Urinary Tract Flashcards
What is the renal cortex?
outer renal parenchyma
(normal is > 1 cm)
E 79
What is the renal medullary?
inner portion of kidney from base of pyramids to center of kidney
E 79
What is the renal sinus?
inner hyperechoic portion of kidney
E 79
What are the medullary pyramids?
anechoic triangles of collecting tubules between cortex and renal sinus
E 79
What is the renal pelvis?
funnel-shaped transition from major calyces to the ureter
E 79
What is the renal hilum?
medial opening for entry/exit of artery, vein, and ureter
E 79
What are the major calyces?
3 extensions for the renal pelvis
E 79
What are the minor calyces?
extensions of the major calyces that collect urine from medullary pyramids
E 79
What is the renal papilla?
apex of medullary pyramids
E 79
What is Gerota’s fascia?
fibrous sheath enclosing kidney and adrenal glands
also called perirenal space
E 79
What is a nephron?
functional unit of a kidney
E 79
Through which arteries is the kidney supplied with blood?
Main renal Segmental Interlobar Arcuate Interlobular E 80
What complications can be seen with congenital abnormalities of the kidneys?
impaired renal function
infection
calculus formation
E 81
Where is the most common ectopic kidney located?
pelvis
E 81
What is a horseshoe kidney?
1 large U-shaped kidney lying in the lower abdomen
E 81
What is a dromedary hump?
common variant of cortical thickening on the lateral aspect of the kidney
E 82
What is a junctional parenchymal defect?
triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney
E 82
What is a duplex kidney?
duplicated collecting systems
appears as a central cortical break w/in the sinus
either complete - 2 ureters or incomplete - 1 ureter
E 83
What is a column of Bertin?
normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids
E 83
Is someone able to live with renal agenesis?
not bilateral, but unilateral agenesis does not necessarily affect your life
E 83
What associations can be seen with unilateral renal agenesis?
VACTERL Vertebral defects Anal atresia Cardiovascular anomalies TE tracheoesophageal fistula Renal anomalies Limb defects E 83
What is an extrarenal pelvis?
renal pelvis lying outside the renal sinus
appears as a cystic collection at the hilum
E 84
What is posterior urethral valve?
urinary obstruction in male neonates
sonographically: large bladder, hydroureter, hydronephrosis, “key-hole bladder”
E 84
Where is a parapelvic cyst located?
cortical cyst bulging into the central sinus
E 85
Where is a peripelvic cyst located?
within the central sinus
E 85
Where is a parenchymal cyst located?
around the periphery
E 85
What are atypical/malignant characteristics of renal cysts?
multiple septations
calcifications
solid components
E 86
What are the characteristics of autosomal dominant (adult) polycystic kidney disease?
seen as early as 20-30 years of age bilateral renal enlargement numerous cysts associated cysts within liver, pancreas, and spleen E 86
What is concerning about autosomal dominant adult polycystic kidney disease?
destruction of residual renal tissue can lead to renal failure and HTN
E 86
What are the sonographic characteristics of autosomal recessive infantile polycystic kidney disease?
bilateral renal enlargement
hyperechoic parenchyma
loss of cortical medullary distinction
E 87
What is concerning about autosomal recessive infantile polycystic kidney disease?
renal dysfunction pulmonary hypoplasia congenital hepatic fibrosis portal hypertension E 87
What is the most common cause of an abdominal mass in newborns?
multicystic dysplastic kidney
E 88
What is multicystic dysplastic kidney (MCDK)?
renal dysplasia characterized by multiple noncommunicating cysts with the absence of renal parenchyma
typically unilateral
E 88
What is MCDK caused by?
results from atresia of the UPJ during fetal development
E 88
Will MCDK change after the fetus is born?
It can stay the same
increase in size
or undergo spontaneous involution (shrink)
E 88
What syndromes is MCDK seen with?
Beckwith-Wiedemann
Trisomy 18
VACTERL
E 88
What is a ureteropelvic junction obstruction caused by?
ureteral hypoplasia
high insertion of ureter into renal pelvis
compression by segmental artery
E 88
What anomalies are associated with UPJ obstruction?
MCDK contralateral renal agenesis duplicated collecting systems horseshoe kidney ectopic kidney E 88
What are the sonographic characteristics of medullary sponge kidney?
hyperechoic medullary pyramids
E 89
What causes medullary sponge kidney?
dilatation of medullary pyramids due to tubular ectasia or dysplasia. calcium collects here and appear hyperechoic
E 89
Why would someone develop acquired cystic disease?
long-term hemodialysis can lead to multiple cysts in the failed kidneys
E 89
What can occur to the kidneys in Von Hippel-Lindau syndrome?
renal cysts
E 89
What is the sonographic appearance of an angiomyolipoma?
hyperechoic tumor
E 90
In a patient with tuberous sclerosis, what might you see in the kidneys?
renal cysts
bilateral angiomyolipomas
E 90
What is the most common solid renal mass in the adult?
renal cell carcinoma
E 91
What are the sonographic characteristics of renal cell carcinoma?
hypoechoic mass
E 91
What are the most common symptoms with RCC?
hematuria flank pain weight loss flank mass fever hypertension hypercalcemia E 91
What is the most common childhood renal tumor?
