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ABD & SMALL PARTS > "nephron isn't a word" > Flashcards

"nephron isn't a word" Flashcards

1
Q

medical renal disease typically __ the echogenicity of the kidneys bilaterally

A

increases

  • brightness of cortex corresponds to severity but does not correlate to cause

+/- prominent pyramids

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2
Q

CHRONIC medical renal disease will typically cause size of kidneys to __

A

SHRINK

  • end stage kds are small in size echogenic and often diff to find
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3
Q

function of kidney to remove waste products, excessive fluid, produce hormones, and regulate body’s __

A

salt, potassium and acid content

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4
Q

renal function to produce hormones ie -

A

stimulate RBC production

regulate blood sugar

control calcium metabolism

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5
Q

lab tests for renal function

A

serum creatinine

BUN

eGFR

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6
Q

serum creatinine __ when kidneys are not funcitoning properly

A

rises

**a waste product of muscle metabolism normally excreted in urine

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7
Q

BUN aka

A

blood urea nitrogen

urea waste product from protein metabolism formed in liver

nitrogenous wastes products of protein metabolism

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8
Q

BUN __ when kidneys are not functioning properly

A

rises

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9
Q

eGFR aka

A

estimated glomerular function

  • calculation to assess how well renal glomeruli are filtering blood
  • based on serum creatinine and age, sex, race
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10
Q

GFR <60 indicates

A

renal disease

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11
Q

GFR >60 indicates

A

normal funciton

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12
Q

GFR <15

A

renal failure

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13
Q

normal amount of urine output per day

A

1-2 L

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14
Q

AFR aka

A

acute renal failure

  • develops over hours -weeks
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15
Q

CKD aka

A

chronic kidney disease

  • develops over weeks - months
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16
Q

rapid decrease in renal function in previously stable chronic renal failure

A

acute on chronic renal failure

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17
Q

broad categories of renal failure

A

pre renal
*hypoperfusion

renal
* medical renal disease

post renal
* bilat obstruction

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18
Q

most common cause of acute renal failure

A

pre renal causes (not enough blood)

hypoperfusion
* shock
* dehydration
* hemorrhage
* heart failure

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19
Q

second most common cause for acute renal failure

A

medical renal disease

  • something wrong with parenchyma of kidney
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20
Q

excessive nitrogenous products in blood

A

azotemia

increased BUN and serum creatinine

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21
Q

urine in your blood showing clinical symptoms

A

uremia

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22
Q

muscle weakness, cramping, cardiac arrhythmia, nausea/vomiting, shortness of breath

A

symptoms of azotemia

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23
Q

broad term referring to renal disorders that are tx with medical rather than sx therapy

A

medical renal disease

primarily involves parenchyma of kidney

“nephropathy”

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24
Q

common causes for nephropathy

A

acute tubular necrosis (ATN)

acute glomerulonephritis

**less common causes

acute cortical necrosis

amyloidosis

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25
Q

ATN aka

A

acute tubular necrosis

reversible if caught early because the tubules constantly regenerate

** common causes are toxic exposures or ischemic (hypotensive)

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26
Q

what is the most common cause for acute renal failure

A

ATN

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27
Q

agents for toxic ATN

A

drugs
- antibiotics
- antineoplastics
- anesthetics

chemicals
- carbon tetrachloride
-antifreeze (ethylene glycol)

pigments
- myoglobn (rhabdomyolysis)
- hemoglobin

xray contrast media
- “contrast nephropathy”

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28
Q

ESRD aka

A

end stage renal disease

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29
Q

unilateral small kidney; ddx??

