Renal pathologies Flashcards
- Most common renal tumor in neonates and children. -Associated with polyhydramnios.
- Hard to distinguish between Wilms tumor on ultrasound.
Mesoblastic Nephroma
- Majority(95%) of bladder tumors
- Focal thickening/solid mass of bladder
- hematuria is most common clinical sign
Transitional Cell Carcinoma
- Herniation of bladder wall occurs
- “outpouchings” may be singular or multiple
- normal bladder wall thickness:
- <5mm nondistended
- <3mm distended
bladder diverticulum(abnormal sac/pouch)
- very echogenic foci with posterior shadowing
- use doppler for “twinkle artifact” if this is suspected
Urolithiasis(kidney stones)
- acquired
- occurs when a blood vessel wall is injured and the leaking blood collects in the surrounding tissue
- may develop after graft anastomosis, renal biopsy, or intratumoral hemorrhage
- Sonography shows a round hypoechoic or cystic mass in the renal parenchyma that fills with color signal on color flow Doppler imaging.
Pseudoaneurysm
- an abnormal connection between an artery and a vein in which blood flows directly from an artery into a vein, bypassing some capillaries
- diagnosis is based on detection of a perivascular artifact that reflects local tissue vibration produced by the arteriovenous shunt.
Arteriovenous fistulas
-Occurs when part of the tissue undergoes
necrosis after the cessation of the blood supply
- ______ within the renal parenchyma appear as
irregular areas, somewhat triangular in shape, and
along the periphery of the renal border
- Irregular area may be slightly more echogenic than
renal parenchyma.
- renal contour may be “lumpy-bumpy”
renal infarction
- Most common correctable cause of hypertension
- symptoms include acute hypertension, or uncontrollable hypertension
- may produce decresed renal size <9cm
- Renal artery/Aorta Ratio(RAR) is >3.5
- Overall waveform shape is “tartus parvus”(small, slow pulse)
Renal Artery Stenosis(RAS)
Normal resistive index is
< 0.7
R.I. formula is….
(Peak systolic velocity - End diastolic velocity)/ Peak systolic velocity
renal dysfunction results in loss of flow in _____
diastole
- hyperparathyroidism is the most common cause
- A.K.A. Albright’s Calcinosis or Anderson’s Carr
- Cortical—-increased cortex echogenicity with spared pyramids
- Medullary–pyramids become more echogenic than cortex
Nephrocalcinosis
- destruction of renal parenchyma
- symptoms—Staghorn Calculus, large nonfuctioning kidney, multiple infections
Xanthogranulomatous Pyelonephritis
- Occurs when gas/air are in the renal parenchyma
- may be cause by E. Coli
- Enlarged hypoechoic kidneys, gas may cause “comet-tail”
- usually unilateral
Emphysematous Pyelonephritis
- Infection that results from bacterial invasion of
the renal parenchyma - when this is focal, its called “Acute Focal Bacteria Nephritis or Lobar Nephronia
- focal wedged- shaped area similar to renal infarction
Acute Pyelonephritis
- Fungal infection in the drainage structures
- hyperechoic, nonshadowing masses within the renal pelvis
Mycetoma/Fungal ball
- occurs when pus is found within the collecting renal system
- emergency that requires urgent intravenous
antibiotherapy or percutaneous drainage or both - low level echoes with a
fluid-debris level in a dilated renal collecting system
Pyonephrosis
- wide ureter, greater than 7mm in diameter
- more common in males(4:1)
- left side more commonly affected
Megaureter
- R.I. greater than .7
- UVJ is most common area for stone
- graded 1-4. 4 being the worst
Hydronephrosis
- diffusely echogenic kidney with a loss of normal anatomy
- if bilater, both kidneys are small
- May be the result of hypertension, chronic inflammation, or chronic ischemia
Chronic Renal Disease/ Chronic Renal Injury
-Most common cause of AKI
-Bilaterally enlarged kidneys evident with hyperechoic
pyramids
Acute Tubular Necrosis
- Most important issue is presence or absence of
urinary tract dilation - kidneys may be normal/enlarged and hypoechoic
Acute Renal Failure/Acute Kidney Injury
Causes of renal failure
Pre renal
Renal
Post renal
Pre-renal
inadequate perfusion
Renal
Medical renal disease, acute tubular necrosis
Post-renal
obstructive nephropathy
occurs when cells at the apex of the renal pyramids are destroyed
papillary necrosis
- a connective tissue disorder resulting from an abnormal immune system
- women affected more, 20-40 y/o
