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ABD Pathology > Renal/Urinary tract > Flashcards

Renal/Urinary tract Flashcards

1
Q

What is acute pyelonephritis?

A

Acute inflammation of the parenchyma typically involving the pyelocaliceal lining

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2
Q

Acute pyelonephritis affects _________ more frequently than ________.

A

Females

Male

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3
Q

What age range is acute pyelonephritis typically identified in?

A

15-30 years

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4
Q

Lab results with acute pyelonephritis

A

Elevated WBC
Pyuria
Bacteremia
Microscopic hematuria

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5
Q

What is emphysematous pyelonephritis?

A

Life threatening infection of renal parenchyma with gas formation in tissue or collecting system

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6
Q

Emphysematous pyelonephritis affects males more frequently than females (2:1)
T/F

A

False

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7
Q

Clinical presentation of Emphysematous pyelonephritis

A 
Fever/chills
Flank pain
Lethargy
Confusion
Dehydration
Acidosis
Electrolyte imbalance
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8
Q

Gas within parenchyma or collecting system will produce what kind of artifact?

A

Ring down reverberations

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9
Q

It is uncommon for Emphysematous pyelonephritis to extend into perirenal space.
T/F

A

False, 80% do

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10
Q

What is the mortality rate for Emphysematous pyelonephritis?

A

High, 30-75% depending on treatment

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11
Q

Ultrasound is the most reliable and sensitive imaging modality for Emphysematous pyelonephritis.
T/F

A

False, CT

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12
Q

What is chronic pyelonephritis?

A

Interstitial nephritis from ongoing/recurring UTIs

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13
Q

What is acute tubular necrosis?

A

Temporary reversible renal failure due to significant reduction in tubular blood flow rate as a result of drugs or ischemia producing processes that increase arteriole resistance

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14
Q

Exposure to mercury, uranium, antifreeze or arsenic can increase the risk of:

A

Acute tubular necrosis

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15
Q

ATN will present with:

A

Oliguria
Uremia
Electrolyte imbalance

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16
Q

With ATN, the kidneys will measure larger in the ______ dimension.

A

AP

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17
Q

Pyonephrosis is the presence of pus in the urinalysis collecting system secondary to:

A

Ureteral obstruction

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18
Q

What are some Sonographic traits of pyonephrosis?

A

Hydro

Low level echo particles in dilated calyces

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19
Q

Acute glomerulonephritis occurs where?

A

In the corticomedullary junction

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20
Q

Acute glomerulonephritis is:

A

Inflammation and necrosis of the glomeruli

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21
Q

Acute glomerulonephritis is usually associated with:

A

Autoimmune and other systemic disease processes

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22
Q

Clinical presentation of acute glomerulonephritis

A

Oliguria
N/V
Fever
Hypertension

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23
Q

Lab values with acute glomerulonephritis

A

Hematuria
Elevated BUN, creatinine and potassium
Azotemia

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24
Q

With acute glomerulonephritis there is focal increase in the cortical echogenicity that makes the normal medulla appear prominent.
T/F

A

False, diffuse

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25
Q

Schistosomiasis is endemic in:

A

Puerto Rico, South Africa, Egypt, Nigeria, Tanzania and Zimbabwe

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26
Q

A 30 year old patient presents with flank pain, dysuria and has blood and albumin in their urine. The kidneys appear normal but the bladder wall is thickened with some calcifications. What is the likely diagnosis?

A

Schistosomiasis

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27
Q

Urinary tuberculosis is an infestation to the kidney of mycobacterium tuberculosis from:

A

An extraurinary source

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28
Q

Urinary tuberculosis affects female more frequently.

T/F

A

False, females

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29
Q

Urinary tuberculosis affects people that are usually less than:

A

50 years age

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30
Q

Urinary tuberculosis is usually bilateral or unilateral?

A

Unilateral

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31
Q

Acute urinary tuberculosis appears as:

A

Enlarged kidney
Multiple focal lesions (tuberculomas)
Possible UVJ edema/obstruction and hydroureter

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32
Q

Chronic urinary tuberculosis appears as:

A

Decreased renal size
Varying scarring and obstruction from fibrotic changes
Eventually shrunken, no functioning, and calcified

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33
Q

What is it called when a kidney is shrunken and calcified and no longer functions?

