urinary system ppt test 3 Flashcards
Urinary System Anatomy- 4 parts
Kidneys
Ureters
Bladder
Urethra
types of PATHOLOGY
Renal masses
Obstructive uropathy
Inflammatory diseases
Vascular pathology
Renal failure
3 types of renal masses
Cystic - anechoic, smooth walls, posterior enhancement
Solid - nongeometric shape with irregular borders, poorly
defined interface, low-level internal echoes
Complex - Shadowing; characteristics of both cystic and
solid components
type of renal mass
anechoic, smooth walls, posterior enhancement
cystic
type of renal mass
nongeometric shape with irregular borders, poorly
defined interface, low-level internal echoes
solid
type of renal mass
Shadowing; characteristics of both cystic and
solid components
complex
This is a term used when the calyces and renal pelvis have a
compressed appearance due to the accumulation of excessive
(nontumorous) fatty tissue within the renal sinus
RENAL SINUS LIPOMATOSIS
what is this
fat around the kidney
2 types of cystic disease placement
perirenal
subcapsular
t/f
cystic disease can be hereditary and non hereditary
true
Non-hereditary
◦ Developmental
◦ Acquired
Hereditary
name that pathology
Unknown origin
Serous fluid collection originating in the renal cortex
Uncommon before 40 years
Found in 50% of people over 50 years old
May be multiple (rarely more than 4 per kidney
simple cyst
they are unilocular
name that pathology
-Anechoic, well-defined mass located at the renal hilum
-No communication with collecting system
-Spherical in shape
-Patient may present with hypertension, hematuria, or
hydronephrosis from pressure the cyst applies to
surrounding structures
PARAPELVIC CYST
name that pathology
Hereditary
Characterized by bilaterally enlarged and cyst-filled
kidneys
Two types:
◦ Adult (APKD)
◦ Infantile (IPKD
POLYCYSTIC KIDNEY DISEASE
name that pathology
-Fairly common
-Autosomal dominant trait—genetic
-Characterized by enlarged, palpable, cyst-filled
kidneys – May create mass effect
-Usually manifests during the 3rd or 4th decade
-Clinically presents as dull, aching pain of the abdomen
or back; possibly hematuria and hypertension
-Associated with cysts in the liver, pancreas, and berry
aneurysms of brain
ADULT POLYCYSTIC KIDNEY DISEASE
sonographic appearance of which pathology
Bilateral
Kidneys appear enlarged, with numerous discrete
cysts in the cortical regions
Should also scan liver, pancreas, and spleen for
cysts
POLYCYSTIC KIDNEY DISEASE
name that pathology
Autozomal recessive (bilateral)
Multiple cystic dilations of the collecting ducts
Usually presents in young adults- incidental
finding
Normal renal function
Cysts are usually very small (<2 cm) usually
cannot be diagnosed sonographically
MEDULLARY CYSTIC DISEASE
name that pathology
Occurs with the destruction of renal tissue
May or may not communicate with the collecting
system
Sonographic appearance varies - must differentiate
with clinical history
ACQUIRED CYSTS
types of AQUIRED CYSTS
Includes:
Hematomas
Inflammatory cysts (abscess)
Uremic renal cystic disease in patients
undergoing dialysis
An abscess to the renal cortex is called a ____________________________ (usually results from the union of several
small abscesses)
renal carbuncle
SONOGRAPHIC APPEARANCE of a pathology
-Anechoic to hypoechoic complex mass
-Irregular borders
-May contain debris, septa, gas
-May cause acoustic shadowing
-Perirenal - may displace the kidney and can be
separated from the parenchyma
-Decreased movement of the kidney on inspiration and
expiration
RENAL & PERIRENAL ABSCESS
Many patients on hemodialysis develop bilateral cystic
disease and carcinoma
Incidence increases with time (especially after 3 years)
3 types of BENIGN NEOPLASMS
Angiomyolipoma
Adenoma
Oncocytoma
name that pathology
-Most common benign renal tumor
-More common in right kidney
-80% of cases occur in women
-Occurs in 80% of patients with tuberus sclerosis
-Composed of fat cells intermixed with smooth muscle cells and
blood vessels
-Asymptomatic
-Sonographically appears as a focal, solid, hyperechoic mass
-May have posterior enhancement
-Vary from 1 - 20 cms