- kidney much more echogenic than liver
- hematuria, proteinuria, hypertension, renal vein thrombosis, renal insufficiency
Lupus Nephritis
- associated with scarlet fever, dipheria
- may be manifestation to allergic reaction to certain drugs
- fever, uremia, proteinuria, rash, eosinophilia(WBC)
Acute Interstitial Nephritis
filter blood and make urine
glomeruli
-Necrosis, damage/proliferation of cellular
elements in the glomeruli
- enlarged, poorly functioning kidney
-acute hematuria, RBC in urine, hypertension, anemia, peripheral edema
- kidney more echogenic than liver
Acute Glomerulonephritis
- tumor of fat cells
- more often in women
- usually asymptomatic, possible hematuria
- well-defined, echogenic mass in kidney
Lipoma
- uncommon, usually benign
- pain, hematuria
- middle aged and older patients
- “spoke-wheel” pattern with central scar
- hard to differentiate from RCC
Oncocytoma
- Most common benign renal tumor
- usually in right kidney
- composed of fat, muscle, blood vessels
- found in 80% of pts with tuberous sclerosis
- hyperechoic(depending on amount of fat etc…)
Angiomyolipoma (AML)
- Most common abdominal malignancy and solid renal tumor in pediatric patients
- peak incidents 2.5-3 y/o’s
- abdominal flank mass, hematuria, fever, anorexia
- hypoechoic to moderately echogenic
- 40% of pts have renal vein/ vena cava thrombosis
Wilms tumor/ Nephroblastoma
mets to the kidneys are
common
most common primary malignancies that metastasize to the kidneys–
lung, breast, RCC of contralateral kidney
- bilateral invasion with multiple nodules
- kidneys are enlarged and hypoechoic
- nonhodgkin is more common than hodgkin
renal lymphoma
- rare
- large mass in renal pelvis
squamous cell carcinoma
- Most common renal neoplasm in adults
-twice as common in men
-also called hypernephroma or Grawitz tumor
AKA adenocarcinoma of kidney - hematuria(most common), flank pain, palpable mass
-isoechoic - High end sytolic & diastolic with low RI
Renal cell carcinoma
_________ in a renal mass is always a sign of malignancy
calcifications
- developmental anomaly
- unilateral or segmental
- associated with Beckwith-Weidemann syndrome
- small cysts in medulla and increased echogenicity
Medullary Sponge Kidney
- small, echogenic kidneys
- loss of corticomedullary differentiation
- multiple medullary cysts under 2cm
Medullary cystic disease
- Most common cystic disease in neonates
- atresia of UPJ
- kidneys are multicystic with absence of renal parenchyma due to all of the cysts
Multicystic Dysplastic Kidney
- bilateral
- enlarged kidneys with multiple asymmetrical cysts
- 40-50 y/o’s
- hypertension, hematuria
- associated with cysts in liver, spleen, pancrease
Autosomal-Dominant Polycystic Kidney Disease/ Adult
- in older children, kidneys are enlarged and echogenic, corticomedullary differentiation lacking.
- portal hypertension, hepatic fibrosis, GI hemorrhage
- infantile polycystic disease
Autosomal-Recessive Polycystic Kidney Disease/Infantile
- Multi system genetic disease
- seizures, mental retardation, facial angiofibromas
- increased incidence of renal cysts and angiomyolipomas
Tuberous Sclerosis
- characterized by retinal and CNS hemangioblastomas
- 20’s-30’s
- inherited, formation of tumors and cysts
Von Hippel-Lindau disease
- originate from the renal sinus
parapelvic cysts
cystlike enlargement of lower ureter
uterocele
Pelvis appears as a central cystic area that is
either partially or entirely beyond the confines of
the bulk of the renal substance.
-usually medial to hilum
extrarenal pelvis
deposition of fat in the renal sinus with parencyma atrophy
sinus lipomatosis
Surfaces of the kidneys are generally indented
in between the calyces, giving the kidneys a
slightly lobulated appearance.
- usually presents in children up to 5
fetal lobulation
lab tests for renal disease
serum creatinine, BUN(blood urea nitrogren)
The main renal vein emerges from the renal hilus, ______ to the renal artery
anterior
anterior to the right kidney…
right adrenal gland, liver, morrisons pouch, second part of duodenum, right colic flexure(Hepatic)
anterior to the left kidney…
left adrenal gland, spleen, stomach, pancreas, left colic flexure(splenic), coils of jejunum
renal fascia is also known as
gerota’s fascia
most posterior and superior structure
renal artery
two branches of the renal vein are _____ to the renal artery
anterior
