Urinary Pathology Ch 14 Flashcards
1
Q
lab value more specific for renal dysfunction
A
serum creatinine
2
Q
- lab value increased with renal disease, failure, dehydration, obstructive disease
- decreased with overhydration, preg., liver failure
A
BUN (blood urea nitrogen)
3
Q
increase in UA, proteinuria, specific gravity
A
urinalysis
4
Q
- most common renal mass, occurring in half of patients over 50 years
- located anywhere in the kidney and are of no clinical significance
- well defined anechoic mass with good through- transmission
A
simple cortical cysts**
5
Q
-may contain septations, thick walls, calcifications, internal echoes and mural nodularity
A
complex cyst
6
Q
any cyst that does not meet the criteria of a simple cyst is considered complex and must be considered _____ until proven otherwise
A
malignant
7
Q
cyst walls thicker than ___ is considered abnormal and requires further evaluation
A
1mm
8
Q
- found at renal hilum
- does not communicate with renal collecting system
- usually asymtomatic - if large, can cause hypertension, pain, or obstruction
A
parapelvic (renal sinus cyst)
9
Q
sonographic appearance
- well-defined mass with no internal septations
- may have irregular borders
- spherical in appearance
A
parapelvic (renal cinus cyst)
10
Q
_________ has cauiflower appearance
A
hydronephrosis
11
Q
cysts associated with multiple renal neoplams
A
- Von Hippel-Lindau
- Tuberous scerosis
- acquired cystic disease of dialysis
12
Q
- autosomal-dominant genetic disorder
- associated with pancreatic cysts
- renal carcinoma (multiple and bilateral)
A
Von Hippel-Lindau
13
Q
- autosomal-dominant genetic disorder
- may cause multiple renal cysts or angiomylipomas or cutaneous, retinal and cerberal hamartomas
A
Tuberous sclerosis
14
Q
-increased incidence of renal cysts, adenomas and renal carcinoma (greater risk after 3 years of dialysis)
A
Acquired cystic disease of dialysis
15
Q
- AKA- autosomal recessive polycystic kidney disease (ARPKD)
- fairly rare genetic disorder
- four forms
A
Infantile polycystic kidney disease (IPKD)
16
Q
four forms of IPKD
A
- perinatal, neonatal, infantile and juvenile
- the earlier symptoms manifest, the less the kidneys are functioning
17
Q
sonograhic appearance
-perinatal- oligohyramnios, bilateral enlarged echogenic kidneys due to microscopic cysts**
A
IPKD
18
Q
- AKA- autosomal dominate polycystic kidney disease
- usually presents as bilateral renal enlargement caused by numerous cysts of varying sizes
- latent untill 4th or 5th decade of life when hypertension or hematuria develops
A
adult polycystic kidney disease (APKD)
19
Q
By age ____ aprox half of patients will have end -stage renal disease (ESRD)
A
60
20
Q
associated findings of APKD
A
- circle of Willis (Berry’s aneurysm)
- liver cysts (a third associated with polycystic liver)
- splenic cysts
- pancreatic cysts
- AAA
21
Q
- common non-hereditary typically occurs unilaterl* with poor functioning kidneys (if functioning at all)
- most common form of cystic disease in neonates and is believed to be the consequence of of early in utero urinary tract obstruction