ANGIOMYOLIPOMA
name that pathology
-Usually less than 1 cm; rarely larger than 3 cm
-Asymptomatic unless large
-Can cause painless hematuria
-Sonographically presents as a highly vascular tumor
with many internal echoes and increased sound
attenuation
-May have calcifications
ADENOMA
name that pathology
-A class of very large vascular adenomas
-Usually cannot be distinguished sonographically
from a typical renal cell carcinoma
-Well-defined, smooth, homogeneous
-May demonstrate a central stellate scar (can
differentiate from renal cell carcinoma)
ONCOCYTOMA
name that pathology
Urine flow obstructed
Urine formation continues, causing calyces to
distend and renal pelvis to dilate
Irreversible damage can occur after 3 weeks
OBSTRUCTIVE UROPATHY
Obstruction can result from
◦ Developmental defects
◦ Calculi
◦ normal pregnancy
◦ Benign prostatic hypertrophy
◦ Infection or inflammation with scar tissue
◦ Possibly even spinal cord injury
name that pathology
-Dilation of the renal pelvis, calyceal structures, and
infundibula by urine
-Obstruction can be either intrinsic or extrinsic
-Sonographic “hallmark” - splaying, spreading, or
ballooning of the central echo complex
-Dilated ureter helpful in differentiation
HYDRONEPHROSIS
hydronephrosis ratings
Mild (aka pelvicaliectasis)
◦ dilatation of the renal pelvis with or without
dilatation of the calyces (pelvicalyceal pattern is
retained)
◦ Dilatation may also be noted in the extrarenal pelvis
◦ no parenchymal atrophy
Moderate
◦ moderate dilatation of the renal pelvis and calyces
◦ blunting of fornices and flattening of papillae
◦ mild cortical thinning may be seen
Grade 4 (severe)
◦ gross dilatation of the renal pelvis and calyces, which
appear ballooned
◦ loss of borders between the renal pelvis and calyces
◦ renal atrophy seen as cortical thinning
name that pathology
Usually develops in the kidney (nephrolithiasis)
Increased prevalence in hot climates
Appears to have a hereditary predisposition
Appears as an echogenic foci < 5 mm with posterior
shadowing
UROLITHIASIS
Demonstrate _________________ to
DISPROVE a stone in the UVJ alone
with sonographic interrogation of the
distal ureter
bilateral ureteral jets
The most common place for a urinary
stone to become lodged is within the
____________ junction, near the
urinary bladder.
ureterovesicle
types of INFLAMMATORY DISEASES
Urinary tract infection (UTI)
Acute glomerulonephritis
Chronic atrophic nephritis
Pyonephrosis
which pathology
PREDISPOSING FACTORS:
◦ Diabetes
◦ Immune compromise
◦ Pregnancy
◦ Benign prostatic hypertrophy
URINARY TRACT INFECTION
which pathology
Necrosis of cellular elements in glomeruli
Results in enlarged, poorly functioning kidneys
Suspected when cortical echogenicity exceeds that
of liver
ACUTE
GLOMERULONEPHRITIS
- Nephritic syndrome is immunologically mediated and is
characterized by inflammation in the glomeruli - Berger disease is the most common glomerular disease
worldwide, and it’s one of the most common causes of
recurrent hematuria. - Nephrotic syndrome is a kidney disorder that causes your body
to excrete too much protein in your urine.
which pathology
-Acute Bacterial infection (usually ascends from lower
urinary tract)
-Unilateral or bilateral; Abrupt onset
-Characterized by diffuse edema and renal enlargement
with intense inflammatory foci
-May lead to microabscess formation
ACUTE PYELONEPHRITIS
sonographic appearance
-Normal
-Homogenous and enlarged
(edema)
-Hypoechoic
-Strong back-wall
-As infection progresses - lose
distinct central echo complex;
blends into edematous
parenchyma
ACUTE PYELONEPHRITIS
which pathology
Results from recurrent infections
Renal scarring involving calyces and pelvis
Lose tubular function and ability to concentrate urine
Leads to parenchymal atrophy
CHRONIC ATROPHIC
NEPHRITIS
which pathology
Pus in an obstructed renal
collecting system
Sonographically appears as
low-level echoes within the
dilated collecting system
PYONEPHROSIS
which pathology
-is defined as a chronic inflammatory disorder
of the kidney characterized by a mass originating in
the renal parenchyma.