A

Autonephrectomy or putty kidney

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34
Q

Diabetics are affected twice as often with:

A

Renal abscesses

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35
Q

ATN accounts for 75% of

A

Acute renal failure

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36
Q

Chronic renal failure may be a result of:

A 
Chronic infection/inflammation
Long standing vascular disease
Diseases affecting blood protein levels
Diabetes, gout, hypercalcemia
Congenital renal diseases
Hepatorenal syndrome and radiation
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37
Q

Four classifications of renal failure causes

A

Prerenal
Renal
Postrenal
Congenital

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38
Q

Prerenal causes of renal failure

A 
When the kidney isn’t getting enough blood
Hemorrhage
Cardiac failure
Fluid and electrolyte depletion
Liver failure
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39
Q

These are the most common causes of renal failure

A 
Renal classification:
ATN
Glomerulonephritis 
Tubointerstitial nephritis
Arterial/venous obstruction
Cortical necrosis
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40
Q

Postrenal causes of renal failure

A 
The least common
Outflow obstruction processes like:
Enlarged prostate
Urinary calculi
Neoplasms
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41
Q

Congenital causes of renal failure

A

Polycystic kidney disease
Multicystic kidney disease
Medullary cystic disease

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42
Q

Lab values associated with renal failure

A

Elevated BUN and creatinine
Proteinuria
Anemia
Uremia

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43
Q

cortical diseases that only affect the CORTEX include:

A 
Renal transplant rejection
Acute/chronic glomerulonephritis 
Acute lupus nephritis (and other forms)
Diabetic/hypertensive nephrosclerosis
Methemoglobinuric renal failure
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44
Q

Cortical disease has lab values of:

A 
Increased BUN and creatinine
Decreased serum calcium
Low urinary specific gravity
Proteinuria, RBC/WBC in urine 
Anemia
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45
Q

Parapelvic cysts are:

A

Fluid filled mass of lymphatic origin in renal sinus

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46
Q

Sono traits of parapelvic cysts

A 
Usually multiple
Usually bilateral
May be complex
Easy to mistake for hydronephrosis
Do not communicate with each other or the calices
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47
Q

MDKD stands for:

A

Multicystic dysplastic kidney disease

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48
Q

What is MDKD?

A

Developmental anomaly resulting in multiple renal cysts and fibrosis of kidney

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49
Q

What is the most common renal cystic disease in infants?

A

Multicystic dysplastic kidney disease

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50
Q

MDKD is more often bilateral.

T/F

A

False, unilateral occurs more often

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51
Q

Unilateral MDKD affects:

A

Males more often

Left kidney more often

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52
Q

Bilateral MDKD is more common in infants with:

A

Diabetic mothers

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53
Q

Bilateral MDKD is uniformly fatal.

T/F

A

True

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54
Q

IPKD is:

A

Infantile polycystic kidney disease

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55
Q

IPKD is AKA ARPKD which stands for:

A

Autosomal recessive polycystic kidney disease

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56
Q

IPKD is an:

A

Autosomal recessive inherited disorder characterized by abnormal proliferation and dilatation of renal tubules resulting in multiple tiny cysts bilaterally

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57
Q

IPKD is more frequent in:

A

Females (1:70)

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58
Q

ARPKD occurs more frequently than ADPKD.

T/F

A

False, less frequent

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59
Q

IPKD sonographically appears as:

A

Bilateral enlarged hyperechoic kidneys

60
Q

Why is IPKD typically fatal?

A

Due to fetal pulmonary hypoplasia and renal failure

61
Q

Adult polycystic kidney disease is AKA:

A

Autosomal dominant polycystic kidney disease (ADPKD)

62
Q

ADPKD is an inherited disorder with bilateral development of:

A

Parenchymal MACROcysts

63
Q

What is the third most common cause of chronic renal failure?

A

Adult polycystic kidney disease

64
Q

Symptoms for ADPKD typically present around what age?

65
Q

What are some associated findings with ADPKD?

A

Concomitant cysts in liver (80%)
Berry aneurysms if cerebral arteries
Aortic aneurysm

66
Q

Medullary cystic disease is a developmental disorder.