- most common cause of an abdominal mass in newborn
A
multicystic dysplastic kidney
22
Q
**multicystic dysplastic kidney is usually diagnosed in ….
A
utero or early childhood
23
Q
- bilateral is incompatible with life
- associated findings contralateral UPJ obstruction, contralateral renal agenesis or hypoplasia, horsehoe kidney
- complications include hypertension, hematoturia, infection and flank pain
- slight risk of malignant transformation if not removed
A
multicystic dysplastic kidney
24
Q
sonographic appearance of multicystic dysplastic kidney in neonates and children
A
-enlarged, multicystic kidney/kidneys, absence of renal parenchyma, renal sinus and atretic renal artery
25
sonographic appearance of multicustic dysplastic kidney in adults
-small and calcified kidney/kidneys
26
- cysts of varying size and shape
- non-medial location of largest cyst
- uretic atresia will be present
- no dilated ureter due to atresia (possible registry question)
- ureteroplevic obstruction and nonfunctioning kindey
multicystic dysplastic kidney
27
- development anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilatation of the distal collecting ducts
- causes stasis of urine and stone formation
- unknown cause
- rare. nonhereditary, benign renal disease found in children
medullary sponge kidney**
28
sonographic appearance
- calcium deposits appear as hyperechoic medullary pyramids
- dysplastic cystic dilatation of medullary pyramids**
- hyperechoic medullary pyramids **
medullary sponge kidney
29
is associated with Caroli's liver disease, Beckwith-Wiedemann syndrome, PKD and congentital hepatic fibrosis
medullary sponge kidney
30
differential diagnosis: -renal tuberculosis, juvenile PKD, nephrocalcinosis
medullary sponge kidney
31
- inherited disorder that eventually lead to end-stage renal disease
- rare
- autosomal recessive presenting in young adults
medullary cystic disease (nephronophthisis)
32
sonographic findings
- small, echogenic kidneys
- small, multiple cysts greater than 2cm
- loss of definition between cortex/medulla
medullary cystic disease (nephronophthisis)
33
- AKA hypernephroma or Grawitz's tumor
- twice as likely to occur in males (6th to 7th decade)
- increased incidence associated with Von Hippel-Lindau syndrome, chronic dialysis (aquired cystic disease), tuberous sclerosis, and APKD
Renal Cell CA
34
most common solid renal adult mass**
Renal Cell CA
35
sonographic appearance
- tumor extension into the renal veins and IVC is common (renal vein thrombosis may result)**
- usually unilateral, encapsulated solid mass (hyop or isoechoic)
- 92% show tumor vascularity by color doppler
Renal Cell CA
36
hematuria (most common), flank pain, and palpable mass
Renal Cell CA
37
renal cell CA that is confined to the kidneys
stage I
38
renal cell CA spread to perinephric fat but within Gerota's fascia
stage II
39
renal cell CA with involvement with renal vein, IVC, and lymph nodes
stage III
40
renal cell CA with invasion of adjacent structures; distant metastases
stage IV
41
the _____ are the most common site of distant metastases. lymph nodes, liver, bone, adrenal glands, and the contralateral kidney are also metastatic sites
lung
42
- most common tumor of the renal collecting system
- can affect the renal pelvis, collecting system, ureter, and/or bladder
- occurs twice as often in men/peaks 7th decade
Transitional Cell CA
43
most common bladder neoplasm**
Transitional Cell CA
44
- hyopechoic solid mass within the collecting system low vascularity on color doppler; rarely- calcification
- hematuria is the most common clinical presentation
- differential diagnosis includes squamous cell tumor, renal cell carcinoma, adenoma, a blood clot or a fungal ball
Transitional cell CA
45
rare, highly invasive tumor with a poor prognosis
squamous cell CA
46
- chronic irritation
- hematuria
- palpable kidney due to severe hydronephrosis
squamous cell CA
47
- large mass in the renal pelvis
| - obstruction from kidney stones
squamous cell CA
48
- primary rare
- secondary most common form**
- more commonly seen bilaterally with multiple nodules
