Urinary system Flashcards
normal kidneys measure _____ long, _____ wide, and _____ thick
9 to 12 cm, 5 cm, and 2.5 cm
the outer cortex is _____ than the inner medulla because of increased perfusion of blood
darker
the inner surface of the medulla is folded into projections called _____, which empty into the renal pelvis
renal pyramids
the _____ are located at the base of the pyramids and separate the medulla from the cortex
arcuate arteries
numerous collecting tubes bring the urine from its sites of formation in the cortex to the pyramids, the renal tubules, or _____, are the functional units of the kidneys
nephrons
a fibrous capsule called the _____ capsule surrounds the kidney
true
outside of the fibrous capsule is a covering of perinephric fat, which is surrounded by the perinephric fascia known as _____
Gerota’s fascia
within the kidney, the upper expanded end of the ureter, known as the renal pelvis of the ureter, divides into two or three _____, each divides further into 2 or 3 _____
major calyces; minor calyces
the apex of the medullary pyramid, called the renal _____, indents each minor calyx
papilla
a nephron consists of 2 main structures, a renal ____ and a renal ____; nephrons filter the blood and produce urine
corpuscle (filers blood); tubule (where substance needed by the body is returned to the blood)
the renal corpuscle consists of a network of capillaries called the _____, which is surrounded by a cuplike structure known as Bowman’s capsule
glomerulus
blood flows into the glomerulus through small _____ arteries and leave the glomerulus through an _____ arteries
afferent; efferent
the ureter is a _____ long tubular structure whose proximal end is expanded and continuous with the funnel shape of the renal pelvis; travels behind the parietal peritoneum long the psoas muscle; enters the pelvis by crossing the bifurcation of the common iliac artery
25 cm
what are the 3 constrictions seen along the ureter’s course?
where the ureter leaves the renal pelvis, where it is kinked as it crosses the pelvic brim, and where it pieces the bladder wall
the _____ has a posterior and lateral opening for the ureters and an anterior opening for the urethra
urinary bladder; interior is lined with elastic transitional epithelium; the middle contracts to expel urine
the ______ includes 2 sphincters; the internal sphincter and the external
urethra
to prevent threatening homeostasis, metabolic waste must be quickly _____
excreted; these include water, carbon dioxide, and nitrogenous waste (urea, uric acid, and creatinine)
a patient with a renal _____ or disease process may present with flank pain, hematuria, polyuria, oliguria, fever, urgency, weight loss, or general edema
infection
_____ is essential to detect urinary tract disorders in patients whose renal function is impaired or absent
urinalysis; the presences of an acute infection causes hematuria, or red blood cells in the urine; pyuria is pus in the urine
______ is very important in managing disease such as bacteriuria and renal calculi
Urine pH; the pH refers to the strength of the urine as a partly acidic or alkaline solution
the _____ is the measurement of the kidney’s ability to concentrate urine
specific gravity; depends of the quantity of dissolved waste products; this is especially low in cases of renal failure, glomerular nephritis, and pyelonephritis
_____ is the appearance of blood cells in the urine; it can be associated with early renal disease
hematuria; abundance may suggest renal trauma, neoplasm, calculi, pyelonephritis, or glomerular or vascular inflammatory processes, such as acute glomerulonephritis and renal infarction
the _____ is the relative ratio of plasma to packed cell volume in the blood
hematocrit; decreased occurs with acute hemorrhagic process secondary to disease or blunt trauma
_____ is present in urine whenever extensive damage or destruction of the functioning erythrocytes occur
hemoglobin; can cause acute renal failure
when glomerular damage is evident, _____ and other plasma proteins may be filtered in excess, allowing the overflow to enter the urine, which lowers the blood serum albumin concentration
albumin; albuminuria is commonly found with benign and malignant neoplasms, calculi, chronic infection, and phylonephritis
specific measurement of _____ concentration in urine and blood serum are considered an accurate index for determining the glomerular filtration rate
creatinine; decreased urinary creatinine clearance indicates renal dysfunction because creatinine blood levels are constant, and only decreased renal function prevents the normal excretion of creatinine
the ______ is the concentration of urea nitrogen in blood and is the end product of cellular metabolism
