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DMST ABD 3 > Metabolic Diseases: Urinary Tract > Flashcards

Metabolic Diseases: Urinary Tract Flashcards

1
Q

What is urolithiasis?

A

Stones in the urinary system

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2
Q

Nephrolithiasis is what?

A

Stones in the renal collecting system

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3
Q

What is nephrocalcinosis?

A

Calcifications in the renal parenchyma

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4
Q

How common is Nephrolithiasis?

A

Very common

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5
Q

Which demographic is affected most commonly with Nephrolithiasis? 2

A
  1. Caucasian males
  2. Increased age
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6
Q

What is the etiology of Nephrolithiasis?

A

Unknown

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7
Q

What is the risk factors of Nephrolithiasis? 4

A
  1. Hereditary
  2. Limited water intake
  3. Diets high in animal protein
  4. Urinary stasis
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8
Q

Can stones move through the collecting system?

A

Yes

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9
Q

Stones may lodge in natural narrowing s of the ureter, where? 3

A
  1. PST UPJ
  2. At iliac vessel
  3. UVH
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10
Q

For stones to pass, what is the range they can be?

A

<5mm

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11
Q

What is the clinical presentation of Nephrolithiasis? 3 (s/s)

A
  1. Often asymptomatic
  2. Hematuria
  3. Flank pain
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12
Q

How does hematuria present/look with Nephrolithiasis? 2

A
  1. Microscopic
  2. Gross or frank (visualized in urine)
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13
Q

What is a twinkling artifact? 2

A
  1. Tiny stones difficult to identify
  2. Color or power doppler
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14
Q

What might lead to false positives in Nephrolithiasis? 4

A
  1. Internal gas
  2. Renal artery calcification
  3. Calcified slough papilla
  4. Ureteric stent
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15
Q

What does Nephrolithiasis stones look like on U/S? 2

A
  1. Echogenic focus
  2. Posterior shadowing
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16
Q

In terms of location and stones in the ureter, what does it cause?

A

Imaging challenges

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17
Q

Where does stones lodge normally?

A

Narrowest point

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18
Q

To look for a stone what do we look for? 2

A
  1. Dilated tube
  2. Try to identify an echogenic focus with shadowing at distal end
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19
Q

In terms of stones in the ureters, what should we always do?

A

Check for jets

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20
Q

How many bladder calculi do we normally have?

A

Single usually

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21
Q

Is bladder calculi asymptomatic or symptomatic?

A

Asymptomatic

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22
Q

What is a bladder calculi?

A

Migration of stone from kidney or result of urinary stasis

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23
Q

What are some S/S for bladder calculi? 2

A
  1. Hematuria
  2. Pain
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24
Q

What do we check for in terms of bladder calculi besides jets?

