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ABD > Renals > Flashcards

Renals Flashcards

1
Q

The paired kidneys are ________, lying against the deep muscles of the back. The right is slightly ______ in location compred to the left.

A

retroperitoneal

inferior

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2
Q 
In relation to the right kidney:
the adrenal gland is \_\_\_\_\_\_,
liver is \_\_\_\_\_\_,
right colic flexure is \_\_\_\_\_\_, and the
2nd portion of the duodenum is \_\_\_\_\_.
A

the adrenal gland is superomedial,
liver is superolateral,
right colic flexure is inferior, and the
2nd portion of the duodenum is medial

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3
Q

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 _____

A

the adrenal gland is superior,
the spleen is superior,
pancreatic tail is anterior to the upper pole, and the left colic flexure is inferior

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4
Q

The diaphragm, psoas muscle ad QL muscle are on the ______ aspect of the kidneys.

A

posterior
Psoas - post/med to kidney
QL - immediately post to kidney

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5
Q

At the hilum of the kidney the vein exits ______, the _____ enters between the vein and ureter, and the ureter exits _______.

A

anteriorly
artery enters between vein and ureter
posteriorly

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6
Q

Describe the echogenicity of the renal cortex, medullary pyramids, renal sinus

A

renal cortex - isoechoic or hypoechoic
pyramids - anechoic
renal sinus - hyperechoic

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7
Q

Outer renal parenchyma from base of medullary pyramids to renal capsule.

A

Renal cortex

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8
Q

Normal thickeness of the renal cortex is > ____cm.

A

1cm

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9
Q

Inner portion of the kidney from the base of pyramids to center of kidney.

A

renal sinus

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10
Q

anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus.

A

Medullary pyramids

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11
Q

Structures commonly seen in enonatal and pediatric kidneys.

A

medullary pyramids

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12
Q

Funnel-shaped transition from the major calyces to the ureter

A

renal pelvis

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13
Q

Medial opeining for entry/exit of artery, vein, ureter

A

renal hilum

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14
Q

3 extension for the renal pelvis

A

Major calyces

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15
Q

Extensions of the major calyces that collects urine from the medullary pyramids.

A

Minor calyces

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16
Q

Apex of medullary pyramid.

A

renal papilla

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17
Q

Fibrous sheath enclosing kidney and adrenal glands. Also referred to as the perirenal space.

A

Gerota’s fascia

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18
Q

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.

A

Nephron

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19
Q

What structures are contained within the nephron?

A 
renal corpuscle
prox. convulted tubule
desced/ascend limbs of Henle's loop
distal convoluted tubule
collecting tubules
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20
Q

Consists of glomerulus and glomerular capsule (Bowman’s capsule)

A

renal corpuscle (malpighian body)

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21
Q

Renal corpuscle is aka?

A

malpighian body

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22
Q

Describe the arterial blood supply to the kidney

A
  • 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
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23
Q

Lists the renal arterial supply in order

A 
MRA
Segmental
Interlobar
Arcuate
Interlobular
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24
Q

T/F - congenital anomalies of the genitourinary tract are more ocmmon than any other organ systems.

A

T

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25
Q

Complications associated with congenital abnormalities:

A

obtsruction/stasis leading to impaired renal function, infection, calculus formation

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26
Q

Emrbyologically, the kidneys originate in the _____ and _____ into the abdomen so that the upper pole of each kidney is more ____ than the lower pole.

A

plevis
ascend
medial

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27
Q

Ectopic kidney aka

A

pelvic kidney

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28
Q

Ectopic kidneys have an increased incidence for (3)

A

UPJ obstruction
ureteral reflux
multicystic renal dysplasia

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29
Q

Horseshoe kidneys are typically fused by the ______ poles across the ML and ______ to the Ao.

A

lower poles

anterior

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30
Q

The large U-shaped horseshoe kdiney lies lower in the abdomen because ascent is prevented by the _____ _______ _____.

A

inferior mesenteric artery

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31
Q

Where are the ureters on a horseshoe kidney typically located?

A

anterior to the isthmus, could be mistaken for lymphadenopathy

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32
Q

Horseshoe kidney is associated with (5)

A 
kidney stones
Infections
Turner Syndrome
Trisomy 13, 18, 21
Wilm's Tumor
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33
Q

Two kidneys are visualized on one side of the abdomen with absence of a contralateral kidney

A

Crossed fused renal ectopia

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34
Q

The developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carying the other one with it across ML.

