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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
Q

What is hydronephrosis?

A

Dilation of renal collecting system

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26
Q

What kind of finding of hydronephrosis?

A

Incidental and asymptomatic

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27
Q

What kind of obstruction is hydronephrosis?

A

obstructive and non obstructive

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28
Q

Hydronephrosis may lead to what?

A

Renal Atrophy

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29
Q

What is obstructive hydronephrosis caused by?

A

Intrinsic/ extrinsic obstruction of urine flow

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30
Q

In terms of Obstructive hydronephrosis, what should we look for?

A

Ureteral jets

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31
Q

What is non obstructive hydronephrosis caused by? 3

A
  1. Reflux
  2. Infection
  3. Polyuria
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32
Q

What is the classifications of hydro? 3

A
  1. Grade 1 - mild
  2. Grade 2 - Moderate
  3. Grade 3 - Sevee
    Based on sonographic appearence
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33
Q

What is grade 1 hydro?

A

Slight separation (splaying) of sinus echoes

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34
Q

What is grade 2 hydro look like? 3

A
  1. Separation of entire central sinus
  2. Pelvis, minor and major calyceal system dilated
  3. Clubbed calyces
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35
Q

What is grade 3 hydro look like? 3

A
  1. Cortical thinning
  2. Extensive enlargement of renal sinus and calyces
  3. Loss of individual calyx definition
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36
Q

What is the prognosis for grade 3 hydro?

A

Severe

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37
Q

What can lead to false positives of hydro? 4

A
  1. Over distended bladder
  2. Extra- renal pelvis
  3. Multiple parapelvic cyst
  4. AV malformation
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38
Q

In terms of false positives of hydro, what must we always do?

A

Post void assessment

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39
Q

What are renal parenchymal calcium deposits examples? 3

A
  1. Nephrocalcinosis
  2. Bilateral and diffuse
  3. Cortical or medulla
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40
Q

What is renal parenchymal calcium deposits caused by? 3

A
  1. Ischemia
  2. Necrosis
  3. Hypercalcemic states
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41
Q

What does renal parenchymal calcium deposits look like on U/S ? 3

A
  1. Increased cortical echogenicity
  2. Echogenic pyramids/ walls of pyramids
  3. Possible shadowing
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42
Q

What is Anderson-car kidney’s 2

A
  1. Theory of stone progression
  2. High concentration of calcium fluid around tubules
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43
Q

In terms of Anderson-car kidney’s, excess results of calcium in fluid and around results in what?

A

Deposits of calcium in margins of medulla

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44
Q

What does this image represent?

A

Nephrolithiasis

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45
Q

What does this image represent?

A

Nephrolithiasis and Twinkling artifact

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46
Q

What does this image represent?

A

Staghorn Calculi or calcifications filling the collecting system

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47
Q

What is this?

A

Staghorn Calculi

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48
Q

What does this represent?

A

Stone in the ureter

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49
Q

What does this represent?

A

Grade 1 Hydro (2mm separations needed)

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50
Q

What does this represent?

A

Grade 2 hydro

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51
Q

What does this represent?

A

Grade 3 hydro

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52
Q

What does Anderson- Car kidneys look like on U/S?

A

Non-shadowing echogenic rims of the pyramids

53
Q

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

A
  1. To determine if there is a mechanical obstruction
  2. No obstruction indicates a renal parenchymal abnormalities
54
Q

What are medical renal diseases?

A

Broad term to describe renal disorders

55
Q

Medical renal disease are usually diseases affecting what?

A

The renal parenchyma diffusely and bilaterally

56
Q

What does medical renal disease describes?

A

poor functioning but unobstructed kidneys

57
Q

In terms of medical renal disease, what is usually needed for specific diagnosis?

A

Renal biopsy

58
Q

Is medical renal disease treatable?