A

vascular compromise

chronic infection

?is the other big ?hypertrophic compensation

**not medical renal disease

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30
Q

what is the most comon malignancy of the kidney

A

RCC

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31
Q

RCC loves __

A

to invade the renal vein and the IVC

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32
Q

RCC sono features

A

NO HYDRO

solid hypoechoic mass

+/- invasion of RV and IVC

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33
Q

TCC arises from __

A

urothelium
* kidney, ureter, bladder

frequently causes hydro

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34
Q

what is the most common benign tumour of the kidney

A

angiomyolipoma

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35
Q

sono features of angiomyolipoma

A

small, echogenic solid cortical mass

can be large, can hemorrhage

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36
Q

when multiple angiomyolipomata, what may this be associated with

A

tuberous sclerosis

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37
Q

which benign tumour causes excessive renin and can thus cause HTN

A

juxtaglomerular tumour

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38
Q

oncocytoma, adenoma and juxtaglomerular tumours are typically __

A

benign

**BUT STILL WORK THESE UP AS RRC CZ YOU CAN’T RELALY TELL THE DIFFERENCE SONOGRAPHICALLY

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39
Q

types of cystic tumours of the kidney

A

cystic RCC

multilocular cystic nephroma

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40
Q

ANGIOMYOLIPOMA AKA

A

RENAL HEMARTOMA

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41
Q

what is the angiomyolipoma made of

A

vessels

smooth muscle

fat

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42
Q

features of angiomyolipoma

A

usually solitary and unilateral

echogenic

in cortex, well defined

if small, typically asymptomatic

avascular

usually homogeneous

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43
Q

more common demographic for angiomyolipomata

A

female

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44
Q

renal hemartomas will demonstrate radio__ in CT

A

radioluscency

made up of fat so will come out DARK

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45
Q

atypical angiomyolipomas

A

ie exophytic

work up as possible RRC

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46
Q

CT cyst classification system aka

A

Bosniak rating (1-4)

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47
Q

renal adenoma vs. RCC

A

appear identical with u/s

typically <3cm

iso/hypo echoic solid parenchymal mass

** consider malignant until proven otherwise

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48
Q

which renal tumour is known for demonstrating a central stellate scar

A

oncocytoma

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49
Q

juxtaglomerular tumour aka

A

reninoma

produces renin

uncommon cause of primary HTN

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50
Q

sono features of reninoma

A

cortical lesion

<3cm

strongly echogenic

  • ddx AML
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51
Q

malignant renal tumours

A

renal cell carcinoma

transitional cell carcinoma

renal lymphoma

nephroblatoma

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52
Q

RCC aka

A

renal cell carcinoma

hypernephroma

Grawitz tumour

renal cell adneocarcionoma

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53
Q

RCC demographic

A

more common in males

50-70 y

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54
Q

associated risks for RCC

A

smoking

ADPKD

acquired cystic kidney disease in end-stage (‘cysts of dialysis’)

con HIppel-Lindau disease

tuberous sclerosis

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55
Q

the “too late” triad of RCC clinical symptoms

A

hematuria (gross or micro)

flank pain

palpable mass

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56
Q

clinical symptoms for RCC

A

many asymptomatic; incidental

hematuria

flank pain

palpable mass

low grade fever

HTN

anorexia, fatigue, weight loss

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57
Q

sono appearance of RCC

A

solid, bulky parenchymal mass

variable echogenicity, usually iso/hypo

tend to invade renal vein
*check IVC

+/- punctate calc

+/- mets

HYDRO UNCOMMON

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58
Q

what features are indicative for malignancy regarding RCC

A

size

evidence of venous thrombus

evidence of metastatic adenopathy

evidence of liver mets

high velocity, low resistance Doppler

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59
Q

urothelial tumour of the renal pelvis

A

TCC

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60
Q

frequent complication of renal TCC

A

obstructive uropathy

*increased risk with smoking, exposure to certain chemicals like printing dyes

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61
Q

sono features and pitfalls for renal TCC

A

variable appearance
- hypoechoic solid mass in SINUS

HYDRO is common

pitfalls - clot; fungus ball
** check there is vascularity

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62
Q

Wilms tumour aka

A

nephroblastoma

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63
Q

tumour from metanephrogenic blastema cells; most common renal neoplasm in children

A

nephroblastoma

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64
Q

ddx of nephroblastoma

A

neuroblastoma (adrenal)