A

Crossed fused renal ectopia

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35
Q

How are the ureters arranged in fused renal ectopic kidneys?

A

ureters connect on both sides of the bladder and one ureter crosses the ML

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36
Q

What are kidneys that fuse to form a round mass in the pelvis known as a discoid or pancake kidney?

A

fused pelvic kidney

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37
Q

Dromedary hump

A

common variant of cortical thickening on the lateral aspect of the left kidney

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38
Q

column of bertin (septal cortex)

A

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

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39
Q

junctional parenchyman defect

A

triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney

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40
Q

Junctional parenchymal defect is aka

A

fetal lobulation, which is partial fusion of the renunculi (embryonic kidney)

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41
Q

Duplex kidney

A

Complete or incomplete duplication of the collecting system

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42
Q

Complete duplex kidney

A

two ureters

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43
Q

incomplete duplex kidney

A

one ureter

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44
Q

Sonographic appearance of duplex kidney

A

typically longer

complete central coritical break within the hyperechoic sinus

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45
Q

A frequent complication of ectopic ureter is a ______.

A

ureterocele

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46
Q

Uretertocele

A

prolapse of the distal ureter into the bladder

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47
Q

Complications of a prolapsed ureterocele that resulted from an ectopic ureter

A

hydroureter and hydronephrosis of the upper collecting system of the kidney (Weigert-Meyer rule)

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48
Q

With complete duplex kidney, double ureters, where does the ureter draining the upper pole typically insert?

A

Typically inserts in an ectopic location on the bladder, and is susceptible to developing ureteroceles

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49
Q

What is associated with oligohydramnios and pulmonary hypoplasia and is it compatible with life?

A

Bilateral renal agenesis

No

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50
Q

what happens to the solitary kidney in unilateral renal agenisis?

A

compensatory hypertrophy in order to maintain normal renal function

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51
Q

Unilateral renal agenesis may be isolated congenital malformation or may be associated with chromosomal abnormalities or a variety of syndromes including ________ and _______.

A

VACTERL

MURCS

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52
Q

VACTERL Syndrome (6)

A 
V - vertebral defects
A - anal atresia
C - cardiovascular anomalies
TE - trachesophageal fistual
R - renal anomalies
L - limb defects
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53
Q

MURCS Syndrome (3)

A

MU - Mullerian agenesis
R - renal agenesis
CS - Cervicothoracic somite abnormalities

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54
Q

Unilateral renal agenesis is associated with genital anomalies related to what embryological origin in females and males?

A

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

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55
Q

Where is the renal pelvis normaly located?

A

within the renal sinus

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56
Q

Where is an extrarenal pelvis found?

A

lies outside the renal sinus

appears as a cystic collection medial to the renal hilum

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57
Q

POsterior uretheral valve is a common cause of ______ _______ in the male neonatal patient.

A

urinary obstruction

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58
Q

What causes the obstrcution in posterior uretheral valve?

A

due to a flap of mucosa that has a slit-like opening in the area of the prostatic urethra

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59
Q

What findings indicate posterior uretheral valve (4)?

A

large bladder
hydroureter
hydronephrosis
urinoma

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60
Q

SImple renal cysts occur in _____% of the people over the age of 50.

A

50%

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61
Q

Sonographic criteria for simple renal cysts

A

acoustic enhancement
absence of internal echoes
sharply defined wall
round or oval shape

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62
Q

Most renal cysts are simple ____ cysts that originate from obstructed _____ _______.

A

cortical cysts

uriniferous tubules

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63
Q

What are threee types of renal cysts?

A

pylogenic
parapelvic
peripelvic

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64
Q

pylogenic cysts

A

calyceal diverticula that sonographicaly appear as a simple cyst

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65
Q

parapelvic cysts

A

cortical cysts that bulge into the central sinus of the kidney
parenchymal cysts

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66
Q

peripelvic cysts

A

lymphatic cysts in the central sinus

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67
Q

T/F - sonographically the different types of renal cysts can be distinguished.

