Pathology Flashcards
cysts of the kidney can be
solitary or multiple
complex cyst may contain
septations, thick walls, calcifications, internal echoes, and mural nodularity
complex cyst are considered
malignant until proven benign
with complex cysts internal echoes are often the result of
protein content, hemorrhage, and/or infection
any irregularity at the base of the cyst should be considered
a malignant growth
if septa is thicker than 1mm with vascularity on color or power Doppler, the lesion is
presumed malignant
parapelvic cyst are
small cysts
parapelvic cysts originate from
the renal sinus
parapelvic cysts do not communicate with
the collecting systems
what are the polycystic kidney disease
- autosomal-recessive polycystic disease (ARPKD)
- autosomal-dominant polycystic kidney disease (ADPKD)
infantile polycystic disease
autosomal-recessive polycystic disease (ARPKD)
rare polycystic kidney disease
autosomal-recessive polycystic disease (ARPKD)
common polycystic kidney disease
autosomal-dominant polycystic kidney disease
adult polycystic kidney disease
autosomal-dominant polycystic kidney disease
four kinds of autosomal-recessive polycystic disease (ARPKD)
- perinatal
- neonatal
- infantile
- juvenile
the type of diagnose of autosomal-recessive polycystic disease (ARPKD) depends on
patients age at the onset of clinical signs
perinatal form of autosomal-recessive polycystic disease (ARPKD) is found in
utero
autosomal-recessive polycystic disease (ARPKD) usually progresses to
renal failure, causing pulmonary hypoplasia and intrauterine demise
with autosomal-recessive polycystic disease (ARPKD) dilation of the renal collecting tubules causes
renal failure
what is the most common form of polycystic kidney disease
autosomal-dominant polycystic kidney disease (ADPKD)
when does autosomal-dominant polycystic kidney disease (ADPKD) usually clinically manifest
does not clinically manifest until the fourth or fifth decade when hypertension or hematuria develops
by age 60 years, patient with autosomal-dominant polycystic kidney disease (ADPKD) approximately
50% of patients have end-stage renal disease
sonographic findings of autosomal-dominant polycystic kidney disease (ADPKD)
- bilateral disease
- enlarged kidneys with multiple asymmetrical cyst vary in size and location in the renal cortex and medulla
clinical symptoms of autosomal-dominant polycystic kidney disease (ADPKD)
- pain
- hypertension
- palpable mass
- hematuria
- headache
- UTI
- renal insufficiency
common non hereditary renal dysplasia (abnormal cells)
multicystic dysplasia kidney
most common form of cystic disease in neonates
multicystic dysplastic kidney
multicystic dysplastic kidney is thought to be caused by
early in-utero urinary tract obstruction
multicystic dysplastic kidney usually occurs
unilaterally, with poor function
when multicystic dysplastic kidney is bilateral involvement it is
incompatible with life
sonographic findings of multicystic dysplastic kidney disease in neonates and children
kidneys are multicystic, with the absence of the renal parenchyma and renal sinus
sonographic findings of multicystic dysplastic kidney disease in adults
kidneys may be small (atrophic and calcified) and echogenic
medullary sponge kidney occurs in
the medullary pyramids
medullary sponge kidney consists of
cystic or fusiform dilation of the distal collecting ducts (ducts of Bellini)
dilation from medullary sponge kidney causes
stasis of urine and stone formation
medullary sponge kidney is a
developmental anomaly
sonographic findings medullary sponge kidney
- small echogenic kidneys
- loss of corticomedullary differentiation
- multiple medullary small cysts under 2 cm
what occurs with nephrocalcinosis
parenchymal calcification occurs
nephrocalcinosis affects
both kidneys
nephrocalcinosis
diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex
hydronephrosis
is distention (dilation) of the kidney with urine caused by backward pressure on the kidney when the flow of urine is obstructed
causes of hydronephrosis
- bladder tumors
- carcinoma of the cervix
- calculi
- neurogenic bladder
- pelvic mass
- prostatic enlargement
- retroperitoneal fibrosis
hydronephrosis grades
1-4
hydronephrosis grade 1
small, fluid-filled separation of the renal pelvis
hydronephrosis grade 2
dilation of some but not all calyces; renal sinus orientation still concave
hydronephrosis grade 3
complete pelvocalictasis
hydronephrosis grade 4
prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma
hydronephrosis with a dilated ureter indicates obstruction of the UVJ junction is called
hydrouteronephrosis
when the renal collecting duct system is dilated what is scanned to located the obstruction
the ureters and bladder are scanned to locate the level of obstruction
a mildly distended collecting system can be caused by
overhydration, a normal variant of extrarenal pelvis, or by a previous urinary procedure
if hydronephrosis is suspected, the sonographer
should examine the bladder
what scanning technique is helpful in preventing the error of hydronephrosis
postvoid
at the level of obstruction from hydronephrosis, the sonographer
should sweep the transducer back and forth in two planes to see if the mass or stone can be distinguished
conditions that mimic hydronephrosis
- extrarenal pelvis
- parapelvic cysts
- reflux
- persistent diuresis (increased or excessive production of urine)
- congenital megacalyces
- papillary necrosis
- renal artery aneurysm
- arteriovenous malformation
arteriovenous malformation
an abnormal tangle of blood vessels where the arterial blood bypasses capillaries and reaches the veins
what is the most common kidney problem that occurs
kidney stones
kidney stones are more common in
men
where are majority of stones formed
in the kidney and course down the urinary tract
large stones that fill the renal collecting system is called
staghorn calculi
sonographic findings of urolithiasis
- very echogenic foci with posterior acoustic shadowing in the renal collecting system
- stones less than 3 mm may not shadow
clinical findings of urolithiasis
is extreme pain followed by cramping on one side. the pain may subside if the stone travels
treatment for urolithiasis
- lithotripsy
- nephrolithomy
if the stone causes obstruction
hydronephrosis will be noted
depending on the location of the stone
the ureter may become dilated superior to the level of obstruction
if a renal mass is solid
it must be considered malignant unless fat is present
calcifications in a renal mass are always
a sign of malignancy
if a cystic renal mass does not meet the sonographic criteria for a simple renal cyst
it must be considered malignant