-Most cases are unilateral
-The kidney is usually nonfunctional.
Xanthogranulomatous Pyelonephritis
-The exact etiology of XGP is unknown, but it is
generally accepted that the disease process requires
long-term renal obstruction and infection.
-Stones (frequently of staghorn proportions) may occur
in 75% of patients with XGP but are not required to
make the diagnosis.
-XGP is often observed in patients with diabetes or in
patients who are immunocompromised.
-XGP occurs in approximately 1% of all renal infections.
-XGP is 4 times more common in women than men and
is usually noted in the fifth and sixth decades of life.
-XGP displays neoplasmlike properties capable of local
tissue invasion and destruction and has been referred
to as a pseudotumor.
-Adjacent organs including the spleen, pancreas, or
duodenum, may be involved.
more on Xanthogranulomatous Pyelonephritis
Patients with XGP often appear chronically ill.
Symptoms include anorexia, fevers, weight loss, and
dull and persistent flank pain.
Urine typically has both leukocytes and bacteria
present.
XGP is notorious for fistulation.
Renal cell carcinoma may be indistinguishable from
XGP sonographically
types of VASCULAR PATHOLOGY
Infarction
Renal artery stenosis
which pathology
-Obstruction of the blood supply or drainage by
the occlusion or stenosis of a vessel
-Initially appears as a hypoechoic mass becoming
more echogenic with time
-Usually hyperechoic, triangular, focal renal mass
INFARCTION
The inability of the kidneys to remove
accumulated metabolites from the blood
MAJOR CAUSES -
◦ Renal pathology
◦ Systemic disease
◦ urologic defects of non-renal origin attributed to
surgery or trauma, various medical conditions,
pregnancy, and nephrotoxix
RENAL FAILURE
ACUTE RENAL FAILURE
Potentially reversible - important to recognize
signs and symptoms
Two phases:
1
2
◦ Oliguric - Urine output is greatly reduced, bun
and creatnine elevated; Complications include
hypertension, muscle weakness, GI bleeding, and
infection
◦ Diuretic - Few days to 6 weeks later, nephrons
recover enough to excrete urine; can cause
excessive loss of water and electrolytes
◦ ______________- Urine output is greatly reduced, bun
and creatnine elevated; Complications include
hypertension, muscle weakness, GI bleeding, and
infection
Oliguric
◦ _____________- Few days to 6 weeks later, nephrons
recover enough to excrete urine; can cause
excessive loss of water and electrolytes
Diuretic
_____________________ is the best
measure of kidney function and thus the stage of
kidney disease.
Glomerular filtration rate (GFR)
GFR a is math formula using the person’s age, race,
gender and their serum creatinine is used to
calculate a GFR.
t/f
GFR levels of normal/abnormal are highly
dependent on RACE—values are different for
Caucasian vs. African American
true
Blood urea nitrogen (BUN) level is another
indicator of kidney function.
Urea is also a metabolic byproduct which can build
up if kidney function is impaired.
The BUN-to-creatinine ratio generally provides
more precise information about kidney function
and its possible underlying cause compared with
creatinine level alone.
WARNINNG: BUN also increases with
DEHYDRATION. Know your patient’s history!
As the kidneys become impaired for any reason,
the _________________level in the blood will rise due to
poor clearance of creatinine by the kidneys.
Abnormally high levels of creatinine thus warn of
possible malfunction or failure of the kidneys.