A

F - they cannot be distinguished, U/S determines the location - cortical/ parenchymal cysts in the periphery and periplevic cysts in the center/sinus

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68
Q

A renal ________ may mimic a simple cyst and is typically associated with a history of renal Bx or trauma.

A

pseudoaneurysm

put color on teh cyst-like structure is you know they’ve had surgery

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69
Q

How can a renal abscess be distinguished from a hemorrhagic renal cyst?

A

If no air then percutaneous aspiration

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70
Q

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.

A

T - atypical renal cysts

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71
Q

When it comes to renal cysts, what characteristics are atypical and suggest malignant cystic lesion?

A

multiple or thick septation
thick calcifications
mural nodule/soild component
-reuires FNA

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72
Q

Bosniak Renal Cyst Classification

A

defines imaging characteristics that relate to increased chances of malignancy into 4 stages

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73
Q

ADPKD

A

autosomal dominant polycystic kidney disease

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74
Q

development of numerous cyst of varying sizes

A

ADPKD

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75
Q

ADPKD is associated with cysts in the _______, _______, and _______.

A

LIV, PANC, SPL

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76
Q

ADPKD results in bilateral renal ________.

A

enlargement

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77
Q

At what age is ADPKD or multiple renal cysts identified?

A

20-30 years

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78
Q

Detsruction of the residual renal tissue ADPKD in advanced stages leads to renal ______ and ______.

A

renal failure and HTN

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79
Q

T/F - ADPKD is associated with arterial aneurysms?

A

T

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80
Q

What type of arterial aneurysms is associated with ADPKD?

A

cerebral arterial (Berry) aneurysms of the circle of Willis

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81
Q

Autosomal Recessive POlycystic Kidney Disease

A

cystic dilation of the collecting tubules secondary to hyperplasia of the interstitial portions of the ducts resulting in multiple small cysts throughout kidney sonographically

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82
Q

Sonographic findings of ARPKD

A

enlarged kidneys bilaterally
hyperechoic parenchyma
loss of cortical medullary distinction

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83
Q

ARPKD is associated with (3)

A

pulmonary hypoplasia (from oligo)
hepatic periportal fibrosis
portal HTN

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84
Q

Can ARPKD be detected in uetero?

A

Yes, assoc with oligo

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85
Q

POtter Syndrome

A

typical physical appearance of a neonate as a direct result of olig and compression while in utero

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86
Q

Causes of Potter Syndrome (6)

A

ARPKD

Auotosomal Dominant POlycystic Kidney diesease

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87
Q

Most common cause of an abdominal mass in newborns?

A

MCDK (multicystic dysplastic kidney)

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88
Q

A form of renal dysplagia characterized by multiple noncommunicating cysts with the absence of renal parenchyma.

A

multicystic dysplastic kidney

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89
Q

MCDK result from what?

A

atresia of the uteropelvic junction during fetal development

90
Q

Is MCDK unilateral or bilateral?

A

can be both but typically unilateral

-the contralateral kidney is usually normal, but up to 10% may have UPJ obstruction

91
Q

What syndromes is MCDK related to (3)

A

Beckwith-Wiedemann syndrome
Trisomy 18
VACTERL

92
Q

T/F - many urinary and non-renal malfomations are associated with MCDK

A

T

93
Q

Describe the progression of MCDK

A

may persist w/o change
may increase in size
may spontaneously involute and disappear

94
Q

Congenital causes of UPJ obstruction

A

ureteral hypoplasia
high insertion of the ureter into renal pelvis
compression by segmental artery

95
Q

Anomalies associated with UPJ obstruction

A 
MCDK
renal agenesis (contralteral)
duplicated collecting system
horseshoe kidney
ectopoic kidney
96
Q

Sonographic evidence of Medullary sponge kidney

A

hyperechoic medullary pyramids

97
Q

In medullary sponge kidney, what causes the congenital dysplastic cystic dilatation of the medullary pyramids?

A

tubular ectasia or dysplasia, ectataic collecting tubules

then urinary stasis and calcium deposits form in the dilated tubules

98
Q

Long-term hemodialysis can affect the kidneys how?

A

acquired cystic disease, development of multiple cysts in chronically failed kidneys

99
Q

Renal dialysis patients who develop acquired cystic disease are at risk for what?

