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Abdominal Sonography > Urinary Tract > Flashcards

Urinary Tract Flashcards

1
Q

Where are the paired kidneys and ureters located?

A

Retroperitoneal lying against the deep muscles of the back

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2
Q

How are the structures located in the hilum of the kidney?

A

Vein exits anteriorly
Artery enters between vein and ureter
Ureter exits posteriorly

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3
Q

Describe the echogenicity of the kidney structures.

A

Renal cortex - isoechoic or hypoechoic
Medullary pyramids - anechoic
Renal sinus - hyperechoic

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4
Q

What is the renal cortex?

A

Outer renal parenchyma from renal sinus to renal capsule (1 cm)

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5
Q

What is the renal medulla?

A

Inner hyperechoic portion of kidney which contains fat, calyces, renal pelvis, CT, renal vessels, and lymphatics

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6
Q

What are the medullary pyramids?

A

Anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus

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7
Q

What is the renal pelvis?

A

Funnel-shaped transition from the major calyces to the ureter

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8
Q

What is the renal hilum?

A

Medial opening for entry/exit of artery, vein and ureter

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9
Q

What are the major calyces?

A

3 extensions for the renal pelvis

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10
Q

What are the minor calyces?

A

Extensions of the major calyces that collects urine from the medullary pyramids

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11
Q

What are the renal papilla?

A

Apex of medullar pyramids

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12
Q

What is Gerota’s fascia?

A

Fibrous sheath enclosing kidney and adrenal glands (perirenal space)

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13
Q

What is a nephron?

A

Functional unit of kidney - renal corpuscle, proximal convoluting tubule, desc and asc limbs of Henle’s loop, distal convoluted tubule, and collecting tubules

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14
Q

What is the renal corpuscle (Malpighian body)

A

Glomerulus and glomerular capsule (Bowman’s capsule)

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15
Q

Describe blood flow from aorta to kidney.

A

Aorta > Main renal artery > 5 Segmental arteries > Interlobar arteries > Arcuate arteries > Interlobular arteries

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16
Q

What are some complications associated with congenital abnormalities?

A

Obstruction and stasis
Impaired renal function
Infection
Calculus formation

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17
Q

What is an ectopic kidney?

A

Kidney that failed to “ascend” into the abdomen and remains in the pelvis

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18
Q

What is the most common fusion anomaly?

A

Horseshoe kidney - lower poles typically connect across midline anterior to the aorta

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19
Q

Where is the horseshoe kidney located?

A

Lower in the abdomen because ascent is prevented by the IMA

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20
Q

What is the difference between a complete and incomplete duplex kidney?

A

2 ureters v 1 ureter

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21
Q

What is a duplex kidney?

A

Duplication of the collecting system

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22
Q

What is a frequent complication of the ectopic ureter in a duplex kidney?

A

It inserts in an ectopic location on the bladder and develops a ureterocele - a prolapse of the distal ureter into the bladder

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23
Q

What is a Column of Bertin?

A

Septal cortex - a normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids

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24
Q

What is bilateral renal agenesis commonly associated with?

A

Oligohydramnios and pulmonary hypoplasia

Incompatible with life

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25
Q

What is unilateral renal agenesis frequently associated with?

A

Bicornuate uterus in females

Seminal vesicle agenesis in males

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26
Q

What is an extrarenal pelvis?

A

A renal pelvis that lies outside the renal sinus sonographically appearing as a cystic collection medial to the renal hilum

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27
Q

What is a common cause of urinary obstruction in the male neonatal patient?

A

Posterior uretheral valve

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28
Q

What are sonographic findings of a posterior urethral valve?

A

Large bladder
Hydroureter
Hydronephrosis
Urinoma

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29
Q

What is the incidence of renal cysts?

A

50% of people over age 50

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30
Q

What are most renal cysts?

A

Cortical cysts that originate from obstructed uriniferous tubules

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31
Q

What are the different types of renal cysts?

A

Cortical cysts
Pylogenic cysts
Parapelvic cysts
Peripelvic cysts

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32
Q

Where are renal cysts located?

A

Cortical and parenchymal cysts - periphery

Peripelvic cysts - center (renal sinus)

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33
Q

What can mimic a simple cyst and is associated with a hx of renal biopsy or trauma?

A

Renal pseudoaneurysm

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34
Q

How can an abscess be differentiated with a hemorrhagic cyst?

A

Percutaneous aspiration

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35
Q

What are characteristics of atypical renal cysts?

A

Multiple or thick septations
Thick calcifications
Mural nodule/Solid component

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36
Q

What is autosomal dominant polycystic kidney disease?

A

Bilateral renal enlargement d/t development of numerous cysts of varying sizes

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37
Q

What occurs in advanced stages of PCKD?

A

Renal failure and HTN

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38
Q

What are commonly associated with PCKD?

A

Arterial aneurysms - particularly cerebral artery (Berry) aneurysms of the circle of Willis

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39
Q

What is autosomal recessive PCKD?