A

Mobility to dependent portion of bladder Change patient position

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25
What is hydronephrosis?
Dilation of renal collecting system
26
What kind of finding of hydronephrosis?
Incidental and asymptomatic
27
What kind of obstruction is hydronephrosis?
obstructive and non obstructive
28
Hydronephrosis may lead to what?
Renal Atrophy
29
What is obstructive hydronephrosis caused by?
Intrinsic/ extrinsic obstruction of urine flow
30
In terms of Obstructive hydronephrosis, what should we look for?
Ureteral jets
31
What is non obstructive hydronephrosis caused by? 3
1. Reflux 2. Infection 3. Polyuria
32
What is the classifications of hydro? 3
1. Grade 1 - mild 2. Grade 2 - Moderate 3. Grade 3 - Sevee *Based on sonographic appearence*
33
What is grade 1 hydro?
Slight separation (splaying) of sinus echoes
34
What is grade 2 hydro look like? 3
1. Separation of entire central sinus 2. Pelvis, minor and major calyceal system dilated 3. Clubbed calyces
35
What is grade 3 hydro look like? 3
1. Cortical thinning 2. Extensive enlargement of renal sinus and calyces 3. Loss of individual calyx definition
36
What is the prognosis for grade 3 hydro?
Severe
37
What can lead to false positives of hydro? 4
1. Over distended bladder 2. Extra- renal pelvis 3. Multiple parapelvic cyst 4. AV malformation
38
In terms of false positives of hydro, what must we always do?
Post void assessment
39
What are renal parenchymal calcium deposits examples? 3
1. Nephrocalcinosis 2. Bilateral and diffuse 3. Cortical or medulla
40
What is renal parenchymal calcium deposits caused by? 3
1. Ischemia 2. Necrosis 3. Hypercalcemic states
41
What does renal parenchymal calcium deposits look like on U/S ? 3
1. Increased cortical echogenicity 2. Echogenic pyramids/ walls of pyramids 3. Possible shadowing
42
What is Anderson-car kidney’s 2
1. Theory of stone progression 2. High concentration of calcium fluid around tubules
43
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
44
What does this image represent?
Nephrolithiasis
45
What does this image represent?
Nephrolithiasis and Twinkling artifact
46
What does this image represent?
Staghorn Calculi or calcifications filling the collecting system
47
What is this?
Staghorn Calculi
48
What does this represent?
Stone in the ureter
49
What does this represent?
Grade 1 Hydro (2mm separations needed)
50
What does this represent?
Grade 2 hydro
51
What does this represent?
Grade 3 hydro
52
What does Anderson- Car kidneys look like on U/S?
Non-shadowing echogenic rims of the pyramids
53
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
1. To determine if there is a mechanical obstruction 2. No obstruction indicates a renal parenchymal abnormalities
54
What are medical renal diseases?
Broad term to describe renal disorders
55
Medical renal disease are usually diseases affecting what?
The renal parenchyma diffusely and bilaterally
56
What does medical renal disease describes?
poor functioning but unobstructed kidneys
57
In terms of medical renal disease, what is usually needed for specific diagnosis?
Renal biopsy
58
Is medical renal disease treatable?
Initially treatable by medication rather than surgery, but can lead to renal failure
59
What do we asssess for in terms of medical renal disease on u/s? 6
1. Renal size 2. Contour 3. Echogenicity 4. CM junction (Distinct or indistinct) 5. Pyramid size 6. Renal sinus (poor seen or well?)
60
What does acute medical renal disease look like? 3
1. Diffuse increase in cortical echogenicity 2. Prominent CM junction 3. Enlarged kidneys
61
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
62
In the acute stage of medical renal disease, the kidneys may appear how?
May appear normal
63
What is the sonographic appearance of chronic medically kidney disease? 2
1. Small 2. Echogenic
64
What is the most common cause of reversible ARF?
Acute tubular necrosis
65
What is seen with acute tubular necrosis?
Deposits of debris in collecting tubules
66
What can cause acute tubular necrosis?
Can be the result of toxic or Ischemic results
67
What might be something we can see as a result of Acute tubular necrosis? (S/S)
Hematuria
68
What does Acute tubular necrosis look like on u/s? 2
1. Most often normal 2. May be bilaterally enlarged with echogenic pyramids
69
What is the RI of acute tubular necrosis?
>0.75
70
How common is acute cortical necrosis?
Rare
71
What is acute cortical necrosis?
Necrosis of the cortex with sparing of the pyramids
72
What causes acute cortical necrosis? 4
1. Sepsis 2. Burns 3. Severe dehydration 4. Pregnancy induced hypertension
73
What does acute cortical necrosis look like on u/s? What does it lead to? 3
1. Normal size initially 2. Hypoechoic cortex, loss of CM junction 3. Leads to atrophy and calcification
74
What kind of reaction is acute glomerulonephritis?
Autoimmune reaction
75