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65
Q

increased incidence of nephroblastoma in children with __ syndrome

A

Beckwith-Wiedemann syndrome

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66
Q

what type of spread causes metastases to kidneys

A

hematogenous spread

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67
Q

cancer of the lymphocytes

A

lymphone

Hodgkin and non-Hodgkin

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68
Q

what is the preferred technique for dx of lymphoma

A

CT

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69
Q

which type of lymphoma is the most concerning

A

non Hodgkin

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70
Q

Reed-Sternberg cells aka

A

B cells

  • type of WBC
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71
Q

malignant mature B cells typically arizing in nodes of the neck, axilla and chest - typically occurring in young adults

A

Hodgkin lymphoma

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72
Q

cancer of B and T cells, can arise in lymph nodes or organs, more common in older people

A

non Hodgkin

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73
Q

enlarged PAINLESS nodes, fever/chills, unexplained weight loss, NIGHT SWEATS, lack of energy, pruritus

A

lymphoma symptoms

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74
Q

renal lymphoma usually associated with systemic __ lymphoma

A

non Hodgkin

*occasionally localized to kidneys

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75
Q

what are the sono appearances of renal lymphoma

A

focal pattern
* hypo, anechoic solid masses

diffuse pattern
* disruption of architecture, reniform shape

perirenal involvement
* hypo perirenal mass; perirenal “rind”

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76
Q

which renal condition can create a “rind” around the kidney

A

renal lymphoma with perirenal involvement

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77
Q

multilocular cystic nephroma aka

A

cystic RCC

encapsulared, multilocular cystic lesion

benign neoplasm

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78
Q

common demographic for cystic RCC

A

young males

older females

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79
Q

sono features of cystic RCC

A

complex cystic mass

unable to differentiate from malignant RCC

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80
Q

common pitfall for renal tumours

A

junctional parenchyma/ hypertrophied column of Bertin
** won’t alter contour

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81
Q

demographic for MCDK

A

obstetrics and pediatrics

non genetic congenital cystic kidney disease

little to no parenchyma

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82
Q

bilat enlarged kidneys with multiple cysts; with cysts in other organs

A

ADPKD

‘adult’ PKD

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83
Q

bilat enlarged echogenic kidneys in utero and pediatrics

A

ARPKD

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84
Q

cysts of dialysis aka

A

ACKD

acquired cystic kidney disease

**look for RCC

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85
Q

hydatic cysts aka

A

cysts within cysts

daughter cysts

water lily sign

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86
Q

multilocular cystic nephroma aka

A

cystic tumour

** younger males, older females

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87
Q

calyceal diverticula aka

A

milk of calcium cysts

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88
Q

cystic dilatation of the renal tubules within the pyramids; congenital disorder

A

medullary spone kidney

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89
Q

medullary sponge kidneys are prone to __

A

nephrocalcinosis and stones

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90
Q

cystic lesion with hx of trauma or intervention

A

think vascular complications
ie pseudoaneurysm

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91
Q

where do parapelvic cysts originate

A

renal sinus

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92
Q

what type of fluid is in a parapelvic cyst

A

lymphatic

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93
Q

sanguinous

A

bloody

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94
Q

t/f parapelvic cysts are usually bilateral

A

true

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95
Q

which plane of section may best help differentiate multiple marapelvic cysts from hydronephrosis

A

coronal

**want to demonstrate no communication

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96
Q

parapelvic cysts are __ cysts

A

lymphatic

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97
Q

parapelvic cysts have potential to cause __

A

HTN

hematuria

hydro

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98
Q

ACKD aka

A

acquired cystic kidney disease

‘cysts of dialysis’

uremic renal cystic disease

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99
Q

what kidney disease is seen in end stage kidneys; 90% of patients on dialysis for 5+ years

A

ACKD

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100
Q

ACKD increases risk for __

A

RCC 35x

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101
Q

associated with cerebral ‘berry’ aneurysms

A

ADPKD

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102
Q

renal hydatid cyst aka

A

Echinococcus granulosus
(tiny tape worm)

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103
Q

dominant inheritance = what percentage of occurrance in offspring

A

50%

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104
Q

recessive inheritance = what percentage of occurrance in offspring

A

25%

105
Q

congenital disease causing microscopic cysts in renal tubules

A

ARPKD

106
Q

all genetic renal disorders are demonstrated __

A

bilaterally

107
Q

t/f MCDK is a genetic disorder

A

f

often unilateral

108
Q

t/f MCDK is often identified incidentally in a >OBS exam

A

t

109
Q

small, malformed kidney with multiple cysts and little to no parenchyma demonstrated