A

Multiple small cysts that result from cystic dilation of the collecting tubules secondary to hyperplasia of interstitial portions of the ducts

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40
Q

What is autosomal recessive PCKD associated with?

A

Renal dysfunction
Pulmonary hypoplasia
Periportal fibrosis
Portal HTN

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41
Q

What is Potter Syndrome?

A

Appearance of a neonate as a direct result of oligohydramnios and compression while in utero

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42
Q

What are causes of oligohydramnios?

A 
B/L renal agenesis
AR PCKD
AD PCKD
Multicystic renal dysplasia
Obstructive uropathy
Early ROM
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43
Q

What is the most common cause of an abdominal mass in newborns?

A

Multicystic dysplastic kidney

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44
Q

What is multicystic dysplastic kidney?

A

Renal dysplasia from multiple noncommunicating cysts with the absence of renal parenchyma from atresia of the UPJ during fetal development

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45
Q

What are associated urinary malformations of MDK?

A 
Contralateral UPJ obstruction
Contralateral renal agenesis or hypoplasia
Crossed fused renal ectopia
Horseshoe kidney
Patent urachus
Ureterocele
Vesiocureteral reflux
46
Q

What causes congenital UPJ obstruction?

A

Ureteral hypoplasia
High insertion of ureter into the renal pelvis
Compression by segmental artery

47
Q

What is acquired cystic disease?

A

Development of multiple cysts in chronically failed kidney during long-term HD

48
Q

What is a medullary sponge kidney?

A

Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia

49
Q

How does medullary sponge kidney appear on US?

A

Hyperechoic medullary pyramids - from Ca++ deposits

50
Q

What is Von Hippel-Lindau disease?

A

Inherited disease that presents in 2nd-3rd decade of life with serious visual impairment from retinal and CNS hemangioblastomas

51
Q

What is an angiomyolipoma?

A

Hyperechoic benign renal tumor

52
Q

What is tuberous sclerosis?

A

Multi-system genetic disease that presents as seizures, MR and facial angiofibromas with increased incidence of renal cysts and angiomyolipomas

53
Q

What is renal cell carcinoma?

A

Most common solid renal mass in adult - typically unilateral encapsulated mass

54
Q

How does renal cell CA appear on US?

A

Hypoechoic relative to normal adjacent renal parenchyma

55
Q

How does renal cell CA present?

A

Hematuria (most common)
Flank pain
Palpable mass

56
Q

Where is the most common site of distant mets for renal cell CA?

57
Q

How do renal mets appear on US?

A

Hypoechoic masses or

Diffusely enlarged inhomogeneous kidney

58
Q

What is a Wilm’s tumor?

A

Nephroblastoma - most common childhood renal tumor

59
Q

How do patient’s present with a Wilm’s tumor?

A 
Age 3-5
Large asymptomatic flank mass
HTN
Fever
Hematuria
60
Q

What must a Wilm’s tumor be differentiated from?

A

Adrenal neuroblastoma

Wilm’s tumors destroy the renal contour

61
Q

How does acute pyelonephritis appear on US?

A

Renal enlargement
Hypoechoic parenchyma
Absence of sinus echoes

62
Q

What is lobar nephronia?

A

Acute focal bacterial nephritis or focal acute pyelonephritis

63
Q

What is emphysematous pyelonephritis?

A

Bacterial infxn associated with renal ischemia

64
Q

Which populations are most commonly affected by emphysematous pyelonephritis?

A

Diabetics
Immunosuppressed patients
Pts with urinary tract obstructions

65
Q

What is chronic pyelonephritis?

A

Renal injury induced by recurrent renal infection due to anatomic anomalies, obstruction, ureteral reflux

66
Q

What is xanthogranulomatous pyelonephritis?

A

Chronic pyelonephritis resulting from chronic infxns due to long term obstruction

67
Q

What are associated findings of xanthogranulomatous pyelonephritis?

A 
Renal enlargement
Parenchymal abscesses
Staghorn calculus
Papillary necrosis
Hydronephrosis
Pyonephrosis
Loss of cortical-medullary boundary
Cortical thinning
68
Q

What is pyonephrosis?

A

Purulent material in the collection system of the kidney associated with an infxn secondary to renal obstruction

69
Q

What is a mycetoma?

A

Fungal ball - candidiasis most common

70
Q

What are hyperechoic renal masses?

A 
Mycetoma
Angiomyolipoma
Blood clots
Pyogenic debris
Sloughed papilla
Renal stones
71
Q

How is US used to dx cause in AKI?

A

Hydronephrosis

Abnormal resistive index

72
Q

What is renal vein thrombosis associated with?

A 
Extrinsic compression
Nephrotic syndrome
Renal tumors
Renal transplants
Trauma
73
Q

How does renal vein thrombosis appear on US?

A

Dilated thrombosed renal vein
Absent intrarenal venous flow
Enlarged hypoechoic kidney
High-resistance renal artery waveform

74
Q

What occurs in renal artery thrombosis?

