Urinary system Flashcards
Define Oliguria
Decreased urine production compared to normal
Define Polyuria
Excessive urine output
Define Dysuria
Painful, difficult, burning urination
Define Hematuria
Blood in urine
Define Hydronephrosis
Distension of the pelvis and calyces (Close to the kidney) caused by obstruction
Define Hydroureter
Dilation of the ureter caused by obstruction
Read over the following anomalies of the Kidneys
Unilateral Renal Agenesis
Hypoplastic Kidney
Supernumerary Kidney
Ectopic Kidney
Horseshoe Kidney
T/F
Unilateral Renal Agenesis is common
False; Unilateral Renal Agenesis is rare
What is Unilateral Renal Agenesis?
One of your kidneys does not form
What structures are missing with Unilateral Renal Agenesis?
Renal vein, artery, ureter, adrenal gland, ½ trigone
What happens to the other kidney with with Unilateral Renal Agenesis?
The Other kidney works twice as hard, compensatory hypertrophy
What is Hypoplastic Kidney?
Miniature normal kidney with good function
What category of pathology is Unilateral Renal Agenesis?
Congenital
What category of pathology is Hypoplastic Kidney
Congenital
What happens to the other kidney with Hypoplastic Kidney?
The other kidney has to work harder, so compensatory hypertrophy
T/F
A supernumerary Kidney is the most common type of congenital condition of the kidney.
False; Supernumerary Kidney is a rare condition
What is a Supernumerary Kidney?
An extra kidney (patient has more than 2 kidneys) with a seperate pelvis, ureter, and blood supply
What is the function of the kidneys with a Supernumerary Kidney?
Normal kidney function, however secondary infections are more common
What is an Ectopic Kidney?
Two kidneys that have developed in a weird place in the body
Where are the two most common spots for Ectopic Kidneys?
Pelvis (almost always in the pelvis)
Intrathoracic
What is the function of an ectopic kidney?
Functions fairly normally, but can be prone to blockages or reflux depending on position
What modailty is best to visualize ectopic kidneys?
CT
What is the category of pathology for the horseshoe kidney?
Congenital
What is a horseshoe kidney?
It is where the renal and connective tissue of the kidneys are fused at the lower poles, with the ureters anterior instead of medial
Kidneys fused at the bottom
Tend to look distorted because of the angle that they are on
What is the risk of having a horseshoe kidney?
Obstruction risk
What are the 2 Anomalies of the Renal Pelvis and Ureters?
Duplication
Ureterocele
What is the most common congenital renal tract abnormality?
Duplication
What are the complications of duplications of the renal pelvis and ureters?
Complications:
-Obstruction-More likely to cause obstruction that drains the upper hole
-Vesicoureteral reflux-Causes lots of infections
What are the three types of duplications seen with the renal pelvis and ureters?
=Simple bifid pelvis (L image)
-Bifid Ureter
-Complete double collecting system
Where is the connection for a simple bifid pelvis?
-Joint together proximally
Left image
Where is the connnection for a Bifid Ureter?
Join together before they enter the bladder
Middle image
Where is the connection for complete double collecting system
No connection-two ureters that enter the bladder on its own
Right image
What is the more inferior ureter in a complete doubling collecting system pathology?
The ureter that drains the upper calyx enters more inferior
T/F
Patients with duplications of the ureter and pelvis are often asymptomatic
True
What is a Ureterocele?
Cystic dilation of distal ureter
-Happens because they are entering at a weird angle
-As it is going in, stenosis occurs, and pressure occurs behind that and pushes part of the ureter into the bladder
T/F
Ureterocele is congenital
True
Where does the ureter enter and prolapse in adults with Ureterocele?
-Entering near the normal spot
-Prolapse into bladder
Simple
What does Ureterocele appear as in children?
Ectopic
Duplication
What is the best modailty to image Ureterocele in children?
Ultrasound
How does Ureterocele appear with contrast?
Round density with radiolucent halo (cobra head sign)
Halo around it=the outer part of the ureter that is being pushed in
How does Ureterocele appear without contrast
Radiolucent mass near orifice(where it enters)
How does Ureterocele appear when it is ectopic with contrast?
Large filling defect
What are the 3 inflammatory conditions of the kidney?
Glomerulonephritis
Pyelonephritis
Cystitis
What is Glomerulonephritis?
Nonsuppurative inflammation of glomeruli
What is the cause of Glomerulonephritis?
-Inflammation due to chronic autoimmune disorder
-Can also occur after acute upper respiratory or middle ear infection
What happens to EGFR with Glomerulonephritis?
EGFR WILL GO DOWN (Let through more proteins and blood in urine)
What are the symptoms of Glomerulonephritis?
Protenuria and hematuria
Oliguria
What does Nonsuppurative inflammation mean?
not producing pus
What area is mostly affected with Glomerulonephritis?
Glomerulus
What are the two types of Glomerulonephritis?
Acute and Chronic
How does acute glomerulonephritis appear on a radiograph?
Often normal
Increased kidney size
At first you don’t see much since it tends to resolve on its own
How does chronic glomerulonephritis appear on a radiograph?