blood urea nitrogen (BUN); impairment of renal function and increased protein catabolism results in BUN elevation that is relative to the degree of renal impairment
renal dysfunction also results in serum creatinine _____
elevation; they are said to be more specific and more sensitive in determining real impairment than BUN
a state of _____ causes the infundibula and renal pelvis to be collapsed and thus indistinguishable from the echo-dense renal sinus fat
dehydrated
the _____ of the pyramid points toward the sinus, and the _____ lies adjacent to the renal cortex
apex; base
_____ is a result of a partial fusion of two embryonic parenchymal masses called renunculi during normal development
junctional parenchymal defect; rectangular echogenic area
_____ is development variation that usually presents in children up to 5 years old, may be present in adults
fetal lobulation
______ is a condition characterized by deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy
sinus lipomatosis
a _____ is a long pelvis that extends outside the renal border
extrarenal pelvis; central cystic region that extends beyond the medial renal border
______ is a fusion of the polar region of the kidneys, usually the lower poles
horseshoe kidney; kidneys are seen more medial and anterior to the spine; most common renal anomaly
_____ shows two echogenic regions separated by moderately echogenic parenchymal tissue
duplex collecting system; located in the central renal sinus
renal _____ is incomplete development of the kidney, usually with fewer than five calyces
hypoplasia
_____ duplication consists of two collecting systems and two ureters, with a single ureter entering into the urinary bladder
incomplete
with ______ it is almost always malrotated; the renal pelvis faces anteriorly and is predisposed to reflex, infection, ureteropelvic junction obstruction, and stone formation
renal ectopia
a _____ lesion is described as 1) smooth, thin, well-defined border 2) round or oval shape 3) sharp interface between the cyst and the renal parenchyma 4) no internal echoes and 5) increased posterior acoustic enhancement
cystic
a _____ lesion projects as a nongeometric shape with irregular borders, a poorly defined interface between the mass and the kidney, low-level internal echoes, a weak posterior border caused by increased attenuation of the mass, and poor through-transmission
solid
areas of necrosis, hemorrhage, abscess, or calcification within the mass may alter the classification and cause the lesion to fall into the _____ category
complex; characteristics of both cystic and solid lesion
ureteral narrowing due to fibrosis is a common form of ureteral _____
stricture
a _____ is a cystlike enlargement of the lower end of the ureter caused by congenital or acquired stenosis or the distal end of the ureter
ureterocele; may cause obstruction and infection of the upper urinary system; a cobra head appearance is seen in sagittal view
with ectopic ureterocele, the ureter which empties the _____ pole inserts low in the bladder by the bladder neck, urethra, or lower genital tract
upper; the ectopic ureter may become stenotic and cause ureteral obstruction, associated with hydroureter and hydronephrosis; round thin-walled cystic structure that may contain debris
the bladder wall should be smooth and thin measuring _____
3-6 mm
a residue of less than _____ of urine is considered normal in an adult
20 ml
_____ cysts may contain septations, thick walls, calcifications, internal echoes, and mural nodularity
complex; must be considered malignant until otherwise proven; walls any thicker than 1mm is abnormal
sonographically it is hard to differentiate between a septated cyst and small, adjacent cortical cysts known as ______ cysts
kissing
the _____ cyst originate from the renal sinus and is most likely lymphatic in origin
parapelvic; could present with hypertension or obstruction (hilum cyst); well-defined sonolucent mass with regular or irregular border; not connected to the renal collecting system
with _____ predominant abnormalities include retinal angiomas, cerebellar hemangioblastomas, and variety of abdominal cysts and tumors, including renal and pancreatic cysts
von Hippel-Lindau; high incidence of renal cysts
______ may be difficult to separate from adult polycystic kidney disease
tuberous sclerosis
_____ is found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis for greater than 3 years
acquired cystic kidney disease; found in cortex; simple cyst; atypical because of hemorrhage; normal or small echogenic kidneys with decrease in corticomedullary distinction with simple or atypical cysts
_____ disease may present in one of two forms: the infantile autosomal recessive form and the adult autosomal dominant form
polycystic kidney disease
