Urinary System Flashcards
The urinary system consists of what 3 parts
rt/lt kidneys
pair of ureters
urinary bladder
Where are the kidneys located
anterior to the deep back muscles in the perirenal space of retroperitoneum
List the order that the structures enter or exit from the hilum of the kidney from anterior to posterior
VAU: vein exits most anterior, artery enters between vein and ureter exits most posterior
What are the average measurements of the normal adult kidney
L: 9-12cm
W: 5 cm
T: 2.5-4cm
functional unit of the Kidney
nephron
What 5 parts make up the nephron
renal corpuscle proximal convoluted tubule descending and ascending portions of henle's loop distal convoluted tubule collecting tubule
Where is the liver in relation to right kidney
superolateral
Where is the adrenal gland in relation to right kidney
superomedial
Where is the right colic flexure in relation to right kidney
inferior
Where is the 2nd portion of the duodenum in relation to right kidney
medial
Where is the adrenal gland and spleen in relation to the left kidney
superior
Where is the pancreatic tail in relation to the left kidney
anterior to the upper pole
Where is the left colic flexure in relation to the left kidney
inferior
Which kidney is most superior
left kidney
What part of the bladder to the ureters insert into
interior/lateral
What are the 2 deep back muscles that lie posterior to the kidneys
psoas
quadrattus lumborum
Fibrous sheath encasing the kidneys and adrenal glands
Gerota’s fascia
What is the connection of the ureter to the kidney
uteropelvic junction
What is the connection of the ureter into the bladder
uterovesical
What is the normal wall thickness of the urinary bladder if distended? undistended?
less than 3cm
less than 5cm
Name the 4 branches of the main renal artery
segmental arteries
interlobar
arcuate
interlobular
Where is the segmental renal artery branch located
hilum
Where is the interlobar renal artery branch located
level of medullary pyramids
Where is the arcuate renal artery branch located
parallel/adjacent to renal capsule
Where is the interlobular renal artery branch located
smallest renal arteries, branch off arcuates, run perpendicular to renal capsule
What is the main function of the kidneys
remove waste from body via excretion of urine
What do kidneys do
adjust electrolyte balance in the blood to maintain homeostasis
List the following normal organs seen sonographically in order by decreasing echogenicity
renal sinus
pancreas
spleen/liver
renal cortex
What 2 structures, in enlarges may cause an indention of the posterior bladder wall
uterus
prostate gland
What renal variant is characterized by hypertrophy of the renal cortical tissue between the medullary pyramids
column of bertin
Common renal variant of cortical thickening on the lateral aspect of the left kidney
dromedary hump
What appears sonographically as a triangular hyperechoic area on the anterior aspect of the right kidney
junctional paranchymal defet/fetal lobulation
A frequent complication of an ectopic ureter, in which there is a prolapse of the distal ureter into the bladder resulting in hydroureter and hydronephrosis of the _____ pole collecting system of the kidney
duplex kidney/duplicated collecting system
upper
Refers to unilateral or bilateral absence of the kidneys
renal agenesis
What is renal agenesis seen as in utero
oligohydramnious
Refers to a kidney that fails to ascend from the pelvis
pelvic kidney/ectopic kidney
Renal variant where renal sinus and perirenal fat increases and replaces the normal renal parenchyma
renal sinus lipomatosis
Appears as a cystic collection medial to the renal hilum
extrarenal pelvis
_____________most common fusion anomaly in which the __________poles of the kidney are connected by an isthmus _________ to the aorta
horseshoe kidney
lower
anterior
Anomaly in which both kidneys are seen on one side of the abdomen and one of the ureters must cross the midline
crossed fused renal ectopia
Anomaly in which the kidneys fuse to form a round, flattened mass in the pelvis
fused pelvic kidney/discoid/pancake kidney
What are the 3 classifications of renal masses
cystic/smooth
solid/well defined border
complex/anechoic
posterior enhancement
Ultrasound is utilized post-procedure following a guided biopsy or aspiration in order to monitor
any potential bleeding or fluid collections
What are the sonographic criteria for a simple cyst
anechoic
acoustic enhancement
well defined thin wall
round or oval shape
Simple renal cysts occur in what % of people over the age of 50
50%
What are the 3 types of renal cysts
peripelvic
parapelvic
pyelogenic
What are 3 possible appearances of an atypical renal cyst
multiple thick septations
irregular walls
solid components
Autosomal Dominant (adult) polycystic kidney disease presents as what caused by numerous cysts of various sizes
bilateral renal enlargement
What happens in advanced stages of autosomal dominant (adult) polycystic kidney disease
renal failure
hypertension
most common genetically determined childhood cystic disease of the kidneys
autosomal recessive polycystic kidney disease
autosomal recessive polycystic kidney disease presents as bilateral enlarged ________ kidneys
hyperechoic
The appearance of ARPKD is due to
multiple small cysts
With ARPKD there is a loss of
cortical medullary distinction
ARPKD may be detected in utero with
oligohydramnios
development of multiple cysts in chronically failed kidneys, seen in patients who have received long-term hemodialysis
acquired cystic disease