A

MCDK

110
Q

MCDK often associated with contralateral __

A

UPJ obstruction

111
Q

etiology of MCDK

A

embryonic urinary tract obstruction

112
Q

which renal cystic disease is most likely to cause oligohydramnios

A

ARPKD

113
Q

which renal cystic diseases are genetic

A

ADPKD

ARPKD

**MCDK is non genetic, congenital

114
Q

which renal cystic disease are you least likely to see cysts

A

ARPKD (microscopic)

115
Q

which renal cystic disease is patient likely to be the oldest

A

ACKD (cysts of dialysis)

116
Q

what maneuver can you perform to differentiate a MOC from other renal cystic lesions

A

changing pt position

117
Q

MOC are frequently the site of __

A

recurrent infection
(static outpouching in collecting system)

118
Q

congenital defect in formation of medullary tubules (not thought to be genetic) - causing dilatation of distal collecting ducts hear the papillae resulting in cysts

A

medullary sponce kidney

** cysts often contain calcium

119
Q

sono features of medullary sponge kidney

A

calcium in medulla
***medullary nephrocalcinosis

calculi

medullary cysts often too small to be seen w/ u/s

rarely symptomatic until adulthood (infection, calculi, hematuria)

120
Q

echogenic pyramids dx

A

medullary nephrocalcinosis

** could be medullary sponge kidney but cannot tell what the etiology was so move on with your life

121
Q

hydatid cysts in the kidney look similar to __

A

hydatid cysts in the liver

122
Q

uncommon types of acute pyelonephritis

A

xanthogranulomatous

emphysematous

focal

abscessed/ cabuncle

123
Q

__ is associated with staghorn calculi

A

xanthogranulomatous pyelonephritis

124
Q

which form of acute pyelonephritis is often seen with diabetics

A

emphysematous pyelonephritis

125
Q

infected collecting system **hx is key

A

pyonephrosis

126
Q

chronic granulomatous calcification

A

renal tuberculosis

127
Q

candida or pneumocystitis affects which demographic

A

fungal infection in kidney

immunocompromised pt

128
Q

clinical picture of renal infection

A

**broad spectrum depending on cause, chronicity etc.

lower back and abd pain

chills, fever

dysuria, frequency, urgency

hematuria

129
Q

inflammation of the kidney and renal pelvis - most commonly an ascending bacterial infection from GI tract organism

A

pyelonephritis

130
Q

high risk groups for renal infection

A

pregnant

congenital anomaly

calculus disease

hydronephrosis

neurogenic bladder

diabetics

immuno-suppressed

131
Q

acute pyelonephritis most frequently __lateral

A

unilateral

132
Q

sono features of acute pyelonephritis

A

diffuse nephromegaly

increased or decreased parenchymal echogenicity

+/- evidence of stones/hydro

+/- urothelial thickening

+/- perinephric fluid

***assess for tenderness

133
Q

focal pyelonephritis aka

A

focal lobar nephronia

134
Q

focal, acute inflammatory mas in the renal parenchyma without drainable puss (essentially a phlegmon) - may regress with antibiotics or become an abscess

A

focal pyelonephritis

*depending on degree of liquification, may have enhancement

135
Q

typically occurs in patients with hydronephrosis secondary to staghorn calculi

A

xanthogranulomatous pyelonephritis

**may be diffuse or segmental

136
Q

typicaly pt is middle aged, obese diabetic female is staghorn calc, recurrent fever and flank pain unresponsive to antibiotics

A

xanthogranulomatous pyelonephritis

137
Q

commonly occurs in chronic diabetes patients, usually VERY ill, F>M but no specific clinical features