_____ polycystic kidney disease is a fairly rare genetic disorder, the gene that causes this disorder has been located on chromosome 6; no distinction between the corticomedullary region; cysts to small to be seen
autosomal recessive (infantile); may be seen in utero; renal insufficiency; long hypoplasia; in juvenile form portal hypertension, hepatic fibrosis, and GI hemorrhage; bilateral enlargment of echogenic kidneys
the most common type of autosomal dominant polycystic kidney disease is _____
type 1; located on the short arm of the forth chromosome and affects the kidney more severely than type 2
with _____ kidneys lose their reniform shape; in late stage, no normal renal parenchyma may be identified; bilateral enlarged kidneys with multiple cysts of varied size; cysts may be atypical because of infection and hemorrhage; cysts may be found in liver, spleen, testes, and pancreas
adult polycystic kidney disease; hypertension; renal failure; abdominal, flank pain; fever chills; uremia; palpable mass; polycythemia; hematuria; does not usually manifest until the 4th or 5th decade of life
_____ disease is a common nonhereditary renal dysplasia that usually occurs unilaterally, with the kidney functioning poorly if at all; no renal parenchyma surrounding the cysts; enlarged kidneys in children, but small in adults
multicystic dysplastic kidney; most common palpable mass in neonates; restricted growth in children; polyuria; hypertension; infection; absence of renal vascularity
_____ is a development anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilatation of the distal collection ducts (duct of Bellini), causing stasis of urine and stone formation
medullary sponge kidney; pain; hydronephrosis; infection; normal or small kidneys with echogenic parenchyma (cysts too small to be resolved on sonogram) or small cysts in medulla and corticomedullary region with increased echogenicity
medullary cystic disease is very similar to the childhood disease familial juvenile _____; anima; salt loss; progressive azotemia; polyuria
nephronophthisis; normal small echogenic kidneys with widening of the renal sinus after 2 cm in the medulla or corticomedullary junction
the presence of _____ in a renal mass is always a sign of malignancy
calcifications; if malignancy is suspected look for thrombus/tumor in surrounding veins; evaluate the contralateral kidney, liver, and retroperitoneum for metastases
_____ also called hypernephroma, or Grawitz’s tumor, is the most common of all renal neoplasms and represents 85% of all kidney tumors; weight loss; fatigue; fever; pain; palpable mass; twice as common in males as females (6th or 7th decade of life)
renal cell carcinoma; cystic or complex mass that may have areas of calcifications; may displace renal pyramids and invade renal architecture; irregular margins; hypervascular; renal vein and IVC thrombosis
_____ carcinoma accounts for 90% of malignancies that involve the renal pelvis, ureter, and bladder; twice as often in man than women; often occurs in 7th decade; most common in renal pelvis
transitional cell; solid hypoechoic mass; not well defined within the renal sinus; may be multiple; papillary are more common (low-grade malignancies); small tend to be flat and generally high-grade malignancies
_____ carcinoma is a rare, highly invasive tumor with a poor prognosis
squamous cell; gross hematuria; history of chronic irritation; large bulky mass; invasion of the renal vein and IVC
_____ form of renal lymphoma is more common; hypoechoic mass may be bilateral; enlarged kidneys
secondary; usually caused by lymph involvement; more common in patients with non-hodgkin lymphoma; usually no renal symptoms
______ or Wilms tumor is the most common abdominal malignancy in children; peak incidence is seen at 2.5 to 3 years of age (normally always younger than 5)
Nephroblastoma; palpable abdominal mass; abdominal pain; nausea and vomiting; usually unilateral; heterogeneous; look for extension into renal vein and IVC
renal _____ is the most common benign renal tumor; hyperechoic; intratumoral hemorrhage
angiomyolipoma; composed of varying proportions of fat, muscle, and blood vessels; associated with tubular sclerosis
_____ is a well-defined mass with spoke-wheel patterns of enhancement and central scar
oncocytoma; asymptomatic
a _____ consists of fat cells and is the most common of the mesenchymal type of tumors
lipomas; well-defined echogenic masses within the kidney
there are 2 classifications of intrinsic renal disease 1) produces an increase in ______ echoes, believed to result from deposition of collagen and fibrous tissue 2) causes loss of normal _____ detail, resulting in inability to distinguish the cortex and medullary regions of the kidney
cortical; anatomic
in _____, necrosis or proliferation of cellular elements occurs in the glomeruli