A

Initially treatable by medication rather than surgery, but can lead to renal failure

59
Q

What do we asssess for in terms of medical renal disease on u/s? 6

A
  1. Renal size
  2. Contour
  3. Echogenicity
  4. CM junction (Distinct or indistinct)
  5. Pyramid size
  6. Renal sinus (poor seen or well?)
60
Q

What does acute medical renal disease look like? 3

A
  1. Diffuse increase in cortical echogenicity
  2. Prominent CM junction
  3. Enlarged kidneys
61
Q

What is the exception to a prominent CM junction with acute medical renal disease?

A

If the pyramids are affected than the CM junction is not defined

62
Q

In the acute stage of medical renal disease, the kidneys may appear how?

A

May appear normal

63
Q

What is the sonographic appearance of chronic medically kidney disease? 2

A
  1. Small
  2. Echogenic
64
Q

What is the most common cause of reversible ARF?

A

Acute tubular necrosis

65
Q

What is acute tubular necrosis?

A

Deposits of debris in collecting tubules

66
Q

What can cause acute tubular necrosis?

A

Can be the result of toxic or Ischemic results

67
Q

What might be something we can see as a result of Acute tubular necrosis?

A

Hematuria

68
Q

What does Acute tubular necrosis look like on u/s? 2

A
  1. Most often normal
  2. May be bilaterally enlarged with echogenic pyramids
69
Q

What is the RI of acute tubular necrosis?

A

> 0.75

70
Q

How common is acute cortical necrosis?

A

Rare

71
Q

What is acute cortical necrosis?

A

Necrosis of the cortex with sparing of the pyramids

72
Q

What causes acute cortical necrosis? 4

A
  1. Sepsis
  2. Burns
  3. Severe dehydration
  4. Pregnancy induced hypertension
73
Q

What does acute cortical necrosis look like on u/s? What does it lead to? 3

A
  1. Normal size initially
  2. Hypoechoic cortex, loss of CM junction
  3. Leads to atrophy and calcification
74
Q

What kind of reaction is acute glomerulonephritis?

A

Autoimmune reaction

75
Q

What clinical signs does patients with Acute glomerulonephritis present with? 3

A
  1. Hematuria
  2. Hypertension
  3. Azotemia
76
Q

What does acute glomerulonephritis look like on u/s? 2 (early and later)

A
  1. Early: variable
  2. Later: small, echogenic kidneys
77
Q

What is amyloidosis?

A

Systemic metabolic disease which results in amyloid deposits in the kidneys

78
Q

Patients with amlyloidosis present with what?

A

Proteinuria

79
Q

What is the u/s of amyloidosis?3

A
  1. Variable appearance
  2. Kidneys might be large, normal, small
  3. Hypoechoic or hyper echoic
80
Q

What is the most cause of chronic renal failure?

A

Diabetes mellitus

81
Q

What does diabetes mellitus look like? 2 (Initially and end stage)

A
  1. Initially: Kidneys enlarged
  2. End stage: small, echogenic, loss of CMJ
82
Q

What is renal failure?

A

Inability of the kidneys to remove waste from blood

83
Q

What does renal failure results in?

A

Azotemia: An excess of urea and nitrogenous waste in the blood

84
Q

What are some of the causes of renal failure? 3

A
  1. Perenal
  2. Renal
  3. Post renal
85
Q

What are pre renal causes? 2

A
  1. Sepsis
  2. Renal artery stenosis
86
Q

What are the renal causes of renal failure?

A

Parenchymal disease

87
Q

What are the post renal causes of renal failure?

A

Obstruction of collection system

88
Q

Complete obstruction does what kind of damage? (Timeframe)

A

Irreversible damage in 3 weeks

89
Q

Incomplete obstruction does what kind of damage? (Timeframe)

A

Damage in 3 months

90
Q

Acute renal failure is reversible?

A

Yes

91
Q

What is acute renal disease due to?

A

Typically due to medical renal disease

92
Q

Acute medical renal disease most often looks like what on u/s?

A

Normal but may look enlarged and hypoechoic

93
Q

With acute renal disease we should check for what? 3

A
  1. Hydronephrosis
  2. Obstruction
  3. Echogenicity of parenchyma
94
Q

Is chronic renal disease reversible?