A

Sudden cause of prerenal failure
Acute flank pain
Hematuria
Sudden rise in BP

75
Q

How does renal artery thrombosis appear on US?

A

Focal hypoechoic areas of infarct
Absence of intrarenal arterial flow
Renal enlargement

76
Q

What is acute tubular necrosis?

A

Most common cause of AKI from prolonged ischemia or nephrotoxins causing damage to the tubular epithelium of the nephron leading to acute renal failure

77
Q

What is acute glomerulonephritis?

A

Inflammatory response resulting in glomerular damage caused be infectious (Strep) and noninfectious causes

78
Q

How does acute glomerulonephritis appear on US?

A

Renal enlargement

Increased resistive index

79
Q

What is evaluated when diagnosing obstructive nephropathy?

A

Intrarenal vascularity

Threshold resistive index (RI) > 0.7 - obstructive hydronephrosis

80
Q

What are the most common causes of newborn/prenatal hydronephrosis?

A

Vesicoureteral reflux
Non-obstructive hydronephrosis
UPJ obstruction

81
Q

What is nephrocalcinosis?

A

Disorders of Ca++ metabolism resulting in the formation of calcium renal stones and deposition of calcium int he renal parenchyma

82
Q

What is Twinkle Sign?

A

Color Doppler artifact that appears as a rapidly alternating mixture of red and blue Doppler signals distal to a strongly reflective surface, like a stone.

83
Q

What are different causes of nephrocalcinosis?

A

Medullary - Primary hyperparathyroidism, RTA, Medullary sponge kidney
Cortical - Chronic GN, Renal cortical necrosis, Transplant kidney

84
Q

What is papillary necrosis?

A

Ischemia of the medullary pyramids

85
Q

What is papillary necrosis associated with?

A

DM
Urinary tract obstruction
Analgesic abuse
Sickle cell disease

86
Q

What does papillary necrosis look like on US?

A

Echogenic material in collecting system
Triangular cystic collections
Bright echoes

87
Q

What is renal sinus lipomatosis?

A

Increase renal sinus fat that replaces normal renal parenchyma

88
Q

How does renal sinus lipomatosis appear on US?

A

Increase in central sinus echo complex with cortical thinning

89
Q

How is the urinary bladder connected to the umbilicus?

A

Median umbilical ligament (urachus)

90
Q

What is a normal bladder wall thickness?

A

<3 mm when distended

91
Q

What is a bladder diverticula?

A

Herniations of the bladder mucosa through the bladder wall musculature

92
Q

What is a urachal cyst?

A

Cystic dilatation of fetal urachus

93
Q

How do the ureters travel in the body?

A

Exit kidney posterior to renal artery and vein, anterior to psoas, anterior to common iliac vessels to insert upon the trigone of bladder

94
Q

What is a ureterocele?

A

Cyst-like enlargement of the lower end of the ureter that projects into the bladder lumen

95
Q

What is a transitional cell carcinoma?

A

Most common bladder neoplasm

96
Q

What type of cells line the urinary tract?

A

Transitional cells

97
Q

What is the most common clinical presentation of transitional cell carcinoma?

98
Q

What is resistive index commonly used for?

A

Evaluate renal transplant rejection
Assess suspected hydronephrosis
Evaluate medical renal disease

99
Q

What does renal dysfunction result in?

A

Loss of diastolic flow thus increased renal arterial resistance

100
Q

How is RI measured?

A

RI = (peak systolic freq - end diastolic freq)/ peak systolic freq

101
Q

What are sxs of renal artery stenosis?

A

Sudden onset of HTN

Uncontrollable HTN

102
Q

What are renal artery stenosis diagnostic criteria?

A 
Direct eval (renal artery velocities) = renal artery/aorta ratio (RAR) >3.5
Indirect eval (intrarenal waveform eval) - Parvus Tardus, Absent early systolic peak
103
Q

Which kidney is typically harvested and why?

A

Left kidney for longer renal vein

104
Q

How is US used in renal transplant?

A

Assess immediate surgical complications
Location for renal biopsy
Vascular status in acute rejection

105
Q

What are post-transplant complications?

A

Fluid collections
Renal artery kinking or thrombosis
Renal vein thrombosis

106
Q

What are sonographic findings of acute transplant rejection?

A

Renal enlargement (increased length)
Decreased kidney echogenicity
Loss of cortical medullary boundary
Increasing flow resistance (RI)

107
Q

What is crossed fused renal ectopia?

A

Developing kidneys fuse in pelvis and one kidney ascends to its normal position carrying the other one with it across the midline

108
Q

What is a discoid or pancake kidney?

A

Fused pelvic kidney

109
Q

What is a Dromedary hump?

A

Common variant of cortical thickening on lateral aspect of left kidney

110
Q

What is a junctional parenchymal defect?

A

Triangular hyperechoic area on anterior aspect of upper pole of the right kidney

111
Q

What is fetal lobulation?

A

Partial fusion of the renunculi

Abdominal Sonography (12 decks)

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