A

emphysematous pyelonephritis

**gas-forming infection

138
Q

chronic pyelonephritis aka

A

chronic atrophic pyelonephritis

**mostly in children with reflux (VUR)

139
Q

if bilateral, chronic pyelonephritis may cause __

A

renal failure

++ cortical scarring

140
Q

sono features of chronic pyelonephritis

A

increased echogenicity

irregularity of contour

141
Q

tx for pyonephrosis

A

percutaneous nephrostomy

needs to be drained

  • purulent exudate becomes walled off and protected from body’s natural immune system (and antibiotics)
142
Q

obstructive uropathy (hydro) with superimposed infection

A

pyonephrosis

143
Q

sono features of pyonephrosis

A

hydro +/- internal echoes or fluid-filled levels

** check history and pain; could be fungal

144
Q

kidney upper pole is located __

A

medial and posterior

145
Q

RK is slightly __ than LK due to the liver

A

lower

psoas pulls it lower down

2-4cm displacement

146
Q

lower pole of kidneys __ and slightly __ due to proximity to psoas muscle

A

anterior and slightly lateral

147
Q

__ space contains pancreas, parts of colon, part of duodenum, pararenal fat and crosses ML

A

anterior pararenal space

148
Q

__ space contains kidney, ureter, renal vessels, adrenals, and perinephric fat. does not cross midline

A

perirenal space

aka perinephric

149
Q

__ space posterior to the kidneys. contains +/- fat

A

posterior pararenal space

150
Q

kidney is surrounded by __

A

renal fascia; surrounds perirenal fat

aka Gerota’s fascia

** not the renal capsule

151
Q

what is contained within the renal sinus

A

collapsed collecting system (minor, major calyces and renal pelvis)

segmental vessels

sinus fat

lymphatics and nerves

152
Q

renal pelvis vs. sinus

A

pelvis is part of the collecting system

sinus is the cavity

pelvis is INSIDE the sinus

153
Q

kidney formed from __ renal lobes called __

A

12

renunculi

154
Q

each renunculus consists of __

A

one pyramid surrounding cortical substance

155
Q

what is the functional unit of the kd

A

nephron

156
Q

list the units of the nephron in order of beginning to end

A

glomerulus

Bowman’s capsule

proximal convoluted tubule

loop of Henle

distal convoluted tubule

collecting duct

157
Q

__ vessels rest within the corticomedullary junction

A

arcuate vessels

158
Q

pyramids contain the loops of __, collecting tubules, and __

A

loops of Henle

Papillae

159
Q

renal columns aka

A

columns of Berlin

medullary extensions of renal cortex

160
Q

renal columns contain __ vessels

A

interlobar

161
Q

renal pyramid contains __

A

papilla (apex)

162
Q

major calyces aka

A

infundibula

2-3

in collecting system (sinus)

163
Q

how many minor calyces

A

12

they cup the apex//papilla of the renal pyramids

164
Q

anterior to posterior, that is the order of the RA, RV, and ureter

A

RV -> RA -> ureter

ov > ureter > IA > IV

165
Q

the point where the renal pelvis becomes the proximal ureter

A

ureteropelvic junction

UPJ

166
Q

common sites for stone obstruction in GU tract

A

UPJ
pelvic brim
UVJ

167
Q

muscle that runs directly posterior to kidney

A

quadratus lumborum

168
Q

the flexure where the transverse and descending colon bend

A

colic flexure/ splenic flexure

169
Q

muscle that is posterior and medial to the kidney

A

psoas major

“tenderloin”