A

No

95
Q

What condition do we normally see with chronic renal disease?

A

Diabetes mellitus

96
Q

What are some lab values affected by chronic renal disease? 5

A

Increased
1. Creatinine
2. BUN
3. Uric acid
4. RBC/WBC in urine
5. Proteinuria

97
Q

What is dialysis?

A

Procedure to remove waste from blood

98
Q

Dialysis assumes what?

A

Physiological function of the nephrons.

Artificial kidney

99
Q

What are transplants for renal medical disease?

A

Treatment when renal homeostasis can no longer be maintained

100
Q

With renal transplants what happens to the native kidney?

A

Left in

101
Q

What is Cushing’s syndrome?

A

Excessive cortisol secretion

102
Q

Cushing’s syndrome may occur as a result of what? 4

A
  1. Adrenal hyperplasia
  2. Adrenal Adenoma
  3. Adrenal Carcinoma
  4. Exogenous corticosteroid administration
103
Q

What might we see with Cushing’s syndrome? (Physical symptoms) 6

A
  1. Moon face
  2. Buffalo hump
  3. Truncal obesity
  4. Hirsutism
  5. Amenorrhea
  6. Hypertension
104
Q

What is cushings disease?

A

Hyperplasticity adrenal gland secreting excessive cortical

105
Q

What is the cause of cushings disease?

A

Elevated ACTH production from a pituitary adenoma

106
Q

What is Conn’s disease?

A

Excessive aldosterone secretion

107
Q

Conn’s disease results from what? 3

A
  1. Adenoma
  2. Hyperplasia
  3. Carcinoma (uncommon)
108
Q

Conn’s patients present with what? 5

A
  1. Hypernatremia
  2. Hypokalemia
  3. Hypertension
  4. Muscle cramps
  5. Altered renal function
109
Q

What does Conn’s disease look like on u/s? 3

A
  1. Small
  2. Solid
  3. Hypoechoic round mass
110
Q

What is MEN’s disease?

A

Multiple endocrine neoplasia

111
Q

How many different types of MEN is there?

A

3

112
Q

Where does tumours in MEN disease develop? 4

A
  1. Adrenal
  2. Pancreas
  3. Pituitary
  4. Parathyroid gland
113
Q

What does MEN cause?

A

Excessive hormones produced

114
Q

Is MENs disorder benign or malignant?

A

Both but type 2 is malignant

115
Q

What is MEN type 2?

A

Autosomal bilateral, dominant pheochromocytomas in adrenal

116
Q

Is MENs type 2 benign or malignant?

A

Malignant

117
Q

What is hypoadrenalism?

A

Due to primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary

118
Q

Hypoadrenaoism may cause what?

A

Adrenal atrophy

119
Q

What is addison’s disease?2

A

Chronic primary hypodrenalism and consists of two types
1. Autoimmune
2. TB

120
Q

What is the ratio of affected parts for addisons disease?2

A
  1. Autoimmune (80%)
  2. TB (20%)
121
Q

In terms of autoimmune aiddison’s disease who is most commonly affected?

A

Females

122
Q

Can we normally see autoimmune addisons disease on u/s?

A

Not typically

123
Q

Who is most likely affected by the TB version of addisons disease?

A

Males

124
Q

What does TB Addisons look like? 4

A
  1. Enarlged, firm, nodular Adrenals
  2. Hyperpigmentation
  3. Low BP, muscle weakness, fatigue
  4. 90% of gland non-funcitioning
125
Q

What is Waterhouse- Friderichsen syndrome?

A

Acute hypoadrenalsism secondary to hemorrhage and infection

126
Q

What do we see with Waterhouse-friderichesen syndrome?

A

Massive destruction of adrenals

127
Q

With Waterhouse-friderichsen syndrome what is necessary?

A

Glucocorticoid therapy

128
Q

What does this image represent?

A

Acute Renal medical disease

129
Q

What does this image represent?

A

Chronic renal medical disorder/ failure

DMST ABD 3 (11 decks)

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