Renals Flashcards
The paired kidneys are ________, lying against the deep muscles of the back. The right is slightly ______ in location compred to the left.
retroperitoneal
inferior
In relation to the right kidney: the adrenal gland is \_\_\_\_\_\_, liver is \_\_\_\_\_\_, right colic flexure is \_\_\_\_\_\_, and the 2nd portion of the duodenum is \_\_\_\_\_.
the adrenal gland is superomedial,
liver is superolateral,
right colic flexure is inferior, and the
2nd portion of the duodenum is medial
In relation to the left kidney:
the adrenal gland is _____,
the spleen is _____,
pancreatic tail is _______ to the upper pole, and the left colic flexure is _____
the adrenal gland is superior,
the spleen is superior,
pancreatic tail is anterior to the upper pole, and the left colic flexure is inferior
The diaphragm, psoas muscle ad QL muscle are on the ______ aspect of the kidneys.
posterior
Psoas - post/med to kidney
QL - immediately post to kidney
At the hilum of the kidney the vein exits ______, the _____ enters between the vein and ureter, and the ureter exits _______.
anteriorly
artery enters between vein and ureter
posteriorly
Describe the echogenicity of the renal cortex, medullary pyramids, renal sinus
renal cortex - isoechoic or hypoechoic
pyramids - anechoic
renal sinus - hyperechoic
Outer renal parenchyma from base of medullary pyramids to renal capsule.
Renal cortex
Normal thickeness of the renal cortex is > ____cm.
1cm
Inner portion of the kidney from the base of pyramids to center of kidney.
renal sinus
anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus.
Medullary pyramids
Structures commonly seen in enonatal and pediatric kidneys.
medullary pyramids
Funnel-shaped transition from the major calyces to the ureter
renal pelvis
Medial opeining for entry/exit of artery, vein, ureter
renal hilum
3 extension for the renal pelvis
Major calyces
Extensions of the major calyces that collects urine from the medullary pyramids.
Minor calyces
Apex of medullary pyramid.
renal papilla
Fibrous sheath enclosing kidney and adrenal glands. Also referred to as the perirenal space.
Gerota’s fascia
Functional unit of kidney consisting of the renal corpsucle, proximal convuluted tubule, descending and ascending limbs of Henle’s loop, distal convuluted tubule, and collecting tubles.
Nephron
What structures are contained within the nephron?
renal corpuscle prox. convulted tubule desced/ascend limbs of Henle's loop distal convoluted tubule collecting tubules
Consists of glomerulus and glomerular capsule (Bowman’s capsule)
renal corpuscle (malpighian body)
Renal corpuscle is aka?
malpighian body
Describe the arterial blood supply to the kidney
- MRA branches off the Ao and divides into 5 segmental arteries at the hilum,
- the segmentals divide into interlobar arteries between the medullary pyramids and travel perpendicular to the renal capsule
- At the base of the medullary pyramids, arcuate arteries branch from the interlobar in a manner that is parallel to the the renal capsule (difficult to obtain spectral bc perepndicular to beam)
- the interlobular arteries branch from the arcuate, running perpendicular to the renal capsule
Lists the renal arterial supply in order
MRA Segmental Interlobar Arcuate Interlobular
T/F - congenital anomalies of the genitourinary tract are more ocmmon than any other organ systems.
T
Complications associated with congenital abnormalities:
obtsruction/stasis leading to impaired renal function, infection, calculus formation
Emrbyologically, the kidneys originate in the _____ and _____ into the abdomen so that the upper pole of each kidney is more ____ than the lower pole.
plevis
ascend
medial
Ectopic kidney aka
pelvic kidney
Ectopic kidneys have an increased incidence for (3)
UPJ obstruction
ureteral reflux
multicystic renal dysplasia
Horseshoe kidneys are typically fused by the ______ poles across the ML and ______ to the Ao.
lower poles
anterior
The large U-shaped horseshoe kdiney lies lower in the abdomen because ascent is prevented by the _____ _______ _____.
inferior mesenteric artery
Where are the ureters on a horseshoe kidney typically located?
anterior to the isthmus, could be mistaken for lymphadenopathy
Horseshoe kidney is associated with (5)
kidney stones Infections Turner Syndrome Trisomy 13, 18, 21 Wilm's Tumor
Two kidneys are visualized on one side of the abdomen with absence of a contralateral kidney
Crossed fused renal ectopia
The developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carying the other one with it across ML.