renal lymphoma
49
________ lymphoma is more common than ______
non-hodgkin, hodgkin
50
-enlarged hyopechoic kidneys with multiple, bilateral, renal masses**
renal lymphoma
51
enlargement of both kidneys with loos of the corticomedullary differentiation
Non-Hodgkin lymphoma
52
-most commonly results from primary
| (lungs)
renal mets
53
-multiple, poor marginated hyopechoic masses or diffusely enlarged inhomogenous kidney
renal met
54
-AKA nephroblastoma**
-most common solid renal tumor and abdominal malignancy in childhood**
usually between 3-5 years old
Wilm's tumor
55
-abdominal pain, large asymptomatic flank mass, anorexia, nausea, and vomiting, fever, and hematuria
Wilm's tumor
56
-hyopechoic to moderately echogenic; usually unilateral, and renal vein and IVC thrombosis is commonly seen
Wilm's tumor
57
- most common benign renal tumor
- composed of varying proportions of fat, muscle and blood vessels
- higher incidence in females and the right kidney
Angiomyolipoma
58
highly echogenic benign tumor**
| associated with tuberous sclerosis**
Angiomyolipoma
59
-focal, solid hyperechoic mass located in the renal cortex (echogenicity is greater than or equel to renal sinus
Angiomyolipoma
60
a _______________ may result in the posterior displacement of structures due to slower acoustic velocity in this fatty mass
propagation speed artifiact
61
-considered the benign counterpart of renal cell carcinoma
adenoma
62
-well defined solid hyperechoic to hypoechoic masses with calcifications
adenoma
63
- rare, benign mass
- well encapsulated, large adenoma
- usually solitary and more common in older men
oncocytoma
64
- usually hypoechoic **
- well defined mass with "spoke-wheel" enhancement**
- central scar**
oncocytoma
65
- most common mesenchymal tumor-consits of fat
- typically asymptomatic
- more prevalent in females
- well-defined echogenic mass
lipoma
66
- necrosis or proliferation of cellular elements occurs int he glomeruli
- enlarged poorly functioning kidneys
- increased echogenicity of renal corticles
Acute Glomerulonephritis
67
- nephrotic syndrome
- hypertension
- anemia
- peripheral adema
acute glomerulonephritis
68
- associated with scarlet fever and diphtheria
| - may be allergic reaction to drugs
acute interstitial nephritis
69
uremia, proteinuria, hematuria, rash, fever, eosinophilia
acute interstitial nephritis
70
- enlarged mottled appearance
| - increased cortical echogenicity
acute interstitial nephritis
71
- connective tissue disorder
- results from abnormal immune system
- females between 20-40 are more commonly affected
- kidneys affected in 50% of cases
Lupus Nephritis
72
-hematuria, proteinuria, hypertension, renal vein, thrombosis, and renal insufficiency
Lupus Nephritis
73
increased cortical echogenicity and renal atrophy
Lupus Nephritis
74
- unexplained uremia-indication of renal problems
- echogenic parenchyma and and increased cortical echogenicity
- normal to enlarged kidneys
AIDS
75
- common
- includes glomerulonephritis, renal vein thrombosis, papillary necrosis, and hematuria
- sonographic depends on disorder
sickle cell nephropathy
76
- uncontrolled can lead to renal damage and azotemia
| - bilateral small kidneys with smooth borders
hypertensive nephropathy
77
- ischemia plays important role in necrosis
- most commonly caused by analgestic abuse
- common in renal transplants (may develop within weeks and or months after)
papillary necrosis
78
-1 or more fluid filled spaces at the corticomedullary junction
papillary necrosis
79
differential diagnosis
| -congenital megocalyces, hydronephrosis, postoperative atrophy
papillary necrosis
80
-uniform loss of renal tissue
renal atrophy
81
- secondary to renal atrophy
| - renal sinus appears to engulf the entire renal parenchyma
sinus lipomatosis**
82
- enlarged
| - highly echogenic renal sinus with a thin cortical rim
sinus lipomatosis**
83
- prerenal (hypoperfusion, hypotension, and congestive heart failure
- renal (infection, nephrotoxicity, renal artery occulusion, renal mass, or cyst
- postrenal (lower urininary tract obstruction)