Values are dependent on gender (female vs males)
creatine
t/f
creatine values are dependent on gender
true
Irreversible - diminished function of the nephrons
SONOGRAPHIC FINDINGS:
◦ small, shrunken, echogenic kidney is definitive for
end-stage renal disease
◦ Dialysis or renal transplantation necessary
◦ May be caused by Renal Artery Stenosis
chronic renal failure
Renal artery stenosis can lead to renal _____________ and
irreparable renal compromise.
infarction
where are transplant kidneys located
Graft placed in iliac fossa, anterior to the psoas muscle
and iliac veins
The “original” kidneys remain in the patient and are
called the “_____________” kidneys
native
TRANSPLANT REJECTION
Often result of ________________. Seen about day
2 post transplant—cause of acute rejection
Acute Tubular Necrosis (ATN)
4 types of MALIGNANT NEOPLASM
Renal cell carcinoma
Transitional cell carcinoma
Wilm’s tumor
Metastasis
Smoking is a risk factor for both renal cell carcinoma
and transitional carcinoma as well as pancreatic cancer
RENAL CELL CARCINOMA aka
Also called a hypernephroma or adenocarcinoma
A form of kidney cancer that involves cancerous
changes in the cells of the renal tubule
RENAL CELL CARCINOMA
Also called a hypernephroma or adenocarcinoma
Most common malignant tumor of the kidney
(85%)
Most common in 6-7th decade
Twice as common in males
RENAL CELL CARCINOMA
Also called a hypernephroma or adenocarcinoma
renal cell carcinoma
Must examine renal vein, IVC,
renal hilum, paraaortic lymph
nodes, and contralateral
kidney for extensions and
metastasis
Most common tumor of the renal collecting system
(often multiple)
TRANSITIONAL CELL CARCINOMA
METASTATIC RENAL TUMORS
Relatively common
Most common from malignant melanoma,
lymphoma, lungs, breast, stomach, and colon
No specific pattern to distinguish from other solid
lesions
Urinary Bladder Anomalies
Diverticula
Posterior urethral valve syndrome
Exstrophy
Contraction of the bladder neck
Ectopic ureter and ectopic ureterocele
Bladder diverticulum
Prostatic urethra is markedly dilated because of an
obstruction at or just below the point where the
seminal ducts enter
POSTERIOR URETHRAL VALVES
Eversion of the bladder through a defect in the
anterior abdominal wall with separation of the
pubic symphasis
EXSTROPHY
cyst-like enlargement of the lower end
of the ureter formed when the ectopic ureter is
obstructed in the area where it enters the bladder,
causing its anterior wall to balloon into the bladder
Ureterocele
ECTOPIC URETER AND URETEROCELE
▪Ureter does not insert near the posterolateral angle
of a normal trigone
▪Most arise from the superior pelvis of a duplicated
kidney
When the bladder wall measures _____________ it is
considered abnormal.
5 mm+
BLADDER CALCULI
__________________ is a rare disorder
characterized by the formation of cystic
malformations in the collecting ducts and the
tubular structures within the kidneys (tubules) that
collect urine.
One or both kidneys may be affected.
Medullary Sponge Kidney
Accounts for majority of palpable abdominal masses
in neonate
HYDRONEPHROSIS
May be caused by Ureteropelvic Junction
Obstruction, Posterior Urethral Valves, or by
compression of the ureter
MEGAURETER
The ____________
rule describes the
situation when an
ectopic ureter from
the upper pole moiety
ends in a ureterocele
in the bladder causing
obstruction
Weigert–Meyer
ureteropelvic junction obstruction
Most common renal cystic disease in neonate
MULTICYSTIC DYSPLASTIC KIDNEYS
can you live with bilateral MULTICYSTIC DYSPLASTIC KIDNEYS
no it is fatal
MESOBLASTIC NEPHROMA aka
fetal renal hemartoma, benign Wilm’s
tumor
Second most common solid abdominal tumor of children
WILM’S TUMOR
WILM’S TUMOR aka
nephroblastoma
The most common tumor of infancy
NEUROBLASTOMA
Sonographic appearance - highly echogenic, with poorly
defined borders; often with calcification; will often
displace the kidney down and outward
NEUROBLASTOMA
