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Vascular Sonography > Renal Vasculature > Flashcards

Renal Vasculature Flashcards

1
Q

What are the triangular-shaped structures within the inner portion of the kidney that carry urine from the cortex to the renal pelvis?

A

Renal pyramids

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2
Q

The RRA courses (blank) from the Ao, then passes (blank) to the IVC?

A

Anterolateral; posterior

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3
Q

What vessel courses anterior to the Ao, posterior to the SMA, and anterior to both renal arteries?

A) Splenic vein
B) RRV
C) LRV
D) IMV

A

C

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4
Q

What renal artery segments does atherosclerotic disease typically occur?

A

Origin to proximal third

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5
Q

At what level is spectral doppler with PSV needed from the aorta for use in the renal-aortic ratio?

A

Proximal - at level of celiac axis and SMA

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6
Q

When comparing renal length from side to side, how much of a difference suggests compromised flow in the smaller kidney?

A

3 cm

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7
Q

Using what angle of insonation are flow patterns within the kidney parenchyma typically obtained with a spectral doppler?

A

0 degrees

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8
Q

What is the normal spectral Doppler waveform in the renal artery?

A

Low resistance, high diastolic flow with velocities in the range of 90-120 cm/s

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9
Q

What will NOT occur on spectral doppler distal to significant stenosis or renal artery?

A

Increased peak systolic velocity

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10
Q

What is measured to determine acceleration time?

A

Onset of systole to the early systolic peak/initial compliance peak

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11
Q

During renal evaluation, the LRV near the hilum of the kidney has continuous, non-phasic low-flow velocity. What might this suggest?

A

Proximal renal vein thrombosis

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12
Q

Patients with sudden onset of chronic hypertension, azotemia, unexplained renal insufficiency, or pulmonary edema should be evaluated for what?

A

Renal artery stenosis

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13
Q

The renal arteries lie below what plane?

A

Transpyloric

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14
Q

The left renal vein courses posterior or anterior to the Ao?

A

Anterior

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15
Q

When kidney parenchymal disease is present, what will happen to the resistance and diastolic flow?

A

Increased resistance; decreased diastolic flow

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16
Q

Diagnostic criteria for identifying renal artery stenosis are based on the ratio between what structures? What must the ratio be to diagnose disease?

A

Renal-aortic ratio. Must be greater than 3.5 to diagnose.

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17
Q

What typically occurs to the velocity in a stented renal artery?

A

Increases

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18
Q

What is the most common cause of renal artery stenosis in a pediatric patient?

A

FMD

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19
Q

For renal artery stenosis, what are the PSV and percent of stenosis correlations?

A
  1. PSV >180cm/s with distal turbulence correlates with a >60% stenosis
  2. PSV >180cm/s without distal turbulence correlates with a <60% stenosis
  3. Renal-aortic ratio (RAR) greater than 3.5 correlates with a >60% stenosis
  4. Acceleration index at renal hilum <3.78 or acceleration time >100ms is consistent with stenosis.
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20
Q

Intrinsic renal parenchymal disease is characterized by what parameters?

A
  1. Increased resistance
  2. RI greater than 0.8
  3. Diastolic to systolic ratio less than 0.3
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21
Q

Does the RRA course anterior or posterior to the IVC?

A

Posterior

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22
Q

FMD typically causes stenosis in what segments of the renal artery?

A

Mid-distal

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23
Q

What is the classic appearance of FMD in the renal artery?

A

“String of pearls”

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24
Q

What pathology is being observed with the renal-aortic ratio?

A

Renal artery stenosis - greater than 3.5 indicates stenosis

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25
Q

Renal artery stenosis is typically caused by what two things?

A
  1. Atherosclerosis
  2. FMD
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26
Q

What is the term for the opening of the renal artery from the aortic wall?

A

Renal ostium

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27
Q

What most common cause of secondary hypertension, chronic renal insufficiency, and incident end-stage renal disease?

A

Renal artery stenosis

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28
Q

Presentation of renal artery stenosis?

A
  1. Sudden onset of hypertension
  2. Azotemia
29
Q

Which kidney is more inferior?

A

Right

30
Q

What is the normal renal length?

A

9-13cm

31
Q

Between which vertebrae are the kidneys seen?

A

T12-L3

32
Q

What is the most common anomaly of the kidney?

A

Horseshoe kidney - isthmus lies anterior to the Ao

33
Q

In the case of horseshoe kidney, the renal arteries may be supplies by what 3 other arteries?

A
  1. Distal Ao
  2. IMA
  3. Iliac arteries
34
Q

Where do the renal arteries lie in relation to the renal veins?

A

Renal arteries are posterior to the veins

35
Q

What is the most common congenital anomaly of the kidney?