Crossed fused renal ectopia
How are the ureters arranged in fused renal ectopic kidneys?
ureters connect on both sides of the bladder and one ureter crosses the ML
What are kidneys that fuse to form a round mass in the pelvis known as a discoid or pancake kidney?
fused pelvic kidney
Dromedary hump
common variant of cortical thickening on the lateral aspect of the left kidney
column of bertin (septal cortex)
Normal variation of prominent renal cortical parenchyma located between two medullary pyramids
-can give the appearance of a mass effect although the echogenicity is the same as the peripheral cortical tissue
junctional parenchyman defect
triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney
Junctional parenchymal defect is aka
fetal lobulation, which is partial fusion of the renunculi (embryonic kidney)
Duplex kidney
Complete or incomplete duplication of the collecting system
Complete duplex kidney
two ureters
incomplete duplex kidney
one ureter
Sonographic appearance of duplex kidney
typically longer
complete central coritical break within the hyperechoic sinus
A frequent complication of ectopic ureter is a ______.
ureterocele
Uretertocele
prolapse of the distal ureter into the bladder
Complications of a prolapsed ureterocele that resulted from an ectopic ureter
hydroureter and hydronephrosis of the upper collecting system of the kidney (Weigert-Meyer rule)
With complete duplex kidney, double ureters, where does the ureter draining the upper pole typically insert?
Typically inserts in an ectopic location on the bladder, and is susceptible to developing ureteroceles
What is associated with oligohydramnios and pulmonary hypoplasia and is it compatible with life?
Bilateral renal agenesis
No
what happens to the solitary kidney in unilateral renal agenisis?
compensatory hypertrophy in order to maintain normal renal function
Unilateral renal agenesis may be isolated congenital malformation or may be associated with chromosomal abnormalities or a variety of syndromes including ________ and _______.
VACTERL
MURCS
VACTERL Syndrome (6)
V - vertebral defects A - anal atresia C - cardiovascular anomalies TE - trachesophageal fistual R - renal anomalies L - limb defects
MURCS Syndrome (3)
MU - Mullerian agenesis
R - renal agenesis
CS - Cervicothoracic somite abnormalities
Unilateral renal agenesis is associated with genital anomalies related to what embryological origin in females and males?
Mullerian Duct derivative for females
-Uterus or Vagina could be abnormal or atretic
-bicornuate/unicornuate, ipsilateral blind vaginas and mullerian duplications
Wolffian Duct derivative in males
-abscence of the seminal vesicles and vas deferens and seminal vesicle cyst
Where is the renal pelvis normaly located?
within the renal sinus
Where is an extrarenal pelvis found?
lies outside the renal sinus
appears as a cystic collection medial to the renal hilum
POsterior uretheral valve is a common cause of ______ _______ in the male neonatal patient.
urinary obstruction
What causes the obstrcution in posterior uretheral valve?
due to a flap of mucosa that has a slit-like opening in the area of the prostatic urethra
What findings indicate posterior uretheral valve (4)?
large bladder
hydroureter
hydronephrosis
urinoma
SImple renal cysts occur in _____% of the people over the age of 50.
50%
Sonographic criteria for simple renal cysts
acoustic enhancement
absence of internal echoes
sharply defined wall
round or oval shape
Most renal cysts are simple ____ cysts that originate from obstructed _____ _______.
cortical cysts
uriniferous tubules
What are threee types of renal cysts?
pylogenic
parapelvic
peripelvic
pylogenic cysts
calyceal diverticula that sonographicaly appear as a simple cyst
parapelvic cysts
cortical cysts that bulge into the central sinus of the kidney
parenchymal cysts
peripelvic cysts
lymphatic cysts in the central sinus
T/F - sonographically the different types of renal cysts can be distinguished.
