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
sonographic evaluation of a malignant mass
- wall thickness greater than 1mm
- irregularity at the base of the cyst
- septations evident
- calcifications evident
- vascularity present in the septa and/or cystic wall
what is another name for renal cell carcinoma
- hypernephroma
- Grawitz tumor
what is the most common of all malignant renal neoplasms
renal cell carcinoma
renal cell carcinoma is twice as common
in men
when does renal cell carcinoma develop
in the sixth or seventh decade of life
clinical presentation of renal cell carcinoma is often
nonspecific
patients with renal cell carcinoma may report
hematuria, flank pain, and palpable mass
sonographic appearance of renal cell carcinoma
most RBCs are solid with no predilection for either right or left kidney or its location in the organ
sonographic findings of renal cell carcinoma
- most RBCs are isoechoic; they may appear hyperechoic
- the larger the tumor, usually the more heterogenous its echotexture, which is caused by intertumoral hemorrhage and necrosis
- tumors less then 3cm are usually hyperechoic; distinguishing them from echogenic fat-containing tumors similar to angiomyolipoma is difficult
Transitional cell carcinoma accounts for
90% of malignancies that involve the renal pelvis, ureter, and bladder
small transitional cell carcinomas ten to be
flat high-grade malignancy tumors
transitional cell carcinoma spread
easily to the other tissues and organs
patients with transitional cell carcinoma may have
gross or microscopic hematuria and flank pain
sonographic findings of transitional cell carcinoma
hypoechoic mass in the collecting system, with low vascularity on color Doppler
what is the most malignant bladder tumor in adults
transitional cell carcinoma in the bladder
bladder tumors are not detected sonographically until they
become advanced
clinical findings of transitional cell carcinoma in the bladder
gross or microscopic hematuria
sonography transitional cell carcinoma in the bladder can not distinguish between
benign and malignant tumors
what is recommended to detect small tumors in the bladder
cystoscopy and to obtain biopsy of the tissue
tumors that are less than
3-4mm can not be seen sonographically
sonographic findings of transitional cell carcinoma in the bladder
- echogenic irregular mass in the bladder
- may be along the bladder wall
- most commonly located in the posterior wall of the bladder
- may also be flat in appearance
- single or multiple
metastases of the kidneys is relatively
common
what are the most common primary malignancies that metastasize to the kidneys
- carcinoma of the lung
- breast
- renal cell carcinoma of the contralateral kidney
sonographic findings of metastases to the kidneys
- multiple
- poorly marginated
- hypoechoic masses are evident
what is the most common abdominal malignancy
nephroblastoma
what is the most common solid renal tumor in pediatric patients
nephroblastoma
what is also know as
nephroblastoma
nephroblastoma peak incidence is
2.5 to 3 years of age
nephroblastoma is
2 to 8 times more common in patients with horseshoe kidneys
clinical signs of nephroblastoma
- abdominal flank mass
- hematuria
- fever
- anorexia
sonographic findings of nephroblastoma
- determine whether the mass is cystic or solid and confirm that it is renal in origin
- mass varies from hypoechoic to moderately echogenic
- increased vascularity
patients with benign renal tumors are usually
asymptomatic
patients with benign renal tumors have flank pain if the mass is
large or if hemorrhaging from the mass has occurred
types of benign renal tumors
- angiomyolipoma
- oncocytoma
- lipoma
what is the most common benign renal tumor
angiomyolipoma
angiomyolipoma are composed of
fat, muscle, and blood vessels
angiomyolipoma tumor size varies between
1 to 20cm
sonographic findings of angiomyolipoma
hyperechoic lesion
angiomyolipoma complications
intramural hemorrhage
angiomyolipoma appears
as echogenic focal mass in the renal parenchyma
what is a uncommon benign renal tumor
oncocytoma
oncocytoma tumor size
varies but average size 6 cm
patients with oncocytoma typically
asymptomatic
oncocytoma may cause
pain and hematuria
sonographic findings of oncocytoma
- hypoechoic in more than 50% of cases
- may have increase vascularity
- “spoke-wheel” patterns of enhancement evident with a central scar
- extremely difficult to differentiate from RCC
oncocytoma has increased incidence in
middle-aged and older patients
lipoma tumors consists of
fat cells
lipoma are found more often
in women than in men
patients with lipoma are typically
asymptomatic
sonographic findings of lipoma is
well-defined echogenic mass within the kidney
what 3 things do sonographers evaluate when scanning the kidneys
- is the cortical thickness WNL?
- can you see a difference between the cortex and the central renal sinus?
