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Abdomen Pathology > Urinary Pathology Ch 14 > Flashcards

Urinary Pathology Ch 14 Flashcards

1
Q

lab value more specific for renal dysfunction

A

serum creatinine

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2
Q
  • lab value increased with renal disease, failure, dehydration, obstructive disease
  • decreased with overhydration, preg., liver failure
A

BUN (blood urea nitrogen)

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3
Q

increase in UA, proteinuria, specific gravity

A

urinalysis

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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**

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5
Q

-may contain septations, thick walls, calcifications, internal echoes and mural nodularity

A

complex cyst

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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

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7
Q

cyst walls thicker than ___ is considered abnormal and requires further evaluation

A

1mm

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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)

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9
Q

sonographic appearance

  • well-defined mass with no internal septations
  • may have irregular borders
  • spherical in appearance
A

parapelvic (renal cinus cyst)

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10
Q

_________ has cauiflower appearance

A

hydronephrosis

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11
Q

cysts associated with multiple renal neoplams

A
  • Von Hippel-Lindau
  • Tuberous scerosis
  • acquired cystic disease of dialysis
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12
Q
  • autosomal-dominant genetic disorder
  • associated with pancreatic cysts
  • renal carcinoma (multiple and bilateral)
A

Von Hippel-Lindau

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13
Q
  • autosomal-dominant genetic disorder

- may cause multiple renal cysts or angiomylipomas or cutaneous, retinal and cerberal hamartomas

A

Tuberous sclerosis

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14
Q

-increased incidence of renal cysts, adenomas and renal carcinoma (greater risk after 3 years of dialysis)

A

Acquired cystic disease of dialysis

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15
Q
  • AKA- autosomal recessive polycystic kidney disease (ARPKD)
  • fairly rare genetic disorder
  • four forms
A

Infantile polycystic kidney disease (IPKD)

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16
Q

four forms of IPKD

A
  • perinatal, neonatal, infantile and juvenile

- the earlier symptoms manifest, the less the kidneys are functioning

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17
Q

sonograhic appearance

-perinatal- oligohyramnios, bilateral enlarged echogenic kidneys due to microscopic cysts**

A

IPKD

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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)

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19
Q

By age ____ aprox half of patients will have end -stage renal disease (ESRD)

A

60

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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
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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

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22
Q

**multicystic dysplastic kidney is usually diagnosed in ….

A

utero or early childhood

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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

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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

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25
Q

sonographic appearance of multicustic dysplastic kidney in adults

A

-small and calcified kidney/kidneys

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26
Q
  • 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
A

multicystic dysplastic kidney

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27
Q
  • 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
A

medullary sponge kidney**

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28
Q

sonographic appearance

  • calcium deposits appear as hyperechoic medullary pyramids
  • dysplastic cystic dilatation of medullary pyramids**
  • hyperechoic medullary pyramids **
A

medullary sponge kidney

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29
Q

is associated with Caroli’s liver disease, Beckwith-Wiedemann syndrome, PKD and congentital hepatic fibrosis

A

medullary sponge kidney

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30
Q

differential diagnosis: -renal tuberculosis, juvenile PKD, nephrocalcinosis

A

medullary sponge kidney

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31
Q
  • inherited disorder that eventually lead to end-stage renal disease
  • rare
    • autosomal recessive presenting in young adults
A

medullary cystic disease (nephronophthisis)

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32
Q

sonographic findings

  • small, echogenic kidneys
  • small, multiple cysts greater than 2cm
  • loss of definition between cortex/medulla
A

medullary cystic disease (nephronophthisis)

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33
Q
  • 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
A

Renal Cell CA

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34
Q

most common solid renal adult mass**

A

Renal Cell CA

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35
Q

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
A

Renal Cell CA

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36
Q

hematuria (most common), flank pain, and palpable mass

A

Renal Cell CA

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37
Q

renal cell CA that is confined to the kidneys

A

stage I

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38
Q

renal cell CA spread to perinephric fat but within Gerota’s fascia

A

stage II

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39
Q

renal cell CA with involvement with renal vein, IVC, and lymph nodes

A

stage III

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40
Q

renal cell CA with invasion of adjacent structures; distant metastases

A

stage IV

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41
Q

the _____ are the most common site of distant metastases. lymph nodes, liver, bone, adrenal glands, and the contralateral kidney are also metastatic sites

A

lung

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42
Q
  • 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
A

Transitional Cell CA

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43
Q

most common bladder neoplasm**

A

Transitional Cell CA

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44
Q
  • 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
A

