulonephritis present with? 3
- Hematuria
- Hypertension
- Azotemia
What does acute glomerulonephritis look like on u/s? 2 (early and later)
- Early: variable
- Later: small, echogenic kidneys
What is amyloidosis?
Systemic metabolic disease which results in amyloid deposits in the kidneys
Patients with amlyloidosis present with what?
Proteinuria
What is the u/s of amyloidosis?3
- Variable appearance
- Kidneys might be large, normal, small
- Hypoechoic or hyper echoic
What is the most cause of chronic renal failure?
Diabetes mellitus
What does diabetes mellitus look like? 2 (Initially and end stage)
- Initially: Kidneys enlarged
- End stage: small, echogenic, loss of CMJ
What is renal failure?
Inability of the kidneys to remove waste from blood
What does renal failure results in?
Azotemia: An excess of urea and nitrogenous waste in the blood
What are some of the causes of renal failure? 3
- Perenal
- Renal
- Post renal
What are pre renal causes? 2
- Sepsis
- Renal artery stenosis
What are the renal causes of renal failure?
Parenchymal disease
What are the post renal causes of renal failure?
Obstruction of collection system
Complete obstruction does what kind of damage? (Timeframe)
Irreversible damage in 3 weeks
Incomplete obstruction does what kind of damage? (Timeframe)
Damage in 3 months
Acute renal failure is reversible?
Yes
What is acute renal disease due to?
Typically due to medical renal disease
Acute medical renal disease most often looks like what on u/s?
Normal but may look enlarged and hypoechoic
With acute renal disease we should check for what? 3
- Hydronephrosis
- Obstruction
- Echogenicity of parenchyma
Is chronic renal disease reversible?
No
What condition do we normally see with chronic renal disease?
Diabetes mellitus
What are some lab values affected by chronic renal disease? 5
Increased
1. Creatinine
2. BUN
3. Uric acid
4. RBC/WBC in urine
5. Proteinuria
What is dialysis?
Procedure to remove waste from blood
Dialysis assumes what?
Physiological function of the nephrons.
Artificial kidney
What are transplants for renal medical disease?
Treatment when renal homeostasis can no longer be maintained
With renal transplants what happens to the native kidney?
Left in
What is Cushing’s syndrome?
Excessive cortisol secretion
Cushing’s syndrome may occur as a result of what? 4
- Adrenal hyperplasia
- Adrenal Adenoma
- Adrenal Carcinoma
- Exogenous corticosteroid administration
What might we see with Cushing’s syndrome? (Physical symptoms) 6
- Moon face
- Buffalo hump
- Truncal obesity
- Hirsutism
- Amenorrhea
- Hypertension
What is cushings disease?
Hyperplasticity adrenal gland secreting excessive cortical
What is the cause of cushings disease?
Elevated ACTH production from a pituitary adenoma
What is Conn’s disease?
Excessive aldosterone secretion
Conn’s disease results from what? 3
- Adenoma
- Hyperplasia
- Carcinoma (uncommon)
Conn’s patients present with what? 5
- Hypernatremia
- Hypokalemia
- Hypertension
- Muscle cramps
- Altered renal function
What does Conn’s disease look like on u/s? 3
- Small
- Solid
- Hypoechoic round mass
What is MEN’s disease?
Multiple endocrine neoplasia
How many different types of MEN is there?
3
Where does tumours in MEN disease develop? 4
- Adrenal
- Pancreas
- Pituitary
- Parathyroid gland
What does MEN cause?
Excessive hormones produced
Is MENs disorder benign or malignant?
Both but type 2 is malignant
What is MEN type 2?
Autosomal bilateral, dominant pheochromocytomas in adrenal
Is MENs type 2 benign or malignant?
Malignant
What is hypoadrenalism?
Due to primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
Hypoadrenaoism may cause what?
Adrenal atrophy
What is addison’s disease?2
Chronic primary hypodrenalism and consists of two types
1. Autoimmune
2. TB
What is the ratio of affected parts for addisons disease?2
- Autoimmune (80%)
- TB (20%)
In terms of autoimmune aiddison’s disease who is most commonly affected?
Females
Can we normally see autoimmune addisons disease on u/s?
Not typically
Who is most likely affected by the TB version of addisons disease?
Males
What does TB Addisons look like? 4
- Enarlged, firm, nodular Adrenals
- Hyperpigmentation
- Low BP, muscle weakness, fatigue
- 90% of gland non-funcitioning
What is Waterhouse- Friderichsen syndrome?
Acute hypoadrenalsism secondary to hemorrhage and infection
What do we see with Waterhouse-friderichesen syndrome?
Massive destruction of adrenals
With Waterhouse-friderichsen syndrome what is necessary?
Glucocorticoid therapy
What does this image represent?
Acute Renal medical disease
What does this image represent?
Chronic renal medical disorder/ failure