F - they cannot be distinguished, U/S determines the location - cortical/ parenchymal cysts in the periphery and periplevic cysts in the center/sinus
A renal ________ may mimic a simple cyst and is typically associated with a history of renal Bx or trauma.
pseudoaneurysm
put color on teh cyst-like structure is you know they’ve had surgery
How can a renal abscess be distinguished from a hemorrhagic renal cyst?
If no air then percutaneous aspiration
T/F - Cysts with a single thin septation, minimal wall calcification, internal echoes cuased by artifact or lobulated shaped may all be associated with simple benign cysts.
T - atypical renal cysts
When it comes to renal cysts, what characteristics are atypical and suggest malignant cystic lesion?
multiple or thick septation
thick calcifications
mural nodule/soild component
-reuires FNA
Bosniak Renal Cyst Classification
defines imaging characteristics that relate to increased chances of malignancy into 4 stages
ADPKD
autosomal dominant polycystic kidney disease
development of numerous cyst of varying sizes
ADPKD
ADPKD is associated with cysts in the _______, _______, and _______.
LIV, PANC, SPL
ADPKD results in bilateral renal ________.
enlargement
At what age is ADPKD or multiple renal cysts identified?
20-30 years
Detsruction of the residual renal tissue ADPKD in advanced stages leads to renal ______ and ______.
renal failure and HTN
T/F - ADPKD is associated with arterial aneurysms?
T
What type of arterial aneurysms is associated with ADPKD?
cerebral arterial (Berry) aneurysms of the circle of Willis
Autosomal Recessive POlycystic Kidney Disease
cystic dilation of the collecting tubules secondary to hyperplasia of the interstitial portions of the ducts resulting in multiple small cysts throughout kidney sonographically
Sonographic findings of ARPKD
enlarged kidneys bilaterally
hyperechoic parenchyma
loss of cortical medullary distinction
ARPKD is associated with (3)
pulmonary hypoplasia (from oligo)
hepatic periportal fibrosis
portal HTN
Can ARPKD be detected in uetero?
Yes, assoc with oligo
POtter Syndrome
typical physical appearance of a neonate as a direct result of olig and compression while in utero
Causes of Potter Syndrome (6)
ARPKD
Auotosomal Dominant POlycystic Kidney diesease
Most common cause of an abdominal mass in newborns?
MCDK (multicystic dysplastic kidney)
A form of renal dysplagia characterized by multiple noncommunicating cysts with the absence of renal parenchyma.
multicystic dysplastic kidney
MCDK result from what?
atresia of the uteropelvic junction during fetal development
Is MCDK unilateral or bilateral?
can be both but typically unilateral
-the contralateral kidney is usually normal, but up to 10% may have UPJ obstruction
What syndromes is MCDK related to (3)
Beckwith-Wiedemann syndrome
Trisomy 18
VACTERL
T/F - many urinary and non-renal malfomations are associated with MCDK
T
Describe the progression of MCDK
may persist w/o change
may increase in size
may spontaneously involute and disappear
Congenital causes of UPJ obstruction
ureteral hypoplasia
high insertion of the ureter into renal pelvis
compression by segmental artery
Anomalies associated with UPJ obstruction
MCDK renal agenesis (contralteral) duplicated collecting system horseshoe kidney ectopoic kidney
Sonographic evidence of Medullary sponge kidney
hyperechoic medullary pyramids
In medullary sponge kidney, what causes the congenital dysplastic cystic dilatation of the medullary pyramids?
tubular ectasia or dysplasia, ectataic collecting tubules
then urinary stasis and calcium deposits form in the dilated tubules
Long-term hemodialysis can affect the kidneys how?
acquired cystic disease, development of multiple cysts in chronically failed kidneys
Renal dialysis patients who develop acquired cystic disease are at risk for what?
hemorrhage often occurs in the acquired cysts, resulting in pain and hematuria
also predisposed to RCC
Inherited disease which usually presents in the 2nd or 3rd decade of life with serous visual impairement due to the development of cysts throughout the body
Von Hippel-Lindau Disease
VHLD is characterizied by retinal and central nervous system ___________.