A

hemorrhage often occurs in the acquired cysts, resulting in pain and hematuria
also predisposed to RCC

100
Q

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

A

Von Hippel-Lindau Disease

101
Q

VHLD is characterizied by retinal and central nervous system ___________.

A

hemangioblastomas

102
Q

VHLD includes what other related tumors in the abdomen (4)

A

RCC (clear cell?
pheochromocytomas
iselt cell tumors (neuroendocrine?
renal and pancreatic cysts

103
Q

If suscicion for VHLD, imaging should focus on what 3 organs?

A

kidneys, adrenal glands, pancreas

104
Q

80% of AMLs involve the _____ kidney

A

right

105
Q

hyperechoic benign renal mass with echogenicity greater than or equal to the of the renal sinus

A

angiomyolipoma

106
Q

what kind of artifact is associated with AMLs

A

propagation speed, reuslting in posterior displacement of structures due to slower acoustic velocity in the fatty mass

107
Q

Multi-system genetic disease that prsents classically with seizures,mental retardation and facial angiofibromas

A

tuberous sclerosis

108
Q

Patients with tuberous sclerosis have an increased risk for _____ _____ and __________, and _____ _____ _____

A

renal cysts
angiomylipomas (usually bilateral)
renal cell carcinoma

109
Q

Most common soild renal mass in adults.

A

renal cell carcinoma

110
Q

What 4 conditions predispose patients to developing RCC?

A

acquired cystic disease from chronic dialysis
von Hippel-Lindau Disease
tuberous sclerosis
ADPKD

111
Q

RCC is typically a unilateral encapsulated mass that is _____ relative to the normal adjacent parenchyma. Patients commonly presnet with _________.

A

hypoechoic
hematuria
-males may have varicoceles due to occclusion of the testicular (gonadal vein)

112
Q

Most common site for mets from RCC

A

lungs

113
Q

T/F - RCC tumor extension into the renal veins and IVC is common

A

T

114
Q

Renal oncocytoma is difficult to distinguish from _____ ______ _____.

A

renal cell carcinoma - epidemiology, presentation, imaging and even histology can be similar

115
Q

Renal oncocytomas are relatively benign tumors and patients are usually ______.

A

asymptomatic, found incidentially

116
Q

Sonographic appearance of renal METS from lung, breast, colon, etc

A

hypoechoic masses in the renal parenchyma or diffusely enlarged inhomogeneous kidney

117
Q

Malignant cells from _____ and ____ can metastasize to the kidney.

A

leukemia, lymphoma

118
Q

Most common childhood renal tumor?

A

Wilm’s Tumor (nephroblastoma)

119
Q

When do Wilm’s tumors usually present?

A

3.5 years

120
Q

What do patients with Wilm’s Tumor usually present with?

A

asymptomatic flank mass
HTN
fever
hematuria

121
Q

METS from Wilm’s tumor can be seen to the ____, _____, ______, _____ _____, and ____________.

A 
lungs
liver
bone
lymph nodes
retroperitoneum
122
Q

What important DDx must be rulled out before diagnosis Wilm’s tumor?

A

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

123
Q

Most common renal tumor in neonates and infants

A

mesoblastic nephroma3% of PED renal tumors

124
Q

Can mesoblastic nephroma be diagnosed prenatally?

A

Yes, poly in 71% of cases

125
Q

It is diffiuct to distinguish mesoblastic nephorma from ______ ______.

A

Wilm’s tumor

126
Q

T/F mesoblastic nephroma is benign

A

F - initially thought to be benign but more of a spectrum exists with the classic type as benign and the cellular variant being aggressive

127
Q

pyelonephritis

A

bacterial invasion of the renal parenchyma

128
Q

T/F - most renal infections occur as a result of ascending infection from the bladder

A

T - they are usually caused by gram-negative bacilli from the intestional tract

129
Q

Acute pyelonephritis ultrasound findings include (3)

A

renla enlargement
hypoechoic parenchyma
absence of sinus echoes, loss of cortical/medullary boundary

130
Q

What acute pyelonephritis appears as a wedge-shaped area or a hypoechoic renal lobe it is referred to as what?

A

acute focal baterial nephrits or lobar nephronia

a similar appearance can be seen in focal ischemia ad renal infarction

131
Q

bacterial infection that is associated with renal ischemia and usually requires a nephrectomy.