A

Duplicated collecting system

36
Q

What is the pathway of flow through the kidney beginning at the Ao?

A

Ao -> RA -> Interlobar A -> Arcuate A -> Interlobular A -> Afferent arteriole -> Efferent arteriole -> Capillaries -> Interlobular V -> Arcuate V -> Interlobar V -> RV -> IVC

37
Q

Atherosclerotic lesions of the renal arteries typically affect what segments?

A

Ostium to the proximal third

38
Q

Is renal artery stenosis more common in men or women?

A

Men

39
Q

What is the second most common cause of renovascular disease?

A

FMD

40
Q

What segments does FMD usually affect in the renal arteries?

A

Mid-distal - more common in women - more often on RT side

41
Q

What appearance is seen with RA FMD?

A

String of beads

42
Q

What segments of the renal arteries can be examined when patient is supine vs when patient is RLD or LLD?

A

Supine - prox to mid segments

RLD or LLD - mis to distal segments and kidneys

43
Q

Spectral waveforms are recorded from the abdominal aorta at the level of what?

A

Celiac trunk and SMA

44
Q

Where do the renal arteries lie in relation the LRV?

A

Immediately inferior

45
Q

What is the normal doppler signal in RA an Ao?

A

RA - low resistance with high end-diastolic flow

Ao - high resistance with low end-diastolic flow

46
Q

Comparing kidneys side to side, a difference in how many cm suggests compromised flow on the side with the smaller kidney?

A

1cm

47
Q

What is the PSV range of the Ao?

A

60-100 cm/s

48
Q

What does the ESP (early systolic peak) represent in the renal artery waveform?

A

Elasticity of the arterial wall - as disease progresses, we lose that ESP

49
Q

What is the normal doppler waveform seen in the renal veins?

A
  1. spontaneous
  2. phasic
  3. flow towards IVC
  4. Velocity: b/w 15- 30 m/s
50
Q

Post-stenotic turbulence will NOT be seen in a stenosis less than what percent?

A

60%

51
Q

What happens to the renal artery waveform if there is a stenosis >80%?

A
  1. Loss of sharp systolic peak/delayed upstroke
  2. PSV will decrease DISTALLY - tardus parvus waveform
52
Q

What will doppler waveforms demonstrate with a renal artery occlusion?

A

Absence of flow in the main renal artery

53
Q

What is the PSV and renal length seen with chronic RA occlusion?

A

PSV <10cm/s
length <9cm

54
Q

What is intrinsic parenchymal destruction also called?

A

Medical renal disease

55
Q

In the case of medical renal disease, what will be seen on doppler waveform within the RA?

A

High resistance and low end-diastolic flow

56
Q

How to calculate resistive index?

A

(PSV - EDV)/PSV

57
Q

What RI indicates medical renal disease?

A

Greater than 0.8

58
Q

Calculate the RI when the PSV = 250cm/s and EDV = 67cm/s

A

0.73

59
Q

Doppler reveals a PSV of 300cm/s and a EDV of 120cm/s. Does this patient have medical renal disease?

  1. Calculate the RI
  2. Does this patient have medical renal disease?
A
  1. Calculate RI: 0.6
  2. Does this RI indicate disease? NO, it is below 0.8
60
Q

How do we evaluate indirect renal hilum?

A

Acceleration index (AI) and acceleration time (AT)

61
Q

Is AI or AT more accurate?

A

AT

62
Q

How do we calculate AI and AT?

A

AI - Slope of systolic upstroke/transmitted frequency
AI of 291cm/s squared or less = stenosis

AT - Calipers placed at onset of systole and early systolic peak
AT greater than 100ms suggests proximal renal artery disease

63
Q

When should the renal-aortic ratio (RAR) NOT be used?

A

When AO PSV exceeds 100 cm/s or is less than 40 cm/s

64
Q

If a patient has increased cardiac output, will a possible stenosis be over or underestimated?

A

UNDER

65
Q

If a patient has decreased cardio output, will a possible stenosis be over or underestimated?

A

OVER

66
Q

What may be seen with a re-stenosis of a renal artery stent?

A
  1. high-velocity, post-stenotic turbulence, and dampening of the distal waveform
  2. PSV threshold value of >240 cm/s
  3. stent–aortic ratio of 3.2 or greater
67
Q

What is the typical length of a pediatric kidney?

A

4-6cm

68
Q

In renal vein thrombosis, what will be seen in the doppler waveform proximally and distally?

A

Proximal to thrombosed venous segment: Continuous, non-phasic, low-velocity flow

Distal to thrombosed segment: no flow or minimal, phasic flow if venous collaterals have developed

69
Q

What will be seen on doppler with renal arteries in the case of renal vein thrombus?

A

Retrograde, blunted diastolic flow components throughout the renal parenchyma

Vascular Sonography (17 decks)

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