170
Q

arterial supply in the kidney

A

main renal artery

segmental arteries (5)
- in sinus

interlobar arteries
- up columns

arcuate arteries
- over base of pyramids

interlobular arteries
- in cortex

afferent and efferent arterioles

171
Q

venous supply of kidney

A

main renal vein
- anterior to artery

(lobar) segmental vein
- only lobar veins anastomose

interlobar vein
- up columns

arcuate veins

interlobular veins

172
Q

multiple renal vessels are __

A

common

173
Q

most common variant of renal artery

A

antecaval RIGHT renal artery

usually an accessory RRA

associated with anterior malrotation of lower pole

174
Q

most common variant of renal veins

A

antecaval right renal artery

circumaortic left renal vein

175
Q

most common renal vein variant

A

circumaortic LEFT renal vein

176
Q

renal arterial blood flow is __ resistance with __ diastolic flow

A

low resistance

good disatole

177
Q

good renal venous flow is __ velocity and __phasic

A

low velocity and monophasic

178
Q

where should you sample a pulsed waveform of a kidney and what is a healthy RI

A

use the segmental or interlobal vessels

RI of arterial vessels should be around 0.7

179
Q

resistive index aka

A

Pourcelot index

RI = (A-B) / A

180
Q

no diastolic flow will give an RI =

A

1.0

181
Q

what is the acceptable discrepancy in length between two kidneys

A

<1.5 cm

182
Q

normal range of kidney volume

A

100-180 cm^3

(using prolate ellipsoid formula)

183
Q

fetal renunculus (lobule) fusion anomaly leaving fat between

A

junctional fat defect between pyramids

tiangular, echogenic appearance

peripheral, often communicates with sinus fat

184
Q

junctional fat defect vs. cortical scar

A

fat defect: between pyramids; may have fat line
* no hx of trauma

cortical scar: more likely at base of pyramid; no fat line
* +/- hx of trauma

185
Q

cortical thinning due to chronic pyelonephritis aka

A

pyelonephritic scar

186
Q

which vessels. course through hypertrophied columnar variant

A

interlobar

187
Q

the unresorbed polar parenchyma of 1 or both subkidneys that fuse to form a normal kidney

A

junctional parenchyma
* due to incomplete fusion of 2 subkidneys

188
Q

what are the types of junctional parenchyma variant

A

superior JP and inferior JP

** angle of indentation

189
Q

abnormal location of renal lobe, indenting the sinus

A

lobar dysmorphism

  • contains cortex and pyramids
    normal vasculature
190
Q

persistent fetal lobulations often mistaken for __

A

cortical scarring

** persistent fetal lobulations usually bilat

191
Q

additional pelvis vs. extrarenal pelvis

A

extrarenal is presence of renal pelvis outside the confines of the hilum

additional pelvis suggests two collecting systems (ie duplex, incomplete fusion)

192
Q

which adjective best describes tuberculosis?
- malignant
- auto immune
- genetic
- granulomatous

A

granulomatous

193
Q

how might we distinguish perirenal fat from a perirenal fluid collection?

A

hx

check other kidney

194
Q

a form of extra-pulmonary TB more common in immunocompromised patients; hematogeneous spread

A

renal tuberculosis

likely bilat but only visible macroscopically in one

195
Q

sono features of renal TB

A

acute -> normal

chronic -> calcs, focal masses, strictures of collecting system, “putty kidney” (calcific autonephrectomy)

will likely see compensatory hypertrophy to less affected kidney

196
Q

renal fungal infection most commonly due to __ in patients with systemic infection

A

candida

197
Q

demographic for renal fungal infection

A

immunocompromised

usually in-patients

non specific clinical findings

198
Q

sono features renal fungus balls

A

echodense, non shadowing mass in dilated collecting sys

ddx tumour, blood clot, pyogenic debris

199
Q

opportunistic infection of the kidneys

A

renal pneumocystis

**pt with AIDS common

200
Q

sono features of pneumocystic infection

A

multiple small punctate calcifications

+/- shadows

201
Q

which component of the waveform provides information about downstream resistance?

A

diastole

*where the flow is going; deeper into organ

202
Q

RI, PI, and S/D ratios __ numerically as downstream resistance increases

A

increase

203
Q

forumla for RI

A

(PSV-EDV) / PSV

204
Q

formula for PI

A

(max-min) / mean

205
Q

formula for S/D ratio

A

PS / ED

206
Q

lab findings for acute renal failure, pain, hematuria, and fever

A

acute renal vein thrombosis

207
Q

pulmonary emboli, HTN

A

chronic renal vein thrombosis

208
Q

acute renal vein thrombosis is usually a complication in ___ patient

A

an already sick patient

209
Q

nephrotic syndrome aka

A

collection of symptoms that can damage kidney

  • proteinuria
  • low levels albumin in blood
  • increased platelets
210
Q

sono features of acute renal vein thrombosis

A

swollen, hypoechoic

distended vein from thrombus

211
Q

what change would be expected in renal arterial waveform when vein has thrombus

A

very high resistance rather than the usual low

pandiastolic flow reversal

212
Q

chronic renal vein thrombosis usually found in __ patient

A

incidentally in patient

**find unilateral small, atrophic kidney

213
Q

RAS aka

A

renal artery stenosis

214
Q

causes for RAS

A

atherosclerosis (70%)

fibromuscular dysplasia (30%)