A

Emphysematous pyelonephritis

132
Q

What kind of patients are associated with emphysematous pyelonephritis?

A

87-97% diabetics
immunosuppressed
those with UTIs

133
Q

Emphysematous pyelonephritis results from _____ bacteria that produce intrarenal gas, which casues ______ and ______ artifacts.

A

anerobic

reverberation and comet-tail

134
Q

Recurrent renal infection that casues renal injury and end-stage renal disease is known as

A

chronic pyelonephritis

135
Q

Chronic pyelonephritis infection reuslts from _3)

A

anatomic anomalies
obstructive lesions
ureteral reflux

136
Q

sonographic appearance of chronic pyelonephritis

A

small hyperechoic kidney with cortical thinning (parenchyma)

137
Q

Staghorn calculus is associated with what type of chronic pyelonephritis resulting from chronic infections from long-term obstruction?

A

XGPN - xanthogranulomatous pyelonephritis

138
Q

associated fidnings with XGPN (8)

A 
renal enlargement
parenchymal abscesses
staghorn calc
papillary necrosis
hydronephrosis
pyonephrosis
loss of cortical-medullary boundary
cortical thinning
139
Q

Infection secondary to renal obstruction that presents with dilated renal collecting systems, hyperechoic purulent debris material in the collection system of the kidney

A

pyonephrosis

140
Q

T/F - percutaneous or surgical drainage is required for treatment of pyonephrosis

A

T

141
Q

Common fungal infections of the urinary trcat that appear as hyperechoic nonshadowing masses

A

mycetoma (fungal ball)

142
Q

Where do fungal infections tend to occur in the kidney?

A

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

143
Q

Hyperechoic masses

A 
mycetoma
AML
blood clots
pyogenic debris
sloughed papilla
renal stones
144
Q

Rapid decrease in renal function characterized by low urine output or increased serum BUN or creatinine

A

acute kidney injury or acute renal failure

145
Q

What are the 3 main mechanisims for AKI?

A

Prerenal failure - inadequat perfusion
Intrinsic Renal failure - pathology within kidney
Postrenal failur - obstructive nephropathy

146
Q

Prerenal failure is charcterized by inadequate perfusion due to (3)

A

hypotension (low BP)
volume depletion
decreased cardiac output

147
Q

Intrinsic renal failure results from pathology within the kidney from things such as (3)

A

acute tubular necrosis
acute glomerulonephritis
nephrotoxins

148
Q

Postrenal failure result from obstructive nephropathy from (3)

A

obstructive tubules with precipitates
bilat ureteral obstrcution
bladder outlet obstruction

149
Q

In tha case of AKI, ultrasound is used to identify _______ and abnormal _____ ______.

A

hydronephrosis = postrenal failure

abnormal RI = suggests intrinsic

150
Q

Common causes of renal vein thrombosis (6)

A 
nephrotic syndrome
hypercoagulabilty disorders
malignant renal tumors
extrinisc compression
trauma
transplant rejection
151
Q

Sonographic fidnings suggestive of renal vein thrombosis (4)

A

dilated thrombosed RV
absent intrarenal venous flow
enlarged hypoechoic kdiney
high-RI RA

152
Q

Renal arery thrombosis is a sudden cause of _______ failure that presnts with (3)

A

prerenal

acute flank pain
hematuria
sudden rise in BP

153
Q

Sonoraphic fidninsg associated with renal artery thrombosis (3)

A

focal hypoechoic areas of infarct
absence of intrarenal arterial flow
renal enlargement

154
Q

Songraphic fidnings associated with ATN

A

renal enlargement

increased RI

155
Q

_____ ______ ______ is the most common casue of AKI (medical renal disease/intrinsic renal failure)

A

acute tubular necrosis

156
Q

ATN likely occurs in patients with history of recent _____, _____, or ______.

A

surgery
sepsis
hypovolemia (dec blood volume circulating)

157
Q

What does ATN result from?

A

prolonged ischemia or nephrotixins (drugs and contrast agents), which casues damage to the tubular epithelium of the nephron and acute renal failure

158
Q

T/F - the renal insufficiency that occurs in ATN can be reversible.