acute glomerulonephritis; increase cortical echoes; nephrotic syndrome; hypertension; anemia; peripheral edema
______ has been associated with the infectious processes of scarlet fever and diphtheria; enlarged kidneys with increased cortical echoes
acure interstitial nephritis; may manifest from an allergic reaction to certain drugs; uremia; hematuria; rash; fever; eosinophilia;
systemic _____ is a connective tissue disorder believed to result from an abnormal immune system
lupus erythematosus (nephritis); increased cortical echoes and renal atrophy; hematuria; proteinuria; renal vein thrombosis; renal insufficiency
_____ is a highly contagious disease, spread mainly by unprotected sex or infected needle; the virus destroys T cells and then replicates rapidly within the body
acquired immunodeficiency syndrome (AIDS); renal dysfunction; kidneys are normal or enlarged; echogenic parenchyma; increased cortical echoes
_____ causes hematuria and renal vein thrombosis; patents with acute renal vein thrombosis has enlarged kidneys with decreased echogenicity; subacute, enlarged kidneys with increased cortical echogenicity
sickle cell Nephropathy
with _____ uncontrolled hypertension can lead to progressive renal damage and azotemia
hypertensive nephropathy; small kidneys with smooth borders may have distortion of intrarenal anatomy
_____ occurs when the cells at the apex of the renal pyramids are destroyed; may develop within weeks or months after transplantation; patients with cadaveric kidney are at greatest risk
papillary necrosis; fluid-filled spaces at the corticomedullary junction; round or triangular; mimics calculi; dysuria; acute renal failure
with renal _____ intrarenal anatomy is preserved with uniform loss of renal tissue; renal sinus lipomatosis occurs secondary
atrophy; renal failure; small echogenic kidneys
decrease profusion of the kidneys can cause _____ failure and can be diagnosed by clinical and laboratory data and also by color doppler
prerenal; acute renal failure findings; decreased renal output; hydronephrosis; enlarged hyperechoic kidneys; renal artery stenosis
______ is usually the result of outflow obstruction and is potentially reversible
postrenal failure; increased in patients with malignancy of the bladder, prostate, uterus, ovaries, or rectum \
______ is the most common medical renal disease to produce acute renal failure
acute tubular necrosis; renal insufficiency; hematuria; bilateral enlarged kidneys with hyperechic pyramids
______ disease is the loss of renal function as a result of disease, most commonly parenchymal disease
chronic renal; hypertension; bilateral small echogenic kidneys
_____ is the separation of renal sinus echoes by interconnected fluid-filled calyces (dilation of the pelvocalyceal system)
hydronephosis; has 3 grades 1) small fluid-filling 2) dilatation of some but not all calyces (still concave) 3) complete pelvocaliectasis (change to convex); echogenic line separating collecting system 4) prominent dilatation of the collecting system, thinning of renal parenchyma; no differentiation between collecting system and renal parenchyma
with a congenital obstruction of the ______ junction the collecting system will be dilated without dilation of the ureter
ureteropelvic; localized hydro occurs as a result of strictures, calculi, focal masses, or a duplex collecting system
hydronephrosis with a dilated ureter indicates obstruction of the ______ junction
ureterovesical; with dilated bladder indicates obstruction of the posterior urethra
______ occurs when pus is found within the collecting renal system; associated with severe urosepsis
pyonephrosis; dilated collecting system with low-level echoes or decrease through transmission; renal insufficiency; hematuria
______ pyelonephritis occurs when air is present in the parenchyma
emphysematous; diffuse gas-forming parenchymal infection; enlarged kidneys appear hypoechoic and inflamed
______ pyelonephritis is an uncommon renal disease associated with chronic obstruction and infection; involves destruction of renal parenchyma and infiltration of lipid-laden histiocytes
xanthgranulmatous; multiple infections; nonfunctioning kidneys; “stagehorn appearance”; increased echogenicity; increased renal size; dilated calyces
linear vascular calcifications commonly are associated with renal artery atherosclerosis and/or ______ malformation
vascular
______, or parenchymal calcification, involve diffuse foci of calcium deposits, which usually are located in the medulla but infrequently can be seen in the renal cortex
Nephrocalcinosis; both kidneys are affected; increased cortical echogenicity with spared pyramids; and increased medulla
the most common type of _____ are atherosclerosis and fibromuscluar dysplasia