What clinical signs does patients with Acute glomerulonephritis present with? 3
1. Hematuria 2. Hypertension 3. Azotemia
76
What does acute glomerulonephritis look like on u/s? 2 (early and later)
1. Early: variable 2. Later: small, echogenic kidneys
77
What is amyloidosis?
Systemic metabolic disease which results in amyloid deposits in the kidneys
78
Patients with amlyloidosis present with what?
Proteinuria
79
What is the u/s of amyloidosis?3
1. **Variable appearance** 2. Kidneys might be large, normal, small 3. Hypoechoic or hyper echoic
80
What is the most cause of chronic renal failure?
Diabetes mellitus
81
What does diabetes mellitus look like? 2 (Initially and end stage)
1. Initially: Kidneys enlarged 2. End stage: small, echogenic, loss of CMJ
82
What is renal failure?
Inability of the kidneys to remove waste from blood
83
What does renal failure results in?
Azotemia: An excess of urea and nitrogenous waste in the blood
84
What are some of the causes of renal failure? 3
1. Perenal 2. Renal 3. Post renal
85
What are pre renal causes? 2
1. Sepsis 2. Renal artery stenosis
86
What are the renal causes of renal failure?
Parenchymal disease
87
What are the post renal causes of renal failure?
Obstruction of collection system
88
Complete obstruction does what kind of damage? (Timeframe)
Irreversible damage in 3 weeks
89
Incomplete obstruction does what kind of damage? (Timeframe)
Damage in 3 months
90
Acute renal failure is reversible?
Yes
91
What is acute renal disease due to?
Typically due to medical renal disease
92
Acute medical renal disease most often looks like what on u/s?
Normal but may look enlarged and hypoechoic
93
With acute renal disease we should check for what? 3
1. Hydronephrosis 2. Obstruction 3. Echogenicity of parenchyma
94
Is chronic renal disease reversible?
No
95
What condition do we normally see with chronic renal disease?
Diabetes mellitus
96
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
97
What is dialysis?
Procedure to remove waste from blood
98
Dialysis assumes what?
Physiological function of the nephrons. *Artificial kidney*
99
What are transplants for renal medical disease?
Treatment when renal homeostasis can no longer be maintained
100
With renal transplants what happens to the native kidney?
Left in
101
What is Cushing’s syndrome?
Excessive cortisol secretion
102
Cushing’s syndrome may occur as a result of what? 4
1. Adrenal hyperplasia 2. Adrenal Adenoma 3. Adrenal Carcinoma 4. Exogenous corticosteroid administration
103
What might we see with Cushing’s syndrome? (Physical symptoms) 6
1. Moon face 2. Buffalo hump 3. Truncal obesity 4. Hirsutism 5. Amenorrhea 6. Hypertension
104
What is cushings disease?
Hyperplasticity adrenal gland secreting excessive cortical
105
What is the cause of cushings disease?
Elevated ACTH production from a pituitary adenoma
106
What is Conn’s disease?
Excessive aldosterone secretion
107
Conn’s disease results from what? 3
1. **Adenoma** 2. Hyperplasia 3. Carcinoma (uncommon)
108
Conn’s patients present with what? 5
1. Hypernatremia 2. Hypokalemia 3. **Hypertension** 4. **Muscle cramps** 5. Altered renal function
109
What does Conn’s disease look like on u/s? 3
1. Small 2. Solid 3. Hypoechoic round mass
110
What is MEN’s disease?
Multiple endocrine neoplasia
111
How many different types of MEN is there?
3
112
Where does tumours in MEN disease develop? 4
1. Adrenal 2. Pancreas 3. Pituitary 4. Parathyroid gland
113
What does MEN cause?
Excessive hormones produced
114
Is MENs disorder benign or malignant?
Both but type 2 is malignant
115
What is MEN type 2?
Autosomal bilateral, dominant pheochromocytomas in adrenal
116
Is MENs type 2 benign or malignant?
Malignant
117
What is hypoadrenalism?
Due to primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
118
Hypoadrenaoism may cause what?
Adrenal atrophy
119
What is addison’s disease?2
Chronic primary hypodrenalism and consists of two types 1. Autoimmune 2. TB
120
What is the ratio of affected parts for addisons disease?2
1. Autoimmune (80%) 2. TB (20%)
121
In terms of autoimmune aiddison’s disease who is most commonly affected?
Females
122
Can we normally see autoimmune addisons disease on u/s?
Not typically
123
Who is most likely affected by the TB version of addisons disease?
Males
124
What does TB Addisons look like? 4
1. Enarlged, firm, nodular Adrenals 2. Hyperpigmentation 3. Low BP, muscle weakness, fatigue 4. 90% of gland non-funcitioning
125
What is Waterhouse- Friderichsen syndrome?
Acute hypoadrenalsism secondary to hemorrhage and infection
126
What do we see with Waterhouse-friderichesen syndrome?
Massive destruction of adrenals
127
With Waterhouse-friderichsen syndrome what is necessary?
Glucocorticoid therapy
128
What does this image represent?
Acute Renal medical disease
129
What does this image represent?
Chronic renal medical disorder/ failure

DMST ABD 3 (11 decks)

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