Transitional cell CA

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45
Q

rare, highly invasive tumor with a poor prognosis

A

squamous cell CA

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46
Q
  • chronic irritation
  • hematuria
  • palpable kidney due to severe hydronephrosis
A

squamous cell CA

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47
Q
  • large mass in the renal pelvis

- obstruction from kidney stones

A

squamous cell CA

48
Q
  • primary rare
  • secondary most common form**
  • more commonly seen bilaterally with multiple nodules
A

renal lymphoma

49
Q

________ lymphoma is more common than ______

A

non-hodgkin, hodgkin

50
Q

-enlarged hyopechoic kidneys with multiple, bilateral, renal masses**

A

renal lymphoma

51
Q

enlargement of both kidneys with loos of the corticomedullary differentiation

A

Non-Hodgkin lymphoma

52
Q

-most commonly results from primary

(lungs)

A

renal mets

53
Q

-multiple, poor marginated hyopechoic masses or diffusely enlarged inhomogenous kidney

A

renal met

54
Q

-AKA nephroblastoma**
-most common solid renal tumor and abdominal malignancy in childhood**
usually between 3-5 years old

A

Wilm’s tumor

55
Q

-abdominal pain, large asymptomatic flank mass, anorexia, nausea, and vomiting, fever, and hematuria

A

Wilm’s tumor

56
Q

-hyopechoic to moderately echogenic; usually unilateral, and renal vein and IVC thrombosis is commonly seen

A

Wilm’s tumor

57
Q
  • most common benign renal tumor
  • composed of varying proportions of fat, muscle and blood vessels
  • higher incidence in females and the right kidney
A

Angiomyolipoma

58
Q

highly echogenic benign tumor**

associated with tuberous sclerosis**

A

Angiomyolipoma

59
Q

-focal, solid hyperechoic mass located in the renal cortex (echogenicity is greater than or equel to renal sinus

A

Angiomyolipoma

60
Q

a _______________ may result in the posterior displacement of structures due to slower acoustic velocity in this fatty mass

A

propagation speed artifiact

61
Q

-considered the benign counterpart of renal cell carcinoma

A

adenoma

62
Q

-well defined solid hyperechoic to hypoechoic masses with calcifications

A

adenoma

63
Q
  • rare, benign mass
  • well encapsulated, large adenoma
  • usually solitary and more common in older men
A

oncocytoma

64
Q
  • usually hypoechoic **
  • well defined mass with “spoke-wheel” enhancement**
  • central scar**
A

oncocytoma

65
Q
  • most common mesenchymal tumor-consits of fat
  • typically asymptomatic
  • more prevalent in females
  • well-defined echogenic mass
A

lipoma

66
Q
  • necrosis or proliferation of cellular elements occurs int he glomeruli
  • enlarged poorly functioning kidneys
    • increased echogenicity of renal corticles
A

Acute Glomerulonephritis

67
Q
  • nephrotic syndrome
  • hypertension
  • anemia
  • peripheral adema
A

acute glomerulonephritis

68
Q
  • associated with scarlet fever and diphtheria

- may be allergic reaction to drugs

A

acute interstitial nephritis

69
Q

uremia, proteinuria, hematuria, rash, fever, eosinophilia

A

acute interstitial nephritis

70
Q
  • enlarged mottled appearance

- increased cortical echogenicity

A

acute interstitial nephritis

71
Q
  • connective tissue disorder
  • results from abnormal immune system
  • females between 20-40 are more commonly affected
  • kidneys affected in 50% of cases
A

Lupus Nephritis

72
Q

-hematuria, proteinuria, hypertension, renal vein, thrombosis, and renal insufficiency

A

Lupus Nephritis

73
Q

increased cortical echogenicity and renal atrophy

A

Lupus Nephritis

74
Q
  • unexplained uremia-indication of renal problems
  • echogenic parenchyma and and increased cortical echogenicity
  • normal to enlarged kidneys
A

