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Abdominal-Renal Vascular Review > Renal Vasculature Review > Flashcards

Renal Vasculature Review Flashcards

1
Q

What do most kidneys have?

A

A single main renal artery

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2
Q

Accessory renal arteries occur in about _____% of individuals.

A

30%

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3
Q

The main renal arteries branch off the:

A

aorta laterally just inferior to the SMA

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4
Q

The right renal artery is ________ and passes ________ to the IVC

A

longer; posterior

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5
Q

The main renal artery ________ into segmental branches just before entering the _____________. What are these 4 or 5 branches responsible for?

A

bifurcates; renal hilum

*supplying blood to a specific segment of the kidney

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6
Q

What do the segmental branches become?

A

The interlobar arteries as they pass through the junction b/n the cortex and the medulla

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7
Q

What do the interlobar arteries divide into?

A

Arcuate arteries farther into the cortex

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8
Q

What do the small veins in the renal cortex combine and drain into?

A

the interlobular veins

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9
Q

The interlobular veins join to form:

A

the main renal vein

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10
Q

The main renal vein leaves the renal hilum to travel ________ to join the ________.

A

cephaled; IVC

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11
Q

Is the right or left renal vein longer?

A

Left renal vein is longer

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12
Q

Where is the left renal vein located?

A

Anterior to the AO and posterior to the celiac

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13
Q

The angle of insonance should be adjusted to:

A

30-60 degrees as the exam progresses

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14
Q

The Doppler angle should be:

A

parallel with the walls of the vessel

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15
Q

You should examine the proximal segment of the main renal artery: (3 things to look for)

A
  • Examine w/ color looking for areas of increased velocity or turbulence
  • Spectal Doppler is recorded in the area of the highest peak systolic velocity
  • The main renal artery has a quick upstroke w/ a sharp systolic waveform and low impedance flow pattern
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16
Q

The segmental, interlobar and arcuate arteries all exhibit:

A

quick upstrokes in systole and a continuous low impedance flow pattern

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17
Q

The smaller vessels have a :

A

lower peak systolic velocities

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18
Q

The renal vein is examined with:

A

color and spectral Doppler for flow and direction of flow

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19
Q

The renal vein waveform is a low velocity monophasic flow that responds to:

A

respiratory variations and flows away from the renal hilum

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20
Q

What is the major cause of renal artery stenosis?

A

arteriosclerosis

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21
Q

2 methods are used to determine renal artery stenosis:

A
  • Directly by evaluating the main renal artery

* Indirectly by evaluating the arcuate and interlobar arteries

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22
Q

Direct method of renal artery stenosis: (3 characteristics)

A
  • Diagnosis relies on identifying a focal area of increased velocity by pulsed Doppler
  • color Doppler can facilitate locating areas of turbulent flow
  • > than 150-190 cm/s
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23
Q

What is RAR?

A
  • Direct Method–Renal Aorta Ratio
  • compares the peak systolic velocity (PSV) of the AO to the PSV of the main renal artery
  • If the renal artery PSV of the main artry is 3.5 times > than the AO, a diagnosis of 60% or greater stenosis is made
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24
Q

what is RI?

A

Resistive index:

peak systole-end diastole/peak systole

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25
Q

What is a normal RI?

A

0.70 is the upper limits of normal (except in pts under the age of 6 and older pts)

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26
Q

What does the indirect method for determining renal artery stenosis do?

A
  • evaluates for intrarenal arteries

* look at the wave form and evaluate the acceleration time and acceleratioin index

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27
Q

Indirect method–shows RAS when:

A

*the absence of ESP and prolonged systolic upstroke or acceleration time together with decreased peak systole and a dampening of the waveform

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28
Q

What is “tardus parus”?

A

Indirect method–describes the decreased acceleration time and the decreased peak

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29
Q

Renal Varients: (6 of these)

A
  • Dromedary hump
  • junctional parenchyma defect
  • fetal lobulation
  • duplex collecting system
  • extrarenal pelvis
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30
Q

Renal abnormalities are abnormalities in:

A

number, size, position, structure or form

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31
Q

What is renal agenesis?

A

Failure of one or both kidneys to form

  • -bilateral renal agenesis: neither kidney formed
  • -unilateral renal agenesis: results in a solitary kidney which may be larger than normal kidneys to compensate
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32
Q

What is renal dysgenesis?

A

defective embryonic formation

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33
Q

What is renal pseudotumor?

A

overgrowth of cortical tissue that indents the echogenic renal sinus. May be mistaken for a renal tumor

34
Q

What is supernumenary tumor?

A

complete duplication of the renal system

35
Q

When should you look for a pelvic kidney?