Wilm’s tumor (nephroblastoma)
E 92
What are clinical indicators for Wilm’s tumor (nephroblastoma)?
abdominal mass hypertension fever hematuria E 92
What sonographic characteristic will help determine Wilm’s tumor?
destruction of renal parenchyma
E 92
What are the sonographic characteristics of acute pyelonephritis?
renal enlargement
hypoechoic parenchyma
absence of sinus echoes
E 93
What is acute pyelonephritis?
renal infection caused typically by bacteria from the intestinal tract
E 93
What is emphysematous pyelonephritis?
bacterial infection seen in diabetics and immunosuppressed patients associated with renal ischemia
E 93
What are the sonographic characteristics of emphysematous pyelonephritis?
gas with reverberations and comet-tail artifact
E 93
What are the sonographic characteristics of chronic pyelonephritis?
small
hyperechoic
cortical thinning
E 94
What can chronic pyelonephritis lead to?
end-stage renal disease
E94
What is a staghorn calculus?
results from chronic infection
large stone filling an entire renal pelvis
E 94
What are the sonographic characteristics of pyonephrosis?
hyperechoic debris in a dilated renal collecting system
E 95
What is mycetoma?
aka fungal ball
most common renal fungal disease
E 95
What are the sonographic characteristics of mycetoma?
hyperechoic nonshadowing masses
E 95
What is acute kidney injury?
abrupt decline in renal function
decreased urinary output
elevated BUN and creatinine
E 96
What is ultrasound’s role in diagnosing acute kidney injury?
hydronephrosis, which indicates postrenal failure
abnormal resistive index, which suggests intrinsic factor
E 96
What are the sonographic findings of renal vein thrombosis?
dilated thrombosed renal vein absent intrarenal venous flow enlarged hypoechoic kidney increased RI E 97
What is the most common cause of acute kidney injury?
acute tubular necrosis
E 98
What are the sonographic findings of acute tubular necrosis?
renal enlargement
increased RI
E 98
What causes acute tubular necrosis?
prolonged drug or contrast agents damage the nephron, leading to acute renal failure
E 98
If hydronephrosis is left untreated, what can it lead to?
HTN
loss of renal function
sepsis
E 99
What are the most common causes of hydronephrosis?
calculi benign prostate hypertrophy pelvic malignancies pregnancy UPJ obstruction E 99
What are the most common causes for newborn hydronephrosis?
vesicoureteral reflux
non-obstructive hydro
UPJ obstruction most common
E 99
In newborns and prenatal patients, bilateral hydronephrosis can suggest what?
obstructive process such as ureterocele or posterior urethral valves
E 100
What is a megaureter?
ureter > 7mm in diameter
E 101
What are the symptoms seen with nephrolithiasis?
back or flank pain fever dysuria cloudy urine hematuria E 102
What are the sonographic findings of papillary necrosis?
echogenic material in the collecting system
triangular, cystic collections representing the absence of the pyramids
bright echoes around the periphery of the pyramids
E 103
How does renal sinus lipomatosis appear sonographically?
increase in the central sinus
cortical thinning
E 103
What is normal bladder wall thickness in both a distended and nondistended bladder?
distended: < 3mm
nondistended: < 5mm
E 104
What is a bladder diverticula?
herniations of the bladder mucosa through the bladder wall
E 104
What is the most common cause for bladder diverticula?
benign prostate hypertrophy
E 104
How does a urachal cyst appear sonographically?
cystic structure superior and anterior to the bladder
E 104
Where do the ureters enter the bladder?
trigone
E 104
What is a ureterocele?
cyst like enlargement of the lower end of the ureter the projects into the bladder
E 105
What is the most common association with ureteroceles?
complete ureteral duplication
E 105
What is the most common bladder neoplasm?
transitional cell carcinoma
E 105
What are the sonographic findings of transitional cell carcinoma?
solid mass of focal thickening of the wall
hydronephrosis can result from the mass
E 105
Is normal renal vascular flow high or low resistance?
low resistance
E 106
What can the resistive index help evaluate?
renal transplant rejection
access hydronephrosis
evaluate medical renal disease
E 106
How is RI calculated?
(peak systolic freq. - end diastolic freq.) / peak systolic freq.
E 106
What is a normal RI?
< 0.7
E 106
What are symptoms of renal artery stenosis?
sudden onset or uncontrollable HTN
E 107
What ratio can indicate renal artery stenosis?
Renal artery / aorta ratio (RAR) > 3.5
E 107
What waveform is defined as a small slow pulse?
Parvus tardus
E 107
What is the most common disease leading to kidney transplantation?
diabetes
E 108
Which kidney is typically harvested for transplant?
left, because it has a longer renal vein
E 108
What are post-transplant complications?
fluid collections- hematomas. urinomas, lymphoceles, and abscesses
renal artery kinking
renal vein thrombosis
E 108
What are the sonographic findings of acute transplant rejection?
renal enlargement decreased echogenicity loss of cortical medullary boundary increased RI E 108
What is a normal RI for a transplant kidney?
< 0.7
E 109
What is the most common neonatal abdominal mass?
multicystic dysplastic kidney
E 110
What is the most common neonatal adrenal mass?
adrenal hemorrhage
E 110
What is the most common childhood adrenal mass?
neuroblastoma
E 110
What is the most common childhood renal mass?
Wilm’s tumor
E 110