Bilateral parenchymal reduction (should appear more rounded and larger)
Normal collecting system
What is Pyelonephritis?
Suppurative (pus producing) inflammation of the kidney and renal pelvis
What part of the kidney does Pyelonephritis affect?
Affects the interstitial tissue (between nephrons and tubules)
What are the 3 Causes of Pyelonephritis?
-Bladder infection (most common)
-Obstruction
=Improper Catheterization or Instrumentation
What is a bladder infection?
Reflux up the ureter and can affect one or both of the kidneys
What are some of the symptoms of Pyelonephritis?
High fever
Chills
Back pain
Dysuria (painful urination)
Pyuria (pus in the urine)
What are the two types of Pyelonephritis?
Chronic and acute
How does Pyelonephritis appear in acute radiographs?
-No imaging appearance
How does Pyelonephritis appear in Chronic radiographs?
-Clubbing of the calyces, cortical thinning
-Collecting system affected
What is Cystitis?
-Inflammation of the bladder
What is the most common nosocomial infection?
-Cystitis
What sex is Cystitis most common in?
Most common in women
What are the causes of Cystitis?
-Spread of bacteria present in fecal material
-Instrumentation or catheterization of bladder not done properly (i.e. not cleaned)
-Retrograde flow from urine bag (make sure bag is lower than the patient)
-Sexual intercourse
What is the appearance of Cystitis in ultrasound?
thickened wall
What is the appearance of cystitis in CT?
thickened wall (sometimes gas in wall)
What is the appearance of cystitis in a Cystogram?
Irregular filling defects in wall
What are the other names for Urinary Calculi?
Urinary Calculi/Nephrolith/Urolith
What is the most common pathology of the kidney?
Urinary Calculi/Nephrolith/Urolith
When does Urinary Calculi start to become symptomatic?
Asymptomatic until stuck in the ureter
What are the common locations for Urinary Calculi?
1.UP junction
2.Pelvic Brim (ureter crosses in front of Iliac vessels)
3.UV junction
What are the causes of urinary calculi?
*Urinary stasis
*Not enough water intake
*Infection
*Underlying metabolic abnormality - Hypercalcemia (hyperparathyroidism)
What percentage of Urinary calculi are radiopaque?
80% radiopaque (calcium)
What percentage of Urinary calculi are radiolucent?
20% radiolucent
What modalities are used to image Urinary calculi?
Contrast study, non contrast study or Ultrasound
T/F
34% of Urinary calculi missed due to size, location or obscuring bowel or bone
True
How would you demonstrate Urinary calculi using general x-ray to show the right UP and right UV junction?
*30 degree RPO to demonstrate the right UP junction
*45 degree LPO to demonstrate the right UV junction
How do Urinary calculi appear in US?
*Echogenic region w/ acoustic shadowing
*Hydroureter/hydronephrosis
What is the modality of choice for urinary calculi?
CT non contrast , helical scan
What are the radiographic signs of urinary calculi in CT?
-Demonstrates hydronephrosis/hydroureter
-Soft tissue rim sign (not necessarily to a 100% sign of Urinary Caluli) (fluid/edema around the ureter head)
What is the Stag horn calculus appearance common with?
Urinary calculi
What are the 2 Treatments for urinary calculi?
- ESWL (Extracorporeal Shock Wave Lithotripsy)
- Ureteroscopy + laser lithotripsy
What is ESWL (Extracorporeal Shock Wave Lithotripsy)
Sound waves are focused on stone to break it up from outside the body
T/F
ESWL is very traumatic for the patient
True; very painful-Often give you lots of local anasthetic
T/F
ESWL is Non-invasive
True
What is Ureteroscopy + laser lithotripsy?
Where a Camera passed into the ureter using a Scope. The Laser breaks up the stone.
What are Phleboliths?
Calcifications within veins
Where are Phleboliths mostly located?
Mostly within inferior pelvis
What percentage of the adult population has Phleboliths?
Fairly common (39-48% of adult population)
How do Phleboliths appear radiographically?
May have radiolucent centre
Lower HU than calculi
Comet-tail sign (curved soft tissue beside)
Read over the following cysts and tumours of the urinary system:
Renal Cyst
Polycystic Kidney Disease
Renal Carcinoma
Wilms’ Tumour (Nephroblastoma)
Carcinoma of the Bladder
Prostatic Hyperplasia
T/F
Renal cysts are most commonly unifocal (everything looks similar)
True
T/F
Renal cysts are usually unilocular.
True; one chamber, some do have septations-content still looks like a cyst
What modalities are used to look at Renal Cysts?
IVU, US, CT
How do renal cysts appear with IVU?
Smooth, very thin, radiopaque rim surrounds lucency
How do renal cysts appear with US?
Anechoic
What is the Modality of choice for differentiating with solid mass lesions?
US
How do renal cysts appear with CT
Does not enhance with contrast (hypodense)
What is the cause of Polycystic Kidney Disease?
Inherited disease
What is Polycystic Kidney Disease?
Progressive renal impairment That causes compression of nephron and Intra renal obstruction
What percentage of patients with Polycystic Kidney Disease also have liver cysts-Hypodense on kidney and liver?