- is the cortical echogenicity less echogenic (or more hypoechoic) than the liver
4 processes that happen to the kidney with medical renal disease
- increase in cortical echogenicity
- cortical thinning
- atrophy of the kidney
- increase in size
increase in cortical echogenicity
produces a generalized increase in cortical echoes, which are believed to be result of a deposition of collagen and fibrous tissue
cortical thinning
causes a loss of normal anatomic detail, resulting in the inability to distinguish the cortex and medullary regions
atrophy of the kidney
decrease in the size of the kidney
acute renal failure
is a common medical condition caused by a variety of diseases or pathophysiologic mechanisms
acute renal failure may occur
- prerenal
- renal
- postrenal
prerenal stage of acute renal failure is
secondary to the hypoperfusion of the kidney
renal stages of acute renal failure may be caused by
parenchymal disease
(acute glomerulonephritis, acute interstitial nephritis, or acute tubular necrosis
acute renal failure may also be caused by
renal vein thrombosis or renal artery occlusion
postrenal failure usually result of
outflow obstruction
postrenal failure usually
increased in patients with a malignancy of bladder, prostate, uterus, ovaries, or rectum
causes of acute renal failure
- prerenal
- renal
- postrenal
prerenal acute renal failure
- hypoperfusion
- hypotension
- congenital heart failure
renal acute renal failure
- infection
- nephrotoxicity
- renal artery occlusion
- renal mass or cyst
postrenal acute renal failure
- lower urinary tract obstruction
- retroperitoneal fibrosis
sonographic findings of acute renal failure
- enlarged
- hypoechoic
loss of renal function as a result of chronic renal disease such as
- glomerulonephritis (infection of the kidneys)
- chronic pyelonephritis (infection of the kidneys)
- renal vascular disease
- diabetes
sonographic findings of chronic renal disease
- small and echogenic
- diffusely echogenic kidney with a loss of normal anatomy; is a nonspecific sonographic findings
- if chronic renal disease is bilateral, small kidneys are identified
- may be the result of hypertension, chronic inflammation (infection), or chronic ischemia
what is the most common renal disease to produce acute renal failure
acute tubular necrosis
acute tubular necrosis can be
reversible
sonographic findings of acute tubular necrosis
bilaterally enlarged kidneys evident with hyperechoic pyramids, can revert to a normal appearance
- if it reverses, it is probably acute tubular necrosis
renal atrophy
is when the kidney has shrunk to an abnormal size with abnormal function
renal atrophy is a result of
numerous disease processes
renal sinus lipomatosis occurs
secondary to renal atrophy
pyonephrosis
occurs when pus is found within the collecting renal system
sonographic findings of pyonephrosis include
the presence of low-level echoes with a fluid-debris level
emphysematous pyelonephritis
occurs when air is in the parenchyma
emphysematous pyelonephritis may cause
for an emergency nephrectomy
xanthogranulomatous pyelonephritis
uncommon renal disease associated with chronic obstruction and infection
emphysematous pyelonephritis and xanthogranulomatous pyelonephritis sonographically show
enlarged and hypoechoic kidneys
renal artery stenosis results from
narrowing of the arteries that carry blood to the kidneys
renal artery stenosis causes
- high blood pressure
- elevated protein levels in urine
- decreased kidney function and swelling
what is the most common correctable of renal artery stenosis
hypertension
what are the most common caused of renal artery stenosis
- atherosclerosis
- fibromuscular dysplasia
sonographic characteristics of renal artery stenosis
- Absence of early
systolic peak (ESP) - Systolic rise time: ΔT <
0.1 sec - Peak systolic velocity
(PSV): >160/180 cm/sec - Overall waveform
shape: “tardus” and
“parvus” waveform - Resistive index: RI = (S-
D) ≥ 0.70 S
renal infaraction
occurs when part of the tissue undergoes necrosis after the cessation of blood supply (usually arterial occlusion)
sonographic findings of renal infarction
- infarctions within the renal parenchyma appear as irregular areas, somewhat triangular, and along the periphery of the renal border
- irregular area may be slightly more echogenic than renal parenchyma
- renal contour may be somewhat “lumpy-bumpy”
arteriovenous fistula
is the connection of a vein and an artery
arteriovenous fistula and pseudoaneurysms are most often
acquired
pseudoaneurysms may develop after
graft anastomosis, renal biopsy, or intratumoral hemorrhage
cystitis
inflammation of the bladder has several infectious and noninfectious causes
cystitis is usually
secondary to another condition that causes stasis of urine in the bladder
sonographic findings of cystitis
the bladder wall may appear normal in the early stages of inflammatory. as duration of inflammation increases, the smooth bladder wall will become diffuse or focal with hypoechoic thickening
as the inflammatory process progresses
the bladder will become fibrotic and scarred
what is the majority of bladder tumors in adults
TCCs
bladder tumors are usually not detected until
they have become advanced
patients with bladder tumors typically have
gross hematuria, dysuria, urinary frequency, or urinary urgency
sonographic findings of bladder tumors
- appearance of bladder masses vary
- usually an echogenic mass
all primary bladder tumors have the same sonographic appearance
irregular echogenic mass that projects into the lumen (wall) of the bladder
