Urinary Tract Pathology Flashcards
what is acute renal failure?
a sudden decrease in renal function
what is the most common cause of acute renal failure?
acute tubular necrosis
what is acute tubular necrosis?
ischemic damage to the renal tubule cells
other causes of acute renal failure (5)
renal infection
urinary tract obstruction
PKD
amyloidosis
Henoch-Schonlein purpura
ultrasound appearance of acute renal failure (3)
normal to enlarged kidneys
may appear more echogenic
hydronephrosis
signs/symptoms of acute renal failure (7)
increase BUN and creatine
oliguria
HTN
leukocytosis
hematuria
edema
hypovolemia
what is chronic renal failure?
gradual decrease in renal function over time
chronic renal failure will lead to _____,
____ and _____ may be needed
lead to end stage renal disease
dialysis and donor kidney may be needed
what is the most common cause of chronic renal failure?
diabetes
other causes of chronic renal failure (7)
glomerulonephritis
chronic pyelonephritis
metabolic disorders
chronic urinary tract obstruction
tuberculosis
renal vascular disease
infection
ultrasound appearance of chronic renal failure (4)
small, echogenic kidneys
thin cortex (<1cm)
no differentiation between cortex & sinus
renal cysts
signs/symptoms of chronic renal failure (5)
malaise
increase BUN and creatine
fatigue
HTN
hyperkalemia
what is dialysis?
removal of accumulated urea, other waste materials, and excess water from those with inadequate kidney function
what are the 3 forms of dialysis?
hemodialysis
hemofiltration
peritoneal dialysis
what is the most common renal mass?
simple renal cyst
simple renal cysts are usually located in the ____
cortex
what is a peripelvic cyst?
renal cyst that originates in the renal sinus
**lack a central communication between multiple small cysts
can be confused with hydronephrosis
peripelvic cysts are associated with the ____ and ____
renal pelvis and calyces
what is a parapelvic cyst?
renal cyst that originates in the renal parenchyma and protrudes into the renal sinus
1 or 2 large cysts
does not communicate with collecting system
parapelvic cysts can cause (3)
pain
HTN
obstruction
what are exophytic cysts?
renal cysts that appear to be projections out away from the kidneys
what is milk of calcium cyst?
colloidal suspension of calcium salts
(carbonate, phosphate, and oxalate)
milk of calcium cyst is related to (3)
urinary stasis
infection
immobility of the patient for extended periods of time
what differentiates milk of calcium cyst from renal calculi?
milk of calcium cyst will move with patient position, renal calculi will not move
ADPKD is also known as
adult polycystic kidney disease
ADPKD can lie dormant for years and full manifestation will occur in ____
the 4th decade of life
by age 60, 50% of patients with ADPKD will suffer from ____
end stage renal disease
40% of patients with ADPKD will also have polycystic ____, ____, and ____
liver
pancreas
spleen
ultrasound appearance of ADPKD (3)
bilateral enlarged kidneys
numerous cortical renal cysts
cysts in pancreas, liver, and spleen
ARPKD is also known as
infantile polycystic kidney disease
ARPKD is characterized by ____
dilation of the renal collecting tubules
ultrasound appearance of ARPKD (3)
bilateral enlarged kidneys
echogenic kidneys
loss of corticomedullary differentiation
what is MCDK is caused by?
early, 1st trimester obstruction of the ureter
what is the most common cystic disease in neonates?
MCDK
what is the most common cause of palpable abdominal mass in infants?
MCDK
what is acquired cystic renal disease?
result of chronic hemodialysis
patients with acquired cystic renal disease are at an increased risk for ___
RCC
ultrasound appearance of acquired cystic renal disease (2)
initially the kidneys will be small with some small cysts
with time the kidneys will enlarge and have numerous cysts throughout the renal parenchyma
what is tuberous sclerosis?
autosomal dominant disorder that causes the development of tumors within various organs
tuberous sclerosis primarily affects the (6)
brain
eyes
heart
kidneys
skin
lungs
tuberous sclerosis is associated with (2)
renal cystic disease and angiomyolipomas
signs/symptoms of tuberous sclerosis (3)
epilepsy
skin lesions of the face
mental retardation
what is acute pyelonephritis?
inflammation of the kidneys
what causes acute pyelonephritis?
ascending infection
what is an ascending infection?
when bacteria begins the bladder and refluxes up through the ureters and into the kidneys
acute pyelonephritis is most common in ___
women
complications of acute pyelonephritis (5)
renal abscess
pyonephrosis
xanthogranulomatous pyelonephritis
emphysematous pyelonephritis
chronic pyelonephritis
what is pyonephrosis?