genetic tumor disorder affecting multiple organs, including the kidneys. Characterized by retinal and central nervous system tumors
von hipple lindau
hyperechoic benign renal tumor that results in a propagation speed artifact, mainly seen in the right kidney and is associated with tuberous sclerosis
angiomyolipoma/hamartoma
most common cause of an abdominal mass in the newborn where the affected kidney is non-functioning and filled with non-communicating cysts that replace the normal renal parenchyma
multicystic dysplastic kidney
multi-system disease that consists of benign tumors in multiple organs. It commonly affects the central nervous system
tuberous sclerosis
with tuberous sclerosis, patients have an increased incidence of renal cyst and
angiomyolipomas
congenital disorder characterized by cystic dilation of the medullary pyramids
medullary sponge kidney
medullary sponge kidney is caused by what and appears
tubular ectasia or dysplasia
hyperechoic pyramids
the most common solid renal mass found in adults
renal cell carcinoma
renal cell carcinoma typically appears how compared to the normal renal parenchyma
hypoechoic
renal cell carcinoma commonly invades into the
renal veins and IVC
most common site of distant metastases for renal cell carcinoma
lungs
most common childhood renal tumor
wilm’s tumor/nephroblastoma
How does wilm’s tumor/nephroblastoma affect the renal countour
destroys it
increased incidence of renal cell carcinoma is associated with
tuberous sclerosis
von hippel lindau syndrome
acquired cystic disease
refers to dilation of the renal collecting system due to obstruction of the ureter
hydronephrosis
renal dysfunction results in loss of _______ flow and an increase in _______ resistance
diastolic
renal artery
Obstructive hydronephrosis is suspected with a resistive index greater than
0.7
results in a reduction in glomerular filtration rate and azotemia
acute renal failure
if hydronephrosis is suspected when performing an ultrasound what should be done
post void scan should be done to image in two planes and show if it remains
What are the 3 types of acute renal failure
prerenal failure
intrinsic failure
postrenal failure
most common cause of intrinsic acute renal failure
acute tubular necrosis
What is the term for renal stones
nephrolithiasis
Disorder of calcium metabolism that results in calcification of the renal parenchyma
nephrocalcinosis
Refers to ischemia of the medullary pyramids
papillary nerosis
will be visualized in the urine of an affected patient. It appears sonographically as triangular cystic collections in the absence of the medullary pyramids
sloughed papilla
refers to infection of the collecting system, causing pus to fill the collecting system
pyo-nephrosis
Pyo-nephrosis is due to
renal obstruction
Papillary necrosis is associated with
analgesic abuse diabetes mellitus urinary tract obstruction/infection renal vein thrombosis sickle cell disease chronic heart failure cirrhosis
renal infection usually caused by gram-negative bacilli from the intestinal tract
acute pyelo-nephritis
bacterial infection associated with renal ischemia which is found commonly in diabetes or immunosuppressed patients
emphysematous
pyelonephritis
Gas from bacteria creates
comet-tail or reverberation artifact
type of chronic peylonephritis that results from long term obstruction and is associated with a staghorn calculus
xanthogranulomatous pyelonephritis
What constitutes renal artery stenosis with direct evaluation
main velocity greater than 180cm/sec
turbulence distal to narrowing
RAR greater than 3.5
What constitutes renal artery stenosis with indirect evaluation
abnormal wave form, small hard pulse which rises and falls slowly, absent early systolic peak
refers to occlusion of the renal artery. it is a sudden cause of prerenal failure.
renal artery thrombosis
Renal vein thrombosis is associated with
trauma renal transplants nephrotic syndrome extrinsic compression renal tumors
What are the sonographic findings of renal vein thrombosis
high resistance renal artery wave form,
enlarges hypoechoic kidney, dilated thrombosed renal vein, absent intrarenal venous flow
inflammation of the bladder
cystitis
cystitis occurs more often in
women
cystitis is typically caused by
bacteria
the sonographic findings of cystitis
thickened bladder wall
most common bladder neoplasm
transitional cell carcinoma
the main symptom of transitional cell carcinoma is
hematuria
most common cause of renal disease leading to renal transplant
diabetes
treatment of choice for end stage renal disease
renal transplant
which kidney is favored to use as a transplant kidney? why?
left, longer renal vein
where are transplanted kidneys typically placed
right iliac fossa of the pelvis in the retroperitoneum
what two arteries are involved in the arterial anastomosis of a renal transplant
internal iliac/hypergastric
external iliac
What are possible post renal transplant complications
fluid collections
renal artery occlusion or thrombosis
renal vein thrombosis
What are the sonographic findings associated with renal transplant rejection
loss of cortical-medullary boundary,
renal enlargement,
prominent hypoechoic medullary pyramids
What 3 labs values are typically evaluated for renal function
urinalysis,
serum creatinine,
blood urea nitrogen (BUN)
How is the serum creatinine related to glomerular filtration rate
inversely (increased creatine=decreased filtration rate)
urinalysis includes microscope evaluation of what contents
glucose protein nitrates and WBC ketones blood