renal artery stenosis; increased velocity through the stenotic area greater than 150 to 190 cm/sec; turbulance distal to the narrowing;
_____ is associated with hypertension, which is more common in older patients, and account for one third of cases of RAS
atherosclerosis; occurs within the first 2cm of the renal artery
_____ dysplasia accounts for approximately two thirds of RAS cases and is seen in younger patients
fibromuscular; may involve any layer of the renal walls; usually in middle portion; string of beads appearance
renal _____ occurs when part of the tissue undergoes necrosis after cessation of the blood supply, usually as a result of artery occlusion
infarction; appear as irregular areas; triangular in shape; contour may be lumpy-bumpy;
complications that can arise after _____ include rejection; acute tubular necrosis, obstructive nephropathy, extraperitoneal fluid collections, hemorrhage or infarction, recurrent glomerulonephritis, graft rupture, and renal emphysema
transplant; patients risk are age, primary diagnosis, secondary medical complications, and transplant source
the success of the transplant is directly related to the _____ of the donated kidney
source; the surgical procedure begins with removal of the donor’s left kidney; which is then rotated and placed in the recipient’s right iliac fossa or groin region; the ureter is inserted into the bladder above the normal ureteral orifice
as early as _____ hours after surgery, a baseline sonographic examination is performed to identify renal size, calyceal pattern, and extrarenal fluid collections
48
the _____ appears as parallel linear echoes posterior to the kidney transplant
psoas
what are the 4 types of renal transplant rejections?
hyperacute, acute, immunologic, chronic
_____ rejection occurs within hours and is caused by vasculitis leading to thrombosis and usually loss of the graft
hyperacute
_____ rejection occurs within days to months after transplant
acute
causes of _____ rejection include pre-formed antibodies, immune complexes, and cell-mediated responses
immunologic
_____ rejection can occur months after transplantation with gradual onset; secondary to mononuclear infiltration and fibrosis
chronic; signs of rejection: enlargement and decreased echogenicity of the pyramids; hyperechogenic cortex; a localized area of renal parenchyma presenting an anaechoic appearance; distortion of the renal outline caused by localized areas of swelling involving both cortex and medulla
irregular parenchymal echo patterns may result from parenchymal atrophy with fibrosis and shrinkage resulting from long-standing renal _____
rejection
_____ is the most common cause of acute posttransplant failure; associated with prolonged severe ischemia
acure tubular necrosis; higher in cadaveric transplants; elevated serum creatinine level
_____ is an immunosuppressant drug used to prevent rejection of kidney allogenic transplants
cyclosporine; toxic to the kidney in high doses
_____ is a newly discovered delayed complication that is now becoming prevalent as the life of transplants have improved
malignancy; 2 major types are non-Hodkins lymphoma and skin cancer; there is a correlation with the immunosuppressant drugs used cyclosporine (increases non-Hodkins) and Azathioprine (increases skin cancer)
a _____ may develop shortly after surgery, one of the major indications for a sonogram may be a drop in hematocrit
hematoma
graft rupture can occur in the first _____ after surgery, presenting with an abrupt onset of pain and swelling over the graft, oliguria, and shock
2 weeks; gross distortion of the graft contour and perinephric or paranephric hematoma
the use of contrast agents for visualization of renal arteries is not ____ approved
FDA
a stone located in the urinary system is called _____; consists of a combination of chemicals that precipitate out of urine
urolithiasis (kidney stones); doppler causes a twinkling artifact posterior to the stone
stones that are large and fill the renal collecting system are called _____
stagehorn calculi; stones are associated with renal acidosis
a bladder _____ is a herniation of the bladder wall
diverticula; congenital lacks a muscular layer and has a neck; acquired are associated with calculi; neck of varying size connecting the adjacent fluid-filled structure to the bladder
______ is usually secondary to another condition that causes stasis of the urine in the bladder; as inflammation increases, the smooth bladder wall will become diffuse or nondiffuse with hypoechogenic thickening, the bladder will become fibrotic and scarred
cystitis
most bladder tumors in adults are _____ carcinoma
transitional cell; present with hematuria, dysuria, urinary frequency, or urinary urgency; focal bladder wall thickness