sonography helpful in evaluating with known or suspected renal failure
renal malfunction
84
- hydronephrosis and site of obstruction
- increase in cortical echogenicity
- loss of anatomical detail
renal malfunction
85
-prevents normal removal of accumulated metabolites from the blood
acute renal failure
86
most common cause of acute renal failure
acute tubular necrosis ATN**
87
- results from prolonged ischema or nephrotoxins (drugs and contrast agents) causing damage to the tubular epithelium of the nephron leading to acute renal failure
- renal insufficiency that occurs can be reversible
acute tubular necrosis ATN
88
- bilaterally enlarged kindeys/hyperechoic renal pyramids
| - increased resistive index
acute tubular necrosis ATN
89
- loss of renal function due to renal disease
- three types (nephron, vascular, and interstitial abnormalities)
- small echogenic kidneys if bilateral
chronic renal disease
90
- dilation (fluid flilled) of the pelvicalyceal collecting system with thinning of the renal cortex
- if untreated, hydronephrosis secondary to obstruction can lead to hypertension, loss of renal function and sepsis
hydronephrosis**
91
causes
- aquired/extrinsic
- ureteral stones
- pelvic mass
- pregnancy
- intrinsic
- stone
- stricture
- UPJ
- ureterpcele
hydronephrosis
92
- purulent material (pus) in the collecting system of the kidney associated with an infection secondary to renal obstruction **
- surgical drainage is required
pyonephrosis
93
echogenic debris or fluid-debris levels in a dilated renal collecting system
pyonephrosis
94
- most renal infections occur via an ascending route from the bladder**
- usually caused by gram-negative bacilli from the intestinal tract
pyelonephritis
95
- diffusely echogenic
| - loss of normal anatomy causing inability to distinguish the cortex from the medullary regions**
pyelonephritis
96
- focal acute pyelonephritis
- AKA-lobar nephronia
- presents as a focal wedge-shaped area of decreased echogenicity involving renal lobe
acute focal bacterial
97
- usually the end result of acute bacterial nephritis
| - occurs from a direct extension
renal abscess
98
- homogeneous debris and fluid-filled cystic parenchymal mass
- acoustic enhancement
- irregular margins
renal abscess
99
collection of many small abscesses
renal carbuncle**
100
- occurs when there is air in the parenchyma (diffuse gas-forming parenchymal infection)
- usually unilateral
emphysematous pylonephritis
101
- shadowing echogenic foci due to intrarenal gas
| - enlarged hypoechoic and inflamed
emphysematous pylonephritis
102
- uncommon renal disease associated with chronic renal obstruction and infection
- renal enlargement
xanthogranulomatous pyelonephritis
103
-disorder of calcium metabolism that result in the formation of calcium renal stones and depositon of calcium slats in the renal parenchyma
nephrocalcinosis
104
presents sonographically as bilateral highly echogenic (calcified) pyramids with or without shadowing
medullary nephrocalcinosis**
105
AKA fungal ball
-hyperechoic non-shadowing masses**
differential diagnosis -angiomylipomas, nonshadowing renal stones**
mycetoma
106
high-resistance renal artery waveform is seen in ...
renal vein thrombosis
107
normal renal artery demonstrates continuous forward flow during diastole, typical of _____ resistance perfusion
low
108
small slow pulse, abnormal renal artery
parvus tardus
109
RI greater than ___ is abnormal
.7
110
- undergoes necrosis due to lack of blood flow
- lumpy and bumpy
- hyopechoic then smaller and more echogenic with time
renal infarction
111
HAUL (post transplant)
- hematomas
- abscesses(perinephric)
- urinomas
- lymphoceles
112
"staghorn" calculus
large stones
113
most common bladder malignancy**
transitonal cell CA
114
normal bladder thickness is less than _____ in non distended bladder and less than _____ in a distended bladder
5mm, 3mm
115
benign tumors of the bladder are typically _______ while malignant primary tumors of the bladder are irregular and echogenic mass that projects into the lumen of the bladder
hypoechoic