A

When the kidney isn’t seen in the normal position in the renal fossa.

36
Q

Where are most ectopic kidneys located?

A

In the bony pelvis

37
Q

Pelvic kidneys may be:

A

malrotated

38
Q

Pelvic kidneys may stimulate:

A

an adnexal mass and may be associated with other abnormalities

39
Q

Complications of pelvic kidneys: (3 things)

A
  • chronic pyelonephritis
  • hydronephrosis
  • stones
40
Q

What is a horseshoe kidney?

A

A fusion anomaly–fusion of the polar regions of the kidneys during fetal development–almost always the lower poles

41
Q

Horseshoe kidney is commonly associated with:

A

improper ascent and malrotation of the kidneys

42
Q

Horseshoe kidneys generally lie close to:

A

the spine

43
Q

What is a crossed-fuse kidney?

A

Both kidneys are located on the same side of the body

44
Q

With a crossed-fuse kidney, commonly the upper pole of the ectopic kidney is fused to the:

A

lower pole of the other kidney

45
Q

How may duplication of the ureters be complete?

A

with separate ureters draining the upper and lower collecting systems of the kidneys

46
Q

How do duplication of the ureters enter the bladder?

A

separately

47
Q

Duplication of the ureters may be:

A

unilateral or bilateral

48
Q

Duplication of the ureters are more common in:

A

females

49
Q

Incomplete duplication of the ureters occurs when:

A

the ureters join together and enter the bladder as one

50
Q

What is a utreterocele?

A

Cyst-like enlargement of the lower end of the ureter

51
Q

Ureterocele is caused by:

A

congenital or acquired stenosis of the distal end of the ureter

52
Q

Ureterocele may cause infection of the:

A

upper urinary system

53
Q

If a ureterocele is large they may cause:

A

bladder outlet obstruction

54
Q

Ureteroceles are found more often in:

A

adults than in children

55
Q

US can be used to evaluate residual bladder volume in pts with:

A

outflow obstruction

56
Q

How many planes is a post void bladder scanned in?

A

two

57
Q

Bladder formula:

A

(Length x width x height) x .523

58
Q

A residue of less than ________ cc of urine is considered normal in an adult

A

20 cc

59
Q

What is the bladder and where is it located?

A

thin walled reservoir, behind the pubic bone

60
Q

Normal bladder wall size:

A

<3mm distended

61
Q

The bladder can hold:

A

600-800 ml of fluid

62
Q

What is the top, bottom and middle of the bladder called?

A

apex=top
neck=bottom
trigone=middle

63
Q

What is acute cystitis?

A

inflammation of the urinary bladder

64
Q

Acute cystitis can be caused by: (7 things)

A 
catheterization
obstruction
bladder calculi
pregnancy
getting pregnant
sexual intercourse
poor hygiene
65
Q

Sonographic findings of acute cystitis:

A

thick urinary bladder, mucosa wall, smooth, continuous redundant and polypoid looking

66
Q

Sonographic findings of a ureterocele:

A

Obstructed ureter, wall of ureter will balloon into the urinary bladder
cyst-like enlargement lower end of ureter

67
Q

What is a papiloma?

A

Pre-malignant tumor to transitional cell carcinoma

68
Q

How big are papilomas?

A

.5-2cm

69
Q

Papilomas have the same appearance as

A

TCC

70
Q

Papilomas are located

A

lateral to bladder wall

71
Q

Transitional Cell Carcinoma–TCC is the:

A

most common bladder tumor

72
Q

Findings of TCC:

A

mass or focal thickening of wall

squamous cell–associated with infections, stones or strictures

73
Q

Patent uracus occurs:

A

early in life continuous with allantois

74
Q

Allantois progresses into urachus if:

A

lumen persists while urachus forms and a fistula develops

75
Q

Patent urachus causes:

A

urine to drain from bladder to umbilicus

76
Q

Urachal cysts develop if:

A

lumen persists

77
Q

Posterior urethral valve syndrome occurs in:

A

male fetuses only; presence of valve in posterior urethra

78
Q

Posterior urethral valve syndrome presents with: (3 things)

A

thickened urinary bladder wall (key hole sign)

  • hydronephrosis
  • hydroureter
79
Q

What is prune belly syndrome? What is it 2ndary to?

A
  • Dilation of the fetal abdomone

* 2ndary to severe bilateral hydronephrosis and fetal ascites, oligohydramnios

80
Q

What is a urinary bladder extrophy?

A

fetal anomaly in utero; defect in abdominal wall of the urinary bladder
*everted bladder becomes exposed on abdominal wall

Abdominal-Renal Vascular Review (1 decks)

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