T/F

A

False, autosomal inherited disorder

67
Q

Dominant medullary cystic disease is:

A

Adult onset with rapid progression, uremia, and death within 2 years

68
Q

Recessive medullary cystic disease is:

A

Juvenile onset with uremia and death within 10 years

69
Q

Lab findings with medullary cystic disease

A

Sodium loss
Anemia
Azotemia
Increased BUN and creatinine in late stages

70
Q

Sono findings will medullary cystic disease

A

Bilateral
Increased echogenicity of pyramids
Thin cortex

71
Q

What is medullary sponge kidney?

A

Dysplastic microcystic dilation of medullary and papillary portions of collecting tubules

72
Q

Sono findings with medullary sponge kidney

A 
Unilateral in 25%
May affect single pyramid in 25%
Increased echogenicity of pyramids
Renal calculi
80% have medullary nephrocalcinosis
73
Q

Acquired cystic kidney disease is:

A

Development of multiple renal macrocysts in native kidneys of patients with chronic renal failure undergoing dialysis.
May affect transplant kidneys

74
Q

Acquired cystic kidney disease is usually unilateral.

T/F

A

False, bilateral

75
Q

Angiomyolipoma is AKA

A

Renal hamartoma

76
Q

What is angiomyolipoma composed of ?

A

Fat, blood vessel, and smooth muscle tissue

77
Q

Angiomyolipomas are benign.

T/F

78
Q

Lesions greater than ________ can cause flank pain, hematuria, and be prone to hemorrhage.

79
Q

Angiomyolipomas appear:

A

Hyperechoic, solid, round

Parenchymal or exophytic

80
Q

What is the most common cortical mass?

81
Q

Renal adenomas occur more frequently in:

A

Males (3:1)

Older than 30 (incidence increases with age)

82
Q

Sono findings of renal adenomas

A

75% solitary
Small, well defined, solid subcapsular cortical mass (3 cm or smaller)
Isoechoic/hypoechoic

83
Q

It is easy to differentiate renal adenomas from RCCs.

T/F

A

False, impossible

84
Q

What is the second most common benign solid tumor of the kidneys?

A

Oncocytoma

85
Q

What is an oncocytoma?

A

A well encapsulated epithelial cell tumor of proximal tubular cells

86
Q

Oncocytomas are more frequent in:

87
Q

Describe the Sono traits of an oncocytoma

A 
Homogeneous
Hypoechoic
Well defined
Solid
Size range .1 cm - 26 cm
88
Q

If oncocytoma is larger how will it appear?

A 
Has a central stellate scar
Central necrosis and hemorrhage 
Calcification
Loss of border distinction
Invasion of renal capsule and renal vein
89
Q

Mesoblastic nephromas are the benign counterpart to:

A

Wilms tumor

90
Q

What’s another name for a mesoblastic nephroma?

A

Fetal renal hamartoma

91
Q

A benign tumor of mesoderm tissue found in children is:

A

Mesoblastic nephroma

92
Q

What is the most common renal tumor of infants?

A

Fetal renal hamartoma

93
Q

Mesoblastic nephromas are more frequent in males and 90% occur in second year of life.
T/F

A

False, in first year of life

Peak incidence is 1-3 months

94
Q

Sono findings of fetal renal hamartomas

A 
Homogeneous
Hypoechoic
Solid
Parenchymal mass that Replaces 60-90% of kidney
Involves sinus
Grows through capsule
DOES NOT invade renal vein
95
Q

RCC is also referred to as:

A

Hypernephroma

96
Q

RCC consists of :

A

Tubular cells

97
Q

RCC accounts for 90% of primary malignancies in adults, has a peak incidence of 50-70 years of age, and more frequent in females.
T/F

A

False, more frequent in males

98
Q

What is the classic triad of clinical presentation for RCC?

A

Gross hematuria
Flank pain
Palpable renal mass

99
Q

Clear cell RCC occurs in:

A

7/10 cases

Most common

100
Q

Papillary RCC has the best prognosis of RCCs.

T/F

101
Q

Clear cell RCC arises from __________ tubules, where as papillary RCC arises from _________ tubules.

A

Proximal

Distal

102
Q

RCC can metastasize to:

A

Lungs, lymph nodes, liver, bone, adrenals, and contralateral kidney

103
Q

Ultrasound is the best imaging modality for RCC diagnosis.