hemangioblastomas
VHLD includes what other related tumors in the abdomen (4)
RCC (clear cell?
pheochromocytomas
iselt cell tumors (neuroendocrine?
renal and pancreatic cysts
If suscicion for VHLD, imaging should focus on what 3 organs?
kidneys, adrenal glands, pancreas
80% of AMLs involve the _____ kidney
right
hyperechoic benign renal mass with echogenicity greater than or equal to the of the renal sinus
angiomyolipoma
what kind of artifact is associated with AMLs
propagation speed, reuslting in posterior displacement of structures due to slower acoustic velocity in the fatty mass
Multi-system genetic disease that prsents classically with seizures,mental retardation and facial angiofibromas
tuberous sclerosis
Patients with tuberous sclerosis have an increased risk for _____ _____ and __________, and _____ _____ _____
renal cysts
angiomylipomas (usually bilateral)
renal cell carcinoma
Most common soild renal mass in adults.
renal cell carcinoma
What 4 conditions predispose patients to developing RCC?
acquired cystic disease from chronic dialysis
von Hippel-Lindau Disease
tuberous sclerosis
ADPKD
RCC is typically a unilateral encapsulated mass that is _____ relative to the normal adjacent parenchyma. Patients commonly presnet with _________.
hypoechoic
hematuria
-males may have varicoceles due to occclusion of the testicular (gonadal vein)
Most common site for mets from RCC
lungs
T/F - RCC tumor extension into the renal veins and IVC is common
T
Renal oncocytoma is difficult to distinguish from _____ ______ _____.
renal cell carcinoma - epidemiology, presentation, imaging and even histology can be similar
Renal oncocytomas are relatively benign tumors and patients are usually ______.
asymptomatic, found incidentially
Sonographic appearance of renal METS from lung, breast, colon, etc
hypoechoic masses in the renal parenchyma or diffusely enlarged inhomogeneous kidney
Malignant cells from _____ and ____ can metastasize to the kidney.
leukemia, lymphoma
Most common childhood renal tumor?
Wilm’s Tumor (nephroblastoma)
When do Wilm’s tumors usually present?
3.5 years
What do patients with Wilm’s Tumor usually present with?
asymptomatic flank mass
HTN
fever
hematuria
METS from Wilm’s tumor can be seen to the ____, _____, ______, _____ _____, and ____________.
lungs liver bone lymph nodes retroperitoneum
What important DDx must be rulled out before diagnosis Wilm’s tumor?
Wilm’s tumor must be differentiated from adrenal neuroblastomas…. Wilm’s will destroy the renal contour where as an adrenal neuroblastoma usually doesnt disrupt the renal contour
Most common renal tumor in neonates and infants
mesoblastic nephroma3% of PED renal tumors
Can mesoblastic nephroma be diagnosed prenatally?
Yes, poly in 71% of cases
It is diffiuct to distinguish mesoblastic nephorma from ______ ______.
Wilm’s tumor
T/F mesoblastic nephroma is benign
F - initially thought to be benign but more of a spectrum exists with the classic type as benign and the cellular variant being aggressive
pyelonephritis
bacterial invasion of the renal parenchyma
T/F - most renal infections occur as a result of ascending infection from the bladder
T - they are usually caused by gram-negative bacilli from the intestional tract
Acute pyelonephritis ultrasound findings include (3)
renla enlargement
hypoechoic parenchyma
absence of sinus echoes, loss of cortical/medullary boundary
What acute pyelonephritis appears as a wedge-shaped area or a hypoechoic renal lobe it is referred to as what?
acute focal baterial nephrits or lobar nephronia
a similar appearance can be seen in focal ischemia ad renal infarction
bacterial infection that is associated with renal ischemia and usually requires a nephrectomy.
Emphysematous pyelonephritis
What kind of patients are associated with emphysematous pyelonephritis?