AIDS

75
Q
  • common
  • includes glomerulonephritis, renal vein thrombosis, papillary necrosis, and hematuria
  • sonographic depends on disorder
A

sickle cell nephropathy

76
Q
  • uncontrolled can lead to renal damage and azotemia

- bilateral small kidneys with smooth borders

A

hypertensive nephropathy

77
Q
  • ischemia plays important role in necrosis
  • most commonly caused by analgestic abuse
  • common in renal transplants (may develop within weeks and or months after)
A

papillary necrosis

78
Q

-1 or more fluid filled spaces at the corticomedullary junction

A

papillary necrosis

79
Q

differential diagnosis

-congenital megocalyces, hydronephrosis, postoperative atrophy

A

papillary necrosis

80
Q

-uniform loss of renal tissue

A

renal atrophy

81
Q
  • secondary to renal atrophy

- renal sinus appears to engulf the entire renal parenchyma

A

sinus lipomatosis**

82
Q
  • enlarged

- highly echogenic renal sinus with a thin cortical rim

A

sinus lipomatosis**

83
Q
  • 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

A

renal malfunction

84
Q
  • hydronephrosis and site of obstruction
  • increase in cortical echogenicity
  • loss of anatomical detail
A

renal malfunction

85
Q

-prevents normal removal of accumulated metabolites from the blood

A

acute renal failure

86
Q

most common cause of acute renal failure

A

acute tubular necrosis ATN**

87
Q
  • 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
A

acute tubular necrosis ATN

88
Q
  • bilaterally enlarged kindeys/hyperechoic renal pyramids

- increased resistive index

A

acute tubular necrosis ATN

89
Q
  • loss of renal function due to renal disease
  • three types (nephron, vascular, and interstitial abnormalities)
  • small echogenic kidneys if bilateral
A

chronic renal disease

90
Q
  • 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
A

hydronephrosis**

91
Q

causes

  • aquired/extrinsic
    • ureteral stones
    • pelvic mass
    • pregnancy
  • intrinsic
    • stone
    • stricture
    • UPJ
    • ureterpcele
A

hydronephrosis

92
Q
  • purulent material (pus) in the collecting system of the kidney associated with an infection secondary to renal obstruction **
  • surgical drainage is required
A

pyonephrosis

93
Q

echogenic debris or fluid-debris levels in a dilated renal collecting system

A

pyonephrosis

94
Q
  • most renal infections occur via an ascending route from the bladder**
  • usually caused by gram-negative bacilli from the intestinal tract
A

pyelonephritis

95
Q
  • diffusely echogenic

- loss of normal anatomy causing inability to distinguish the cortex from the medullary regions**

A

pyelonephritis

96
Q
  • focal acute pyelonephritis
  • AKA-lobar nephronia
  • presents as a focal wedge-shaped area of decreased echogenicity involving renal lobe
A

acute focal bacterial

97
Q
  • usually the end result of acute bacterial nephritis

- occurs from a direct extension

A

renal abscess

98
Q
  • homogeneous debris and fluid-filled cystic parenchymal mass
  • acoustic enhancement
  • irregular margins
A

renal abscess

99
Q

collection of many small abscesses

A

renal carbuncle**

100
Q
  • occurs when there is air in the parenchyma (diffuse gas-forming parenchymal infection)
  • usually unilateral
A

emphysematous pylonephritis

101
Q
  • shadowing echogenic foci due to intrarenal gas

- enlarged hypoechoic and inflamed

A

emphysematous pylonephritis

102
Q
  • uncommon renal disease associated with chronic renal obstruction and infection
  • renal enlargement
A

xanthogranulomatous pyelonephritis

103
Q

-disorder of calcium metabolism that result in the formation of calcium renal stones and depositon of calcium slats in the renal parenchyma

A

nephrocalcinosis

104
Q

presents sonographically as bilateral highly echogenic (calcified) pyramids with or without shadowing

A

medullary nephrocalcinosis**

105
Q

AKA fungal ball
-hyperechoic non-shadowing masses**
differential diagnosis -angiomylipomas, nonshadowing renal stones**

A

mycetoma

106
Q

high-resistance renal artery waveform is seen in …

A

renal vein thrombosis

107
Q

normal renal artery demonstrates continuous forward flow during diastole, typical of _____ resistance perfusion

A

low

108
Q

small slow pulse, abnormal renal artery

A

parvus tardus

109
Q

RI greater than ___ is abnormal

A

.7

110
Q
  • undergoes necrosis due to lack of blood flow
  • lumpy and bumpy
  • hyopechoic then smaller and more echogenic with time
A

renal infarction

111
Q

HAUL (post transplant)

A
  • hematomas
  • abscesses(perinephric)
  • urinomas
  • lymphoceles
112
Q

“staghorn” calculus

A

large stones

113
Q

most common bladder malignancy**

A

transitonal cell CA

114
Q

normal bladder thickness is less than _____ in non distended bladder and less than _____ in a distended bladder

A

5mm, 3mm

115
Q

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

A

hypoechoic

Abdomen Pathology (9 decks)

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