T/F

A

False, MRI

104
Q

TCC is a primary malignant ___________ tumor originating in renal _______, ________, and _________.

A

Epithelial
Sinus
Ureters
Bladder

105
Q

What is the most common tumor of the collecting system lining?

106
Q

What is the peak incidence of TCC?

A

Males
Caucasians
Mean age is 68
In bladder (30-50x)

107
Q

Which modality is the best for staging with bladder presentation of TCC?

108
Q

Wilm’s tumor is AKA

A

Nephroblastoma

109
Q

Wilms tumor is a malignant pediatric tumor composed of:

A

Embryonal elements

110
Q

What is the most common malignant mass of the abdomen for kids 8 years and younger?

A

Wilms tumor

111
Q

Peak age of wilms tumor incidence

112
Q

33% of people with __________________ will have a wilms tumor.

A

Sporadic aniridia

113
Q

90% of the time, wilms tumor presents as:

A

An asymptomatic palpable mass

114
Q

Sono findings of wilms tumor

A

Large (avg size 12 cm)
Sharply marginated
Solid
Heterogeneous because of cystic, necrosis, hemorrhage, calcifications and fat

115
Q

Wilms tumor may metastasize to:

A

Lymph nodes
Renal vein, IVC, right atrium
Contralateral kidney
Liver

116
Q

What is a nephroblastoma easily confused with?

A

A neuroblastoma

117
Q

Common Mets to the kidney

A 
Bronchus
Breast
GI tract 
Contralateral RCC
Non-Hodgkin lymphoma
Neuroblastoma (in peds)
118
Q

Metastatic lesions occur 2-3 times less often than primary renal cancer.
T/F

A

False, more often

119
Q

Medullary nephrocalcinosis is calcium aggregates in the:

A

Distal convoluted tubules and loops of Henle

120
Q

95% of all nephrocalcinoses are:

121
Q

Hyperparathyroidism, hypercalcemia and hypercalcuria are indications of:

A

Medullary nephrocalcinosis

122
Q

Blunt force, penetrating trauma or rupture of a neoplasm can result in:

A

Rupture of kidney/capsule
Subcapsular hematoma
Parenchymal laceration
Urinoma

123
Q

Most bladder trauma is associated with:

A

A pelvic fracture

124
Q

Most renal traumas are minor injuries with:

A

No or small perinephric hematoma

125
Q

Minor injuries due to trauma

A

Renal contusion
Subcapsular hematoma
Intrarenal hematoma
Small subsegmental cortical infarct

126
Q

Major renal injuries

A

Cortical laceration
Cortical fracture
Shattered kidney
Vascular disruption

127
Q

Infarctions are __________ shaped defects.

128
Q

Necrosis of tissue due to occlusion of arterial blood supply is an:

A

Infarction

129
Q

Acute infarctions appear ___________. Chronic infarctions appear __________.

A

Hypoechoic

Hyperechoic

130
Q

Causes of RAS

A

60% atherosclerosis

35% fibromuscular dysplasia

131
Q

RAR greater than ________ indicates RAS

132
Q

PSV greater than _________ indicates RAS.

A

150 cm/sec

133
Q

RI of less than ______ is normal for cortical vessels.

134
Q

How do you find RAR?

A

PSV of Renal artery/PSV of aorta

135
Q

How do you find RI?

A

PSV - ED/ PSV

136
Q

Fibromuscular dysplasia strictures of the renal artery gives a _____________ appearance.

A

String of beads

137
Q

Cystitis is more frequent in:

138
Q

Nondistended bladder wall should measured less than:

139
Q

Distended bladder wall should measure less than:

140
Q

Majority of bladder stones are caused by:

A

Urinary stasis

141
Q

Dilation of collecting system above the obstructing mass occurs in the lower one third of ureter how often?

A

75% of time

142
Q

Which lab value is most sensitive and specific for renal dysfunction?

A

Serum creatinine

143
Q

Low level debris in dilated calyces is most likely:

A

Pyonephrosis

144
Q

Uremia may be found in patients with:

A

Renal insufficiency

145
Q

What artifact may help identify calculi?

A

Twinkle reverb

ABD Pathology (5 decks)

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