1/3 or 33% of patients
What percentage of patients with Polycystic Kidney Disease also have cerebral aneurysms?
10% of patients
T/F
Many patients with Polycystic Kidney Disease are hypertensive
True (compresses the artery)
How does Polycystic Kidney Disease appear in all modalities?
Enlarged kidney, multilobular contour-ON ALL MODAILTIES
How does Polycystic Kidney Disease appear in IVU?
*Swiss Cheese pattern
*Cyst wall calcifications
How does Polycystic Kidney Disease appear in Ultrasound?
Shows many anechoic areas
Can CT be used to image Polycystic Kidney Disease?
Yes
What is another name for Renal Carcinoma?
Hypernephroma
What is the primary cancer of the kidneys and the most common renal neoplasm?
Renal Carcinoma
What population is Renal Carcinoma seen in?
Predominantly in 40+ population
*More common as you get older
Where does Renal Carcinoma arise from in the kidneys?
Arises from tubular epithelium of renal cortex
What percentage of Renal Carcinomas involved calcification? Where is the calcification located?
10% involve calcification-Typically central (not along the edges)
What percentage of renal carcinomas display the “triad of symptoms?”
10% “triad of symptoms”
What are the “triad of symptoms” as seen with renal carcinoma?
-Hematuria-Peeing blood (usually painless)
-Flank pain
-Palpable abdominal mass
Where does renal carcinoma metastasis?
Metastases to lung, liver, bones, and brain
What two modalities are used to image Renal Carcinoma?
CT and US
What are the radiographic appearances of renal carcinoma in CT?
-Solid mass, but heterogeneous
-Necrotic neoplasms
What is the modality of choice for imaging renal carcinomas?
CT
How do renal carcinomas appear in US?
Solid mass with internal echoes
What modality is a really good starting point and ruling out whether it’s a cyst or a tumour?
Ultrasound
What is the most common abdominal neoplasm of infancy and childhood?
Wilms’ Tumour (Nephroblastoma)
T/F
Wilms’ Tumour (Nephroblastoma) Tends to become very large
True
What is Wilms’ Tumour (Nephroblastoma)?
Displacement +/or distortion of collecting system
What is the modality of choice to image Wilms’ Tumour (Nephroblastoma)?
US modality of choice
What treatment is done for Wilms’ Tumour (Nephroblastoma)?
Nephrectomy, followed by chemo/radiation
What population is Carcinoma of the Bladder most commonly seen in?
Most common in men 50+
What are the predisposing factors for Carcinoma of the Bladder?
*Industrial chemicals
*Cigarette smoking
What are the Imaging appearances for Carcinoma of the Bladder?
*Finger-like projections into lumen
*Infiltration of bladder wall-in this image; spreads in towards the bladder
*Possible calcifications
What is Prostatic Hyperplasia and what population is it most commonly seen in?
An Enlarged prostate in men 60+ which may obstruct urethra.
How does Prostatic Hyperplasia appear?
-Smooth elevation of bladder floor
What does Prostatic Hyperplasia lead to?
Causes bilateral hydroureter, hydronephrosis, and cystitis
What modalities are used to image Prostatic Hyperplasia?
US, MRI, or Urogram
What imaging is best for Prostatic Hyperplasia
-Transrectal biopsy using ultrasound
-Biopsy is the BEST option-transrectally
What is renal hypertension?
-Body thinks that the reason you don’t have enough blood in kidney is because of low blood pressure; but the real cause is stenosis
What is the cause of Renal Hypertension
-Can be caused by renal artery stenosis
What modalities are used to image Renal Hypertension
Seen with Doppler US, CT angiography, DSA, MRA
What are the two types of renal failure?
Acute Renal Failure-Sudden
Chronic Renal Failure-Long
What is Acute Renal Failure?
Rapid deterioration of kidney function
What pathology causes the breath to smell fishy?
Acute Renal Failure
What pathology is this describing?: Urea and creatinine accumulate in blood (whether acute or chronic)
Acute Renal Failure
What are the Causes of Acute Renal Failure?
1.Prerenal
2.Postrenal
What is the prerenal cause of acute renal failure?
-Decreased blood flow to kidneys
-Hemorrhage, heart failure, renal artery stenosis
What is the postrenal cause of acute renal failure?
-Obstruction of urine outflow from kidneys
-Prostatic enlargement, kidney stones, neoplasms-affects the ability to drain
What is one non radiographic sign of Acute Renal Failure
Oliguria (less than 400mls of urine in 24 hours)
What is seen radiographically with acute renal failure?
-Bilateral smooth kidney enlargement
-Kidneys themselves are becoming larger
T/F
With Chronic Renal Failure, the kidneys will appear smaller
True
T/F
Chronic Renal Failure is End-stage kidney disease
True
What is the treatment for Chronic Renal Failure?
Long-term dialysis or kidney transplant
What are 6 non radiographic signs of Chronic Renal Failure?
1.Uremia (increased levels of urea and creatinine)
2.Irritates GI tract (nausea, diarrhea)
3.Drowsiness, dim vision
4.Pruritis (intense itching of skin)
5.Generalized edema
6.CHF (congestive heart failure)
