urinary system - abnormal Flashcards
Renal calculi Description
The presence of calculi (stones) anywhere in the kidney.
• There are different types including – calcium, struvite (often formed in response to infection), uric acid (from food high in purines)
Renal calculi causes and symptoms
causes = stones form when urine becomes concentratedallowing minerals to crystallise and stick together
dehydration
diet - high levels of salt, animal protein and vitamin C can increase the risk
family history
mainly in eldery patients and more common in men
symptoms = pain often severe depends on where the stone is
diagnosis and treatment of renal calculi
diagnosis = • Radiographic features depend on stone composition and modality used.
• Some stones seen on AXR cannot be seen on CT
• AXR – can see calcium containing stones. Struggle to see uric acid stones
• CT – can see almost all stones but some can be really hard to see
• US – harder to see small stones
Treatment
surgery if:
Large stones (above 5mm)
Long duration of symptoms
Infection / sepsis
Failed conservative management
ureter calculi
Any calculi lying within the ureter
ureter calculi causes and symptoms
causes = stones form when urine becomes concentratedallowing minerals to crystallise and stick together
dehydration
diet - high levels of salt, animal protein and vitamin C can increase the risk
family history
mainly in eldery patients and more common in men
symptoms = depends on location pain may be located away from the kidney so patients may
have groin pain or can mimic appendicitis
diagnosis and treatment of ureteric calculi
Diagnosis
• AXR – can see large radiopaque calculi. Not good for assessing for obstruction or hydronephrosis
• CT – gold standard. 99% can be seen over 1mm.
• US – useful and no radiation
Treatment
• Hydration and pain relief
• Surgery if failed conservative management
Bladder stones (calculus)
Stones found in the bladder
bladder stones causes and symptoms
causes = • Rare. Often form when you don’t fully empty your bladder of urine
3 types
Symptoms
• Pain, infection, haematuria
diagnosis and treatment of bladder stones
Diagnosis
• AXR – dense, radiopaque calculi, often large and often lots. Smooth and rounded
• US – they are mobile and echogenic. May also see bladder wall thickening due to inflammation
Treatment
• Surgery
• Treatment of the underlying cause
renal cysts
General term for any cystic lesion
simple cyst = round/oval
causes and symptoms of renal cysts
Causes
• Incidences increased with age
Symptoms
• Mostly asymptomatic
diagnosis and treatment of renal cysts
Diagnosis
• Often found incidentally
• CT – round, homogenous, fluid filled with no septations or calcifications
• US – round, oval shape with smooth walls, no calcifications
Treatment
• If asymptomatic they are normally left – sometimes monitored.
Polycystic kidneys
• Description
• Lots of different names
Causes
genetic - inherited adult cystic renal disease
Symptoms
• Recurrent urinary tract infections
• Cyst haemorrhage / infection
• At 30 approx. 68% of patients will have cysts that can be seen on US
• Urinary tract stones
• Depends on amount and size – pain, palpaable mass hypertension and renl failure
polycystic kidneys diagnosis and treatment
Diagnosis
• Generally family history and imaging
• It can be really hard to report on imaging due to the amount and size of the cysts
• Radiographs – no role
• US – quick, no radiation dose, good first line diagnosis
• CT – simple cysts appear as rounded structures with HU like water and thin walls.
• MRI – most sensitive for small cysts
Treatment
transplant or dialysis
recurrent urinary tract infections
cyst haemorrhage/infection
urinary tract stones
Medullary sponge kidneys Description
comdition where the medullary portions of the collecting systems are dysplastic and dilated
causes and symptoms of medullary sponge kidneys
causes =
- developmental defect
- associated with ehlers danlos syndrome and other congenital syndromes
symptoms =
- UTIs
- haematuria and urinary tract calculi
diagnosis and treatment of medullary sponge kidney
diagnosis =
- radiograph/ CT
- US
treatment =
- no specific treatment
- mainly focuses on managing the urinary tract infections and renal calculi
Renal cell carcinoma
Description
• Primary malignant adenocarcinoma derived from the renal tubular epithelium
- most common renal tumour
causes and symptoms of renal cell carcinoma
causes =
- risk factors include smoking, hypertension
- Associations with some inherited syndromes and sickle cell disease
symptoms =
-haematuria
- flank pain
- palpable mass
- patients can also develop hypertension
diagnosis and treatment of renal cell carcinoma
Diagnosis
US not as sensitive as MRI or CT
CT
MRI
treatment
nephrectomy - full or partial
bladder cancer
there are different types
TCC - most common cancer of the bladder and the entire urinary system
causes and symptoms of bladder cancer
causes = risk factors - treatment with certain chemo drugs, smoking , environmental triggers
symptoms = haematuria
depending on location - pain and urinary retention
diagnosis and treatment of bladder cancer
diagnosis =
cystoscopy and biopsy
US - limited
CT
MRI
treatment =
depends on staging
local tumours can be diagnosed by resection and chemo
invasive tumours require cystectomy and chemo and radiotherapy
Chronic kidney disease
Description
• Also called chronic renal failure
• Abnormal kidney structure or function, typically seen by a progressive loss of glomerular function
causes and symptoms chronic kidney disease
Causes
• Diabetes, hypertension, polycystic kidney disease
Symptoms
• Depends on the aetiology – may have no symptoms until there are serious complications
diagnosis and treatment of chronic kidney disease
Diagnosis
• No specific imaging features
• Long standing CKD on US may look like a thin renal cortex, smaller kidney size, marginal irregularities
treatment
Patients may need dialysis, renal transplant
Why don’t we give contrast to people with low
eGFR’s?
• The risk of contrast induced acute kidney injury is highest in patients with the lowest renal function
• Usually presents 24-48hours of exposure to contrast with elevation in creatinine levels
• Contrast is toxic to the tubular epithelial cells leading to necrosis and apoptosis
• IV hydration is the best way to mitigate the effects
Adrenal pathology
there are a large number of adrenal tumours both benign and malignant often found incidently
adrenal denoma is the most common adrenal lesion
causes and symptoms adrenal pathology
causes = no definite cause but frequency increases with age
symptoms = 95% or more are asymptomatic
diagnosis and treatment adrenal pathology
diagnosis = imaging is important for assessment
CT
or atypical
MRI
treatment
if there is hormone disruption the tumour needs resecting
small tumours may be left and monitored
Ureterostomy / urostomies
• This is the creation of a stoma for a ureter or kidney
• It diverts the flow of urine away from the bladder when the bladder has been removed or is not functioning
Peritoneal dialysis
• Dialysis is a procedure to remove waste
products and excess fluid from the blood when the kidneys aren’t functioning
• Usually done while waiting for a renal transplant
• Peritoneal dialysis uses the peritoneum
as the filter instead of a machine
• Tube is placed into the peritoneal cavity. Fluid is pumped through the cavity and the used fluid is drained a few hours later.
• Normally done 4 times a day for 30mins
