Urinary Tract Flashcards
What type of organ are the kidneys and ureters?
Retroperitoneal organ
What muscles are posterior to the kidneys?
Psoas muscle and quadratus muscle
Know about the echogenicity of the kidneys…
- Renal cortex: Isoechoic or hypoechoic
- Medullary pyramids: Anechoic
- Renal sinus: Hyperechoic
What is the measurement of the renal cortex?
> 1 cm
What is Gerota’s fascia?
Fibrous sheath enclosing the kidney and adrenal glans
- AKA perirenal space
What is the functioning unit of the kidney?
Nephron
Know the order of the renal vascularity…
Main Renal Artery > Segmental Artery > Interlobar Artery > Arcuate Artery > Interlobular Artery
What is an Ectopic kidney?
Displaced or in a location away from normal location
- AKA Pelvic kidney
What is a horseshoe kidney?
- Most common fusion anomaly in which lower poles typically connect across midline anterior to aorta.
What is a crossed fused renal ectopia?
Developing kidneys fuse in the pelvis and one kidney ascends to normal position and the other one midline
What is a Fused pelvic kidney?
Kidneys that have fused to form a round mass in pelvis
- Known as discoid or pancake kidney
What is a Dromedary Hump?
Thickening of the lateral aspect of the kidney
What is Junctional Parenchymal Defect?
Triangular Hyperechoic area on the anterior aspect of the upper pole of right kidney
- AKA fetal lobulation
Know about a Duplex Collecting system…
- 2 collecting systems
- Complete: two ureters
- Incomplete: one ureter
What is a frequent complication of an ectopic ureter inserting into the bladder in a ectopic location?
Ureterocele
What is a Column of Bertin?
- Septal Cortex
- Cortex parenchyma located between two medullary pyramids
What is Renal Agenesis?
- Bilateral Renal Agenesis: Oligo and Pulmonary Hypoplasia, incompatible with life.
- Unilateral Renal Agenesis: One kidney. Associated with Bicornuate or didelphic uterus, VACTERL
What is a Extrarenal Pelvis?
Pelvis lies outside the renal sinus appearing as a cystic collection medial to the renal hilum.
Know about posterior urethral valves…
- most common cause of urinary obstruction in male neonatal patient
- obstruction due to flap of mucosa that has slit-like opening in the area of prostatic urethra.
What is a common finding in people over 50 years old?
Simple renal cyst
What is a Pylogenic cyst?
Calyceal diverticula that appears as a simple cyst
What is a Parapelvic cyst?
Cortical cysts that bulge into the renal sinus
What is a Peripelvic cyst?
Lymphatic cysts in central sinus
What is a Atypical Renal cyst?
Cysts with a thing septation, minimal wall calcification, internal echoes caused by lobulated shapes may be associated with benign cysts
Know about Autosomal Dominant Polycystic Kidney Disease…
- Bilateral renal enlargement due to the developmental of numerous cysts varying in sizes
- Associated with cysts in liver, pancreas, and spleen
- Destruction of the residual tissue in advanced stages leads to renal failure and hypertension
Know about Mulicystic Dysplastic Kidney…
- Most common cause of abdominal mass in newborns
- Multiple non communicating cysts with the absence of renal parenchyma
- Syndromes: Trisomy 18, Beckwith, VACTERL
Know about UPJ…
- high insertion of ureter into renal pelvis
- Associated with MCDK, Renal agenesis, Horseshoe kidney, Ectopic kidney
What is Medullary Sponge kidney?
Cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia
What is Von Hippel-Lindau Disease?
- Inherited disease which usually presents in second to third decade of life with impairment
- Retinal and central nervous system hemangioblastoma
What is a angiomyolipoma?
- Hyperechoic benign renal tumor
- echogenicity is greater than or equal to renal sinus
What is Tuberour Sclerosis?
- Multi-system genetic disease
- increased incidence of renal cysts and angiomyolipomas
- Seizures, retardation, and facial angiofibromas
Know all about Renal Cell Carcinoma…
- Most common solid renal mass in adults.
- Travel through renal veins and IVC
- hypoechoic adjacent to renal parenchyma
Know about Renal Mets…
- site of secondary tumors that mets to other primary organs ( lung, breast, colon)
- Leukemia and Lymphoma can mets to kidneys
Know about Wilm’s Tumor…
- Nephroblastoma
- most common childhood renal tumor
- Mets seen to lungs, liver, bone, lymph nodes, and retroperitoneum
- Also travel to renal vein and IVC
- Wilm’s tumor will destroy the renal contour, where as normal renal contour mean adrenal neuroblastoma
What is pyonephrosis?
purulent material in the collection system of the kidney associated with an infection secondary to renal obstruction.
- hyperechoic debris in dilated collecting system.
What is a Mycetoma?
- Fungal Ball
- Candidiasis is the most common renal fungal disease
- result from hematogenus seeding and ascend from the bladder
What are all the hyperechoic masses of the kidneys?