A

T

159
Q

______ _____ is an inflammatpry response resulting in glomerular damage caused by infectious and noninfectious casues.

A

Acute glomerulonephritis (GN)

160
Q

Clinical presentation of acute GN

A

sudden onset of hematuria, proteinuria, RBC casts in the urine
-often accmpanied by HTN, edema, azotemia (dec GFR), renal salt/water retention

161
Q

MOst common infectious casue of acute GN?

A

infection by stretococcus species due to upper respiratory and skin infections

162
Q

Sonographic fidninsg associated with acute GN?

A

renal enlargement

increased RI

163
Q

Adult hydronephrosis

A

dilatation of the renal pelvis and calyces from an anechoic urine collection

164
Q

Hydro secondary to obstruction can lead to what if left untreated?

A

HTN
loss of renal function
sepsis

165
Q

Common casues of adult hydro (6)

A 
calculi
benign prostatic hypertrophy
prostate ca
pelvic malignancies
pregnancy
UPJ obstruction
166
Q

What are three common areas of obstruction by a stone causing adult hydro

A

UVJ*
UPJ
Pelvic brim

167
Q

How else can can obstrcutive nephropathy be diagnosed?

A

By evalulating intrarenal vascularity]RI > 0.7 = suggests obstructive hydro

168
Q

Newborn/Prenatal hydro can occur for a variety of reasons, the most common include: (3)

A

vesicoureteral reflux
non-obstructive hydro
UPJ obstruction

169
Q

T/F - renal pelvic dilatation in PEDS can be transient, most pateints with moderate hydro will resolve by 18 months of age.

A

T

170
Q

An increased risk of congenital anomalies of the kidney and urinary tract are assoicated with the presence of ____ ___ abnormalities and ____ ____ _____.

A

outer ear

single umbilical artery

171
Q

spinal and/or LE abnormalities may be assoicated with a _______ _____, which is assocaited with ______ and _____ ______.

A

neurgenic bladder
hydro
dilated ureters

172
Q

What does billateral hydro suggest in a PEDS pateint?

A

an obstructive process at the level or diatls to the bladder (ureterocele or posterior uretheral valves in male infants)

173
Q

What is the graded severity for hydro postnatally, performed after 48hrs of life in a full-term infant.

A

NML <7mm
Mild 7-8mm
Mod 9-15mm
Severe >15mm (at greastes risk for renal diz and surgery)

174
Q

What is the most common casue of pediatric hydro?

A

UPJ obstruction

occurring more in males on the left kidney

175
Q

What qualifies as a megaureter?

A

Diameter >7mm

176
Q

How is megaurter classified?

A

according to the presence or absence of reflux and obstruction

177
Q

What is obstrcutive primay megaureter?

A
  • 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
178
Q

What casues secondary megaureter?

A

abormalities that involve the bladder or urethra such as: neurgenic bladder, prune belly syndrome, posteriro urethral valves

179
Q

Nephrocalcinosis related to hyperparathyroidism is aka

A

Albright’s calcinosis

Anderson-Carr Kidneys

180
Q

Nephrocalcinosis

A

deposition of microscopic crystaline calcium precipitates

181
Q

renal stones in the collecting system

A

Nephrolithiasis

  • presents with acute flank.back pain radiating down ipsilateral groin
  • if severe, fever, chills, dysuria (discomfort with urination), cloudy urine,hematuria
182
Q

What is the single most common cause of nephrocalcinosis in adults?

A

primary hyperparathyroidism

183
Q

caclium deposits in the renal pyramis (papillae)

A

Anderson-Carr-Randall

184
Q

Sonographic presentation of papillary nephrocalcinosis

A
  • 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
185
Q

What is papillary necrosis?

A

necrosis of the meduallary pyramids and papillae brought on by several conditions and toxins leading to ischemia of the pyramids

186
Q

How is the clincial diagnoses of paillary necrosis achieved?

A

identifying sloughed papillae in the urine

-passage can casue pain and urinary tract obstrcution

187
Q

What conditions are associated with papillary necrosis?

A

DM
analgesic abuse
sickle-cell disease

188
Q

______ _____ was orginally described with the overuse of analegesics containing phenacetin, but also NSAID.

A

analgesic nephropathy

189
Q

Increase renal sinus fat that replaces normal renal parenchyma, causes compression of teh calyces and renal pelvis.

