Urinary Tract Flashcards
Where are the paired kidneys and ureters located?
Retroperitoneal lying against the deep muscles of the back
How are the structures located in the hilum of the kidney?
Vein exits anteriorly
Artery enters between vein and ureter
Ureter exits posteriorly
Describe the echogenicity of the kidney structures.
Renal cortex - isoechoic or hypoechoic
Medullary pyramids - anechoic
Renal sinus - hyperechoic
What is the renal cortex?
Outer renal parenchyma from renal sinus to renal capsule (1 cm)
What is the renal medulla?
Inner hyperechoic portion of kidney which contains fat, calyces, renal pelvis, CT, renal vessels, and lymphatics
What are the medullary pyramids?
Anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus
What is the renal pelvis?
Funnel-shaped transition from the major calyces to the ureter
What is the renal hilum?
Medial opening for entry/exit of artery, vein and ureter
What are the major calyces?
3 extensions for the renal pelvis
What are the minor calyces?
Extensions of the major calyces that collects urine from the medullary pyramids
What are the renal papilla?
Apex of medullar pyramids
What is Gerota’s fascia?
Fibrous sheath enclosing kidney and adrenal glands (perirenal space)
What is a nephron?
Functional unit of kidney - renal corpuscle, proximal convoluting tubule, desc and asc limbs of Henle’s loop, distal convoluted tubule, and collecting tubules
What is the renal corpuscle (Malpighian body)
Glomerulus and glomerular capsule (Bowman’s capsule)
Describe blood flow from aorta to kidney.
Aorta > Main renal artery > 5 Segmental arteries > Interlobar arteries > Arcuate arteries > Interlobular arteries
What are some complications associated with congenital abnormalities?
Obstruction and stasis
Impaired renal function
Infection
Calculus formation
What is an ectopic kidney?
Kidney that failed to “ascend” into the abdomen and remains in the pelvis
What is the most common fusion anomaly?
Horseshoe kidney - lower poles typically connect across midline anterior to the aorta
Where is the horseshoe kidney located?
Lower in the abdomen because ascent is prevented by the IMA
What is the difference between a complete and incomplete duplex kidney?
2 ureters v 1 ureter
What is a duplex kidney?
Duplication of the collecting system
What is a frequent complication of the ectopic ureter in a duplex kidney?
It inserts in an ectopic location on the bladder and develops a ureterocele - a prolapse of the distal ureter into the bladder
What is a Column of Bertin?
Septal cortex - a normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids
What is bilateral renal agenesis commonly associated with?
Oligohydramnios and pulmonary hypoplasia
Incompatible with life
What is unilateral renal agenesis frequently associated with?
Bicornuate uterus in females
Seminal vesicle agenesis in males
What is an extrarenal pelvis?
A renal pelvis that lies outside the renal sinus sonographically appearing as a cystic collection medial to the renal hilum
What is a common cause of urinary obstruction in the male neonatal patient?
Posterior uretheral valve
What are sonographic findings of a posterior urethral valve?
Large bladder
Hydroureter
Hydronephrosis
Urinoma
What is the incidence of renal cysts?
50% of people over age 50
What are most renal cysts?
Cortical cysts that originate from obstructed uriniferous tubules
What are the different types of renal cysts?
Cortical cysts
Pylogenic cysts
Parapelvic cysts
Peripelvic cysts
Where are renal cysts located?
Cortical and parenchymal cysts - periphery
Peripelvic cysts - center (renal sinus)
What can mimic a simple cyst and is associated with a hx of renal biopsy or trauma?
Renal pseudoaneurysm
How can an abscess be differentiated with a hemorrhagic cyst?
Percutaneous aspiration
What are characteristics of atypical renal cysts?
Multiple or thick septations
Thick calcifications
Mural nodule/Solid component
What is autosomal dominant polycystic kidney disease?
Bilateral renal enlargement d/t development of numerous cysts of varying sizes
What occurs in advanced stages of PCKD?
Renal failure and HTN
What are commonly associated with PCKD?
Arterial aneurysms - particularly cerebral artery (Berry) aneurysms of the circle of Willis
What is autosomal recessive PCKD?
Multiple small cysts that result from cystic dilation of the collecting tubules secondary to hyperplasia of interstitial portions of the ducts
What is autosomal recessive PCKD associated with?
Renal dysfunction
Pulmonary hypoplasia
Periportal fibrosis
Portal HTN
What is Potter Syndrome?
Appearance of a neonate as a direct result of oligohydramnios and compression while in utero
What are causes of oligohydramnios?
B/L renal agenesis AR PCKD AD PCKD Multicystic renal dysplasia Obstructive uropathy Early ROM
What is the most common cause of an abdominal mass in newborns?
Multicystic dysplastic kidney
What is multicystic dysplastic kidney?
Renal dysplasia from multiple noncommunicating cysts with the absence of renal parenchyma from atresia of the UPJ during fetal development