215
Q

hyperplasia of vessel media causing ‘string of beads’ appearance

A

fibromuscular dysplasia

most common in young adult females

216
Q

high blood pressure due to renal artery stenosis

A

renovascular hypertension

treatable

140/90 mmHg

217
Q

diagnostic tests for RAS

A

captopril test

digital subtraction renal angiography

renal ateriography and systemic renin test

magnetic renal angiogrpahy

Doppler ultrasound

218
Q

tx for RAS

A

percutaneous transluminal balloon angioplasty

sx -> renal endarterectomy; aorto-renal bypass graft

219
Q

RAR aka

A

renal-aortic ratio

  • compare velocity in stenosis to velocity proximal to stenosis (at Ao)

look for “step up” in velocity

(PSV in stenosis / PSV in Ao)
= renal / Ao

> 60% stenosis with 3.5:1

220
Q

waveform within kidney with RAS

A

tardus parvus

221
Q

chronic vascular insult aka

A

chronic RAS

chronic venous thrombosis

**small echogenic kidney, unilateral with opposing kidney demonstrating compensatory hypertrophy

222
Q

chronic renal insult will cause renal __ and a decrease in renal size

A

renal infarction

  • check perfusion with power Doppler
223
Q

allograft vs isograft

A

same species used for graft

allo = different DNA
iso = same DNA

224
Q

preferred placement of renal transplant

A

contralateral iliac fossa; extraperitoneal

ideally RIGHT iliac fossa (no sigmoid to move)

anastomoses attached to external iliac vessels

225
Q

ureter attachment with renal transplant

A

oblique implantation direct anastomosis to bladder (mucosa to mucosa) to prevent reflux

ureter kept as short as possible to reduce risk of ischemia

stent often inserted at time of sx

226
Q

what happens to the non functioning kidney that a pt is receiving a transplant to replace

A

unless it is infected, chronic reflux or large polycystic –

non functioning kidney left in situ

227
Q

sono technique for scanning renal transplant

A

greyscale and doppler

high freq 7MHz transducer ideal
- convex array

+/- standoff pad
+/- EFOV

228
Q

clinical signs of transplant pathology

A

increased BUN
increased serum creatinine
** azotemia

oligouria

hematuria, proteinuria

HTN

pain

fever

malaise

palpable mass

*** look for any rapid change in size - should look like a normal kidney

229
Q

abnormal sono findings for renal transplant

A

rapid enlargement (check volume)

hypo or hyperechoic cortex

prominent large pyramids

decrease in sinus echogenicity

+/- urothelial thickening

hydro?? look for level and cause

RI >0.75

fluid collections
** hematoma right away; abscess wouldnt form for 2 w and lymphocele 2-6w
** may cause venous compression

230
Q

complications related to pressure effects of renal transplant fluid collections

A

leg swelling
*compression of iliac vein

hydronephrosis
* compression of graft ureter

renal ischemia or infarction
* compression of renal vessels

231
Q

“lymphoceles are most __ and the __ “

A

lymphoceles are the most LIKELY and the LATEST

accumulation of lymphatic fluid
* take several weeks to form (2-6)

usually medial and inferior

often septates

usually asymptomatic but can obstruct ureter if large

232
Q

important question to answer regarding hematomas and renal transplants

A

is it subcapsular or perinephric

233
Q

how do you tell the difference between urinoma and lymphocele

A

FNA

234
Q

clinical signs of transplant rejection & types

A

immune system response
* proliferation of antibodies, WBC, macrophages

types:
hyperacute (immediate, severe(

acute (common) ( days, weeks)

chronic (months, years)