A

renal sinus lipomatosis

190
Q

Sono findings of renal sinus lipomatosis

A

increase in central sinus echo complex with cortical thinning

191
Q

Bladder is located behind the ____ ____. The apex points ________ and is connected to the umbilicus by the ______ ______ ________ (urachus).

A

pubic bone
anteriorly
median umbilical ligament

192
Q

The ureters enter the bladder at the _______ angle of the trigone and ext the bladder via the _____.

A

supeolateral

urethra

193
Q

What is the normal wall thickness in a distended and nondistended bladder?

A

<3mm distended

<5mm nondistended

194
Q

What are bladder diverticula?

A

herniations of the bladder mucosa through the bladder wall musculatur

195
Q

Most acquired bladder diverticula are associated with longstanding bladder ____ ______ due to benign _____ _______.

A

outlet obstruction

prostatic hypertrophyr

196
Q

______ _____ is a cystic dilatation of the fetal urachus. Seen sonographically as a cystic structure superior and anterior to the bladder

A

Urachal cyst

197
Q

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.

A

posterior
anterior
anterior
trigone

198
Q

Cyst-liek enlargement of the lower end of the ureter which projects into teh bladder lumen at the UVJ.

A

ureteroceles

199
Q

Ureteroceles are most commonly found in association with what?

A

compelete ureteral duplication from duplex kidney, ectopic insertion into the bladder

200
Q

Most common bladder neoplasm

A

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

201
Q

Sonographc finding of TCC

A

solid mass or focal thickening of bladder wall

-hydro may be caused by TCC originating in the ureter

202
Q

Most common clinical finding of TCC

A

hematuria

203
Q

In addition to TCC, what other bladder masses are there (6)

A 
cystitis
prostate ca
squamous cell ca
blood clots
pyogenic debris
bladder papilloma
204
Q

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?

A

RI = peak systolic freq - end diastolic freq/peak systolic freq

205
Q

Normal RI

A

<0.7

  1. 5 = diastole is 50% of systole
  2. 7 = diastole is 30% of systole
  3. 0 = diastole is absent
206
Q

Symtoms of renal artery stenosis

A

sudden onset of HTN

uncontrollable HTN

207
Q

A hemodynamically significant renal artery stenosis may produce decreased renal size ____

A

<9cm in length

208
Q

Direct eval for RA stenosis

A

renal artery velocities

RA/Ao ration (RAR) >3.5 = suggests at least a 65% stenosis

209
Q

Indirect eval for RA stenosis

A 
intrarenal waveforms
parvus tardus (small slow pulse) mole hill appearance
absent early systolic peak
210
Q

Most common casue of renal disease (ESRD) leading to kideny trasnplantation.

A

diabetes

211
Q

Why is the left kidney preferred for harvesting?

A

because the renal vein is longer

212
Q

In the immediate posttransplant period, poor function may be the result of _____ _____ ____.

A

acute tubular necrosis

213
Q

Post-tx complications

A 
fluid collections
-hematomas, 24 hrs
-urinomas, 24 hrs
-lymphoceles
-abscesses
RA kinking or thrombosis
RV thrombosis
214
Q

The Tx ureter is attache dto the ____. The arterial anastomoses may be with the ______ or _______ ____ ____.

A

bladder

EIA or IIA

215
Q

Sonographic findings of acute Tx rejection:

A

renal enlargement
dec echogenicity
loss of cortical medullary boundary
inc flow resistance index

216
Q

Describe the breakdow ofRIs to evaluate the arterial flow resistance in the renal vascualr bed of a Tx

A

<0.7 = NML
0.7 - 0.8 = quetsionnable Tx dysfunction
>0.8 = Tx dysfunction

217
Q

Urinalysis

A 
microscopic examination of sediment and qualitative evaluation of the following in urine:
specific gravity
acidity
protein
glucose
ketones
blood
nitrates
WBCs
bilirubin
218
Q

waste/break-down product of skeletal muscle that is filtered out of the blood by the kidneys

A

serum creatinine - thresholdsmay vary 1.2 to 2.0 depending on the amount of skeletal muscle

219
Q

determines stages of kideny disease, calculated by determing creatinine clearance

A

glomerular filtration rate

220
Q

_____ is produced by the liver and is a waste product of protein metabolism.

A

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

ABD (20 decks)

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