87-97% diabetics
immunosuppressed
those with UTIs
Emphysematous pyelonephritis results from _____ bacteria that produce intrarenal gas, which casues ______ and ______ artifacts.
anerobic
reverberation and comet-tail
Recurrent renal infection that casues renal injury and end-stage renal disease is known as
chronic pyelonephritis
Chronic pyelonephritis infection reuslts from _3)
anatomic anomalies
obstructive lesions
ureteral reflux
sonographic appearance of chronic pyelonephritis
small hyperechoic kidney with cortical thinning (parenchyma)
Staghorn calculus is associated with what type of chronic pyelonephritis resulting from chronic infections from long-term obstruction?
XGPN - xanthogranulomatous pyelonephritis
associated fidnings with XGPN (8)
renal enlargement parenchymal abscesses staghorn calc papillary necrosis hydronephrosis pyonephrosis loss of cortical-medullary boundary cortical thinning
Infection secondary to renal obstruction that presents with dilated renal collecting systems, hyperechoic purulent debris material in the collection system of the kidney
pyonephrosis
T/F - percutaneous or surgical drainage is required for treatment of pyonephrosis
T
Common fungal infections of the urinary trcat that appear as hyperechoic nonshadowing masses
mycetoma (fungal ball)
Where do fungal infections tend to occur in the kidney?
In the drainage structures vs the parenchyma
ex: PT with systemic candidiasis are vulnerbale to the formation of cortical abscesses or obstructive intrarenal masses (fungal balls) usually at the renal pelvis
Hyperechoic masses
mycetoma AML blood clots pyogenic debris sloughed papilla renal stones
Rapid decrease in renal function characterized by low urine output or increased serum BUN or creatinine
acute kidney injury or acute renal failure
What are the 3 main mechanisims for AKI?
Prerenal failure - inadequat perfusion
Intrinsic Renal failure - pathology within kidney
Postrenal failur - obstructive nephropathy
Prerenal failure is charcterized by inadequate perfusion due to (3)
hypotension (low BP)
volume depletion
decreased cardiac output
Intrinsic renal failure results from pathology within the kidney from things such as (3)
acute tubular necrosis
acute glomerulonephritis
nephrotoxins
Postrenal failure result from obstructive nephropathy from (3)
obstructive tubules with precipitates
bilat ureteral obstrcution
bladder outlet obstruction
In tha case of AKI, ultrasound is used to identify _______ and abnormal _____ ______.
hydronephrosis = postrenal failure
abnormal RI = suggests intrinsic
Common causes of renal vein thrombosis (6)
nephrotic syndrome hypercoagulabilty disorders malignant renal tumors extrinisc compression trauma transplant rejection
Sonographic fidnings suggestive of renal vein thrombosis (4)
dilated thrombosed RV
absent intrarenal venous flow
enlarged hypoechoic kdiney
high-RI RA
Renal arery thrombosis is a sudden cause of _______ failure that presnts with (3)
prerenal
acute flank pain
hematuria
sudden rise in BP
Sonoraphic fidninsg associated with renal artery thrombosis (3)
focal hypoechoic areas of infarct
absence of intrarenal arterial flow
renal enlargement
Songraphic fidnings associated with ATN
renal enlargement
increased RI
_____ ______ ______ is the most common casue of AKI (medical renal disease/intrinsic renal failure)
acute tubular necrosis
ATN likely occurs in patients with history of recent _____, _____, or ______.
surgery
sepsis
hypovolemia (dec blood volume circulating)
What does ATN result from?
prolonged ischemia or nephrotixins (drugs and contrast agents), which casues damage to the tubular epithelium of the nephron and acute renal failure
T/F - the renal insufficiency that occurs in ATN can be reversible.
T
______ _____ is an inflammatpry response resulting in glomerular damage caused by infectious and noninfectious casues.
Acute glomerulonephritis (GN)
Clinical presentation of acute GN
sudden onset of hematuria, proteinuria, RBC casts in the urine
-often accmpanied by HTN, edema, azotemia (dec GFR), renal salt/water retention
MOst common infectious casue of acute GN?
infection by stretococcus species due to upper respiratory and skin infections
Sonographic fidninsg associated with acute GN?
renal enlargement
increased RI
Adult hydronephrosis
dilatation of the renal pelvis and calyces from an anechoic urine collection
Hydro secondary to obstruction can lead to what if left untreated?