235
Q

sono signs of kidney transplant rejection

A

enlarged kidney

prominent big pyramids

loss of echogenicity to sinus fat

thickening of lining of collecting sys

increases RI and PI in intrarenal vessels

** findings non specific and need biopsy to make dx

236
Q

common cause for transplant failure (acute renal failure)

A

acute tubular necrosis (ATN)

due to post surgical hypotensive state

237
Q

renal ATN is an __ process

A

ischemic

usually transient

if uncomplicated, is reversible

238
Q

sono findings for transplant ATN

A

often normal

increased cortical echogenicity

mild nephromegaly

+/- increased RI and PI

** need biopsy for dx

239
Q

4 key assessments for renal transplant doppler

A

at arterial anastamosis
?stenosis

renal vein
?thrombus

overall perfusion
?infarcts

intrarenal arteries
?tardus parvus ?infarcts

240
Q

normal external iliac artery waveform

A

very high resistance

flowing to resting leg muscles

compare PSV to RA; should be similar at site of anastamosis in transplant

** ensure correct angle

241
Q

what is the most common site for a renal artery stenosis

A

site of transplant anastamosis

242
Q

criteria for RAS

A

PSV > 1.8m/s

> 2:1 step up in PSV from RA:EIA

RI >0.75

243
Q

pandiastolic flow reversal in the intrarenal veins suggests __

A

renal vein thrombosis

OR pseudoaneurysm neck (check with biopsy)

244
Q

tardus parvus flow in the intrarenal arteries suggests __

A

proximal arterial stenosis

245
Q

what complications do we look for post biopsy of a kidney

A

hematoma

pseudoaneurysm

AV fistula

246
Q

doppler signs for AVF in kidney

A

high velocity, very low resistance

RI <0.45

aliasing

247
Q

hematoma as a result of a leaking hole in an artery; forming outside the arterial wall and contained within tissues

A

pseudoaneurysm

** it must continue to communicate with the artery to be considered a pseudoaneurysm

** yinyang sign (turbulent mess)

248
Q

immunosuppressed patients are at increased risk for both infection and some cancers (lymphoma) - look for enlarged LN and solid masses in or around transplant to r/o ___

A

post transplant lymphoproliferative disorder

** complication of both solid organ and allogenic bone marrow transplant

249
Q

in most cases of post transplant lymphoproliferative disorder, the associated virus is __ infection of the B cells

A

Epstein-Barr virus

250
Q

transplant of 2 pediatric kidneys into an adult

A

En Bloc transplant

also transplant section of aorta and IVC

** kidneys will hypertrophy over time and grow to be normal size

251
Q

bilateral increased deposition of renal sinus fat

A

renal sinus lipomatosis

more common with age

M>F

  • mild cortical thinning; normal sized kidney
252
Q

rounded, triangular cystic spaces in medulla at the edge of pyramids

A

can be papillary necrosis

pulsating specular echoes from arcuate vessels at the base of the hypoechoic spaces help distinguish from hydronephrosis

can slough off and cause obstruction

253
Q

peeing protein problem

A

nephrotic syndrome

proteinuria (primary albuminuria)

hypoalbuminuria

generalized edema

hyperlipidemia

lipiduria

** hx matters

254
Q

renal manifestation of DM

A

diabetic nephropathy

255
Q

diabetic nephropathy aka

A

glomerulosclerosis

  1. decreased GFR
  2. azotemia (increased BUN and creatinine)

u/s findings = medical renal disease
* hx is important

256
Q

atherosclerosis vs. Monckeberg sclerosis vs. diabetic atherosclerosis

A

atherosclerosis = build up of plaque in intima

Monckeberg = calcification of media (uterus)

diabetic athero = protein buildup in intima

257
Q

accelerated atherosclerosis associated with diabetic nephropathy

A

diabetic atherosclerosis

protein buildup in the intima because of DM

can calcify, causing narrowing of the lumen

** u/s appears like linear calc but in area of artery
** segmental, interlobar, arcuate

258
Q

common complications of renal biopsy

A

hematuria

hematoma

  • less complications in children

less common: urinoma, infection, acquired AVF, pseudoaneurysm

ABD & SMALL PARTS (16 decks)

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