- Mycetoma
- Angiomyolipomas
- blood clots
- pyogenic debris
- sloughed papilla
- renal stones
Know about Acute Renal Injury…
- AKA: Acute Renal Failure
- abrupt decline in renal function, manifested by decreased urinary output and elevation in plasma blood urea nitrogen (BUN) and serum creatinine.
What are the studied used to evaluate AKI?
- urine output
- urinalysis
- BUN
- Creatinine
What are the three main mechanisms for AKI?
- Prerenal Failure
- Hypotension
- Volume depletion
- Decreased cardiac output
Know about renal vein thrombosis…
- Dilated thrombosed renal vein
- Enlarged hypoechoic kidney
- ** High-resistance renal artery waveform (Increased RI)
Know about renal artery thrombosis…
- sudden cause of prerenal failure that presents as acute flank pain, hematuria, rise in blood pressure
- Findings: Absence intrarenal arterial flow, renal enlargment
What is Acute Tubular Necrosis (ATN) ?
- most common cause of acute kidney injury
- results for ischemia causing damage to the tubular epithelium of the nephron leading to acute renal failure.
- Increased RI
What is Acute Glomerulonephritis (GN) ?
- inflammatory response resulting in glomerular damage caused by infectious and noninfectious causes.
- most common reason for GN is Streptococcus species
- Increased RI
Know about Hydronephrosis…
- Dilatation of the renal pelvis
- instead of echogenic renal sinus, it is anechoic with fluid.
What can hydronephrosis lead to?
- hypertension
- loss of renal function
- sepsis
What are the common areas obstruction by a stone can be?
- Ureterovesical junction (most common)
- UPJ
- Pelvic brim
What does the RI have to be to suggest obstructive hydronephrosis?
Greater than 0.7
What is the most common reason for hydronephrosis in pediatrics?
UPJ obstruction
Know the measurements of the pelvic diameter…
- Normal: < 7 mm
- Mild: 7 to 8 mm
- Moderate: 9 to 15 mm
- Severe: > 15 mm
What is a Megaureter?
Wide ureter, greater than 7 mm in diameter
- left side is more often affected than the right side.
What is Nephrocalcinosis?
Formation of calcium renal stones and deposition of calcium in the renal parenchyma.
What is the “Twinkle sign”?
Color Doppler artifact that appears as rapidly alternating mixture of red and blue Doppler signals distal to the renal stone
What is renal sinus Lipomatosis?
- increased renal sinus fat that replaces normal renal parenchyma.
- compression of calyces and renal pelvis by renal sinus fat
What is the normal measurement for the urinary bladder?
< 5 mm in nondistended bladder
< 3 mm in distended bladder
What is a bladder diverticula?
Herniation of the bladder musoca through the bladder wall musculature.
- most acquired diverticula occur do to longstanding bladder outlet obstruction due to benign prostatic hypertrophy.
What is a urachal cyst?
cystic dilatation of the fetal urachus
- seen superior and anterior to the bladder
Where do ureters insert into the bladder?
Trigone
What is a ureterocele?
cyst-like enlargement of the lower end of the ureter which projects into the bladder lumen at the ureterovesical junction (UVJ)
When are ureteroceles most common?
complete ureteral duplication
Know all about Transitional Cell Carcinoma…
- most common bladder neoplasm
- solid mass or focal thickening of bladder wall
- can cause hydronephrosis
- Hematuria is the most common clinical presentation
- 15,000 deaths due to bladder cancer
What kind of flow should a normal renal artery demonstrate?
continuous forward flow during diastole, low resistance perfusion
What is Resistive index commonly used for?
- Evaluate renal transplant rejection
- Access suspected hydronephrosis
- Evaluate medical renal disease
What is the equation for RI?
peak systolic freq. - end diastolic freq. / peak systolic freq.
Know about renal artery stenosis…
- sudden onset of hypertension
- decrease in renal size( < 9 cm in length)
What does RAR stand for?
Renal Aortic Ratio
- needs to be greater than 3.5
What is Parvus Tardus?
Small slow pulse
What is the most common cause for renal disease?
- diabetes
Know all about the transplant kidney…
- placed in either side of the pelvis
- Arterial anastomosis may be with the external or internal iliac artery
- poor function of renal transplant may result of ATN
Know the resistances for a transplant kidney…
- Normal: <0.7
- Questionable: 0.7 - 0.8
- Dysfunction: > 0.8
Kidney labs….
Page 109 ESP
What is the most common neonatal abdominal mass?
Multicystic dysplastic kidneys
What is the most common neonatal adrenal mass?
Adrenal hemorrhage
What is the most common childhood adrenal mass?
Neuroblastoma
What is the most common neonatal renal mass?
Multicystic dysplastic kidneys
What is the most common childhood renal mass?
Wilm’s tumor