HTN
loss of renal function
sepsis
Common casues of adult hydro (6)
calculi benign prostatic hypertrophy prostate ca pelvic malignancies pregnancy UPJ obstruction
What are three common areas of obstruction by a stone causing adult hydro
UVJ*
UPJ
Pelvic brim
How else can can obstrcutive nephropathy be diagnosed?
By evalulating intrarenal vascularity]RI > 0.7 = suggests obstructive hydro
Newborn/Prenatal hydro can occur for a variety of reasons, the most common include: (3)
vesicoureteral reflux
non-obstructive hydro
UPJ obstruction
T/F - renal pelvic dilatation in PEDS can be transient, most pateints with moderate hydro will resolve by 18 months of age.
T
An increased risk of congenital anomalies of the kidney and urinary tract are assoicated with the presence of ____ ___ abnormalities and ____ ____ _____.
outer ear
single umbilical artery
spinal and/or LE abnormalities may be assoicated with a _______ _____, which is assocaited with ______ and _____ ______.
neurgenic bladder
hydro
dilated ureters
What does billateral hydro suggest in a PEDS pateint?
an obstructive process at the level or diatls to the bladder (ureterocele or posterior uretheral valves in male infants)
What is the graded severity for hydro postnatally, performed after 48hrs of life in a full-term infant.
NML <7mm
Mild 7-8mm
Mod 9-15mm
Severe >15mm (at greastes risk for renal diz and surgery)
What is the most common casue of pediatric hydro?
UPJ obstruction
occurring more in males on the left kidney
What qualifies as a megaureter?
Diameter >7mm
How is megaurter classified?
according to the presence or absence of reflux and obstruction
What is obstrcutive primay megaureter?
- distal adynamic segment with proximal dilatation, -ureter tapers to a short segment of narrowed distal ureter, usally just above the VUJ (vesicoureteric junction)
- assoicated hydro and active peristaltic waves seen
- bilateral involvement in 20% of patients
- male:female 4:1, left side more than right
What casues secondary megaureter?
abormalities that involve the bladder or urethra such as: neurgenic bladder, prune belly syndrome, posteriro urethral valves
Nephrocalcinosis related to hyperparathyroidism is aka
Albright’s calcinosis
Anderson-Carr Kidneys
Nephrocalcinosis
deposition of microscopic crystaline calcium precipitates
renal stones in the collecting system
Nephrolithiasis
- presents with acute flank.back pain radiating down ipsilateral groin
- if severe, fever, chills, dysuria (discomfort with urination), cloudy urine,hematuria
What is the single most common cause of nephrocalcinosis in adults?
primary hyperparathyroidism
caclium deposits in the renal pyramis (papillae)
Anderson-Carr-Randall
Sonographic presentation of papillary nephrocalcinosis
- echogenic material in collecting system (sloughed papillae)
- triangular cystsic collection representing the absence of medullary pyramids
- bright echoes produced by arcuate arteries at the base of pyramids
What is papillary necrosis?
necrosis of the meduallary pyramids and papillae brought on by several conditions and toxins leading to ischemia of the pyramids
How is the clincial diagnoses of paillary necrosis achieved?
identifying sloughed papillae in the urine
-passage can casue pain and urinary tract obstrcution
What conditions are associated with papillary necrosis?
DM
analgesic abuse
sickle-cell disease
______ _____ was orginally described with the overuse of analegesics containing phenacetin, but also NSAID.
analgesic nephropathy
Increase renal sinus fat that replaces normal renal parenchyma, causes compression of teh calyces and renal pelvis.
renal sinus lipomatosis
Sono findings of renal sinus lipomatosis
increase in central sinus echo complex with cortical thinning
Bladder is located behind the ____ ____. The apex points ________ and is connected to the umbilicus by the ______ ______ ________ (urachus).
pubic bone
anteriorly
median umbilical ligament
The ureters enter the bladder at the _______ angle of the trigone and ext the bladder via the _____.
supeolateral
urethra
What is the normal wall thickness in a distended and nondistended bladder?
<3mm distended
<5mm nondistended
What are bladder diverticula?
herniations of the bladder mucosa through the bladder wall musculatur
Most acquired bladder diverticula are associated with longstanding bladder ____ ______ due to benign _____ _______.
outlet obstruction
prostatic hypertrophyr
______ _____ is a cystic dilatation of the fetal urachus. Seen sonographically as a cystic structure superior and anterior to the bladder
Urachal cyst
The ureters exit the kidney _____ to the RA and RV. Descending inferiorly, the ureters lie on the _____ surface of the psoas. In the pelvis, the ureters cross ______ to the common iliac vessels to insert upon the ______ of the bladder.
posterior
anterior
anterior
trigone
Cyst-liek enlargement of the lower end of the ureter which projects into teh bladder lumen at the UVJ.
ureteroceles
Ureteroceles are most commonly found in association with what?
compelete ureteral duplication from duplex kidney, ectopic insertion into the bladder
Most common bladder neoplasm
TCC (trasnitional Cell Carcinoma)
-urinary tract is lined with trasitional cells, so can occur in the ureters or renal pelvis but more commonly the bladder
Sonographc finding of TCC
solid mass or focal thickening of bladder wall
-hydro may be caused by TCC originating in the ureter
Most common clinical finding of TCC
hematuria
In addition to TCC, what other bladder masses are there (6)
cystitis prostate ca squamous cell ca blood clots pyogenic debris bladder papilloma
Renal dysfunction, caused by a variety of reasons, results in loss of diastolic flow and increased renal arterial resistance. RA normally demosntrated continuous forward flow during diastole (low resistance). What is the equation for RI?
RI = peak systolic freq - end diastolic freq/peak systolic freq
Normal RI
<0.7
- 5 = diastole is 50% of systole
- 7 = diastole is 30% of systole
- 0 = diastole is absent
Symtoms of renal artery stenosis
sudden onset of HTN
uncontrollable HTN
A hemodynamically significant renal artery stenosis may produce decreased renal size ____
<9cm in length
Direct eval for RA stenosis
renal artery velocities
RA/Ao ration (RAR) >3.5 = suggests at least a 65% stenosis
Indirect eval for RA stenosis
intrarenal waveforms parvus tardus (small slow pulse) mole hill appearance absent early systolic peak
Most common casue of renal disease (ESRD) leading to kideny trasnplantation.
diabetes
Why is the left kidney preferred for harvesting?
because the renal vein is longer
In the immediate posttransplant period, poor function may be the result of _____ _____ ____.
acute tubular necrosis
Post-tx complications
fluid collections -hematomas, 24 hrs -urinomas, 24 hrs -lymphoceles -abscesses RA kinking or thrombosis RV thrombosis
The Tx ureter is attache dto the ____. The arterial anastomoses may be with the ______ or _______ ____ ____.
bladder
EIA or IIA
Sonographic findings of acute Tx rejection:
renal enlargement
dec echogenicity
loss of cortical medullary boundary
inc flow resistance index
Describe the breakdow ofRIs to evaluate the arterial flow resistance in the renal vascualr bed of a Tx
<0.7 = NML
0.7 - 0.8 = quetsionnable Tx dysfunction
>0.8 = Tx dysfunction
Urinalysis
microscopic examination of sediment and qualitative evaluation of the following in urine: specific gravity acidity protein glucose ketones blood nitrates WBCs bilirubin
waste/break-down product of skeletal muscle that is filtered out of the blood by the kidneys
serum creatinine - thresholdsmay vary 1.2 to 2.0 depending on the amount of skeletal muscle
determines stages of kideny disease, calculated by determing creatinine clearance
glomerular filtration rate
_____ is produced by the liver and is a waste product of protein metabolism.
Urea/blood urea nitrogen
BUN is unsuitable as a single measure of renal function because it varies with urine flow rates and production of urea