pus/purulent material within the collecting system
what causes pyonephrosis?
obstructive process or infection that leads to urinary stasis
ultrasound appearance of pyonephrosis (2)
hydronephrosis
layering, low-level echoes
what causes xanthogranulomatous pyelonephritis?
chronic urinary tract obstruction and subsequent infection
xanthogranulomatous pyelonephritis is associated with _____ in about 70% of cases
staghorn calculus (large stone)
what is emphysematous pyelonephritis?
life threatening infection of the kidneys that causes gas accumulation within the renal parenchyma
emphysematous pyelonephritis is caused by ____ infection
E. coli infection
emphysematous pyelonephritis is common in ___ and _____
diabetics and immunocompromised
what is chronic pyelonephritis?
recurrent infections of chronic obstruction that leads to scarring of the calices and renal pelvis
chronic pyelonephritis can cause ___ and ___
xanthogranulomatous pyelonephritis and end-stage renal disease
children with a history of ____ are at an increased risk for chronic pyelonephritis
vesicoureteral reflux (VUR)
ultrasound appearance of chronic pyelonephritis (3)
small, echogenic kidneys
lobulated borders
renal scar = echogenic area within the kidney that extends from the renal sinus through the parenchyma
what is the most common cause of renal fungal disease?
candida albicans
who are at risk for developing renal fungal disease? (4)
immunocompromised
diabetics
intravenous drug abuse patients
infants who have long standing, indwelling catheters
ultrasound appearance of renal fungal balls (3)
hyperechoic, nonshadowing, mobile structures
what causes glomerulonephritis?
distant infection like strep throat and autoimmune reaction
ultrasound appearance of acute glomerulonephritis (3)
normal to enlarged
increase echogenicity
prominent pyramids
ultrasound appearance of chronic glomerulonephritis
increase cortical echogenicity
sign/symptoms of glomerulonephritis (7)
smoky urine
azotemia (increase nitrogen levels)
hematuria
proteinuria
HTN
fever
leukocytosis
what is the most common parasitic infection of the kidneys?
schistosomiasis
ultrasound appearance of schistosomiasis
thick bladder wall
what is hydronephrosis?
dilation of the renal collecting system secondary to the obstruction of normal urine flow
causes of obstruction that result in hydronephrosis (3)
congenital
intrinsic cause
extrinsic cause
what happens in mild hydronephrosis?
distention of the renal pelvis
what happens in moderate hydronephrosis?
further calyceal separation
what happens in severe hydronephrosis?
thinning of the parenchyma
what is caliectasis?
dilation of the calices
what is pelviectasis/pyelectasis?
dilation of the renal pelvis
what is pelvicaliectasis/pyelectasis?
dilation of the calices and renal pelvis
false-positives of hydronephrosis (4)
over distention of the bladder
parapelvic cysts
prominent renal vein
extrarenal pelvis
what is urolithiasis?
kidney stones located anywhere within the urinary system
what is nephrolithiasis?
kidney stones
what are kidney stones made of?
calcium oxalate
kidney stones form in the ___ and ___
kidneys and bladder
where is the most common location for a kidney stone to become lodged?
UVJ
what is the twinkle sign?
increased color doppler signal posterior to a kidney stone
what is nephrocalcinosis?
accumulation of calcium within the renal parenchyma
what are the two forms of nephrocalcinosis?
medullary nephrocalcinosis and cortical nephrocalcinosis
medullary nephrocalcinosis is caused by ___ and ____
hyperparathyroidism and hypercalcemia
what is the most common cause of medullary nephrocalcinosis?
medullary sponge kidney
what is medullary sponge kidney?
accumulation of calcium within abnormally dilated collecting ducts located within the medulla
ultrasound appearance of medullary nephrocalcinosis
echogenic renal pyramids
causes of cortical nephrocalcinosis (3)
hyperparathyroidism
AIDS
associated with some malignancies
ultrasound appearance of cortical nephrocalcinosis
echogenic foci within the cortex
angiomyolipoma is also called
renal hamartoma
what is the most common benign renal tumor?
angiomyolipoma
angiomyolipomas are composed of (3)
blood vessels
muscle
fat
95% of patients with tuberous sclerosis have multiple, bilateral _____
angiomyolipomas
ultrasound appearance of angiomyolipoma (2)
solid, hyperechoic mass
20-30% will produce shadowing
what is oncocytoma?
benign renal tumor often found in men in their 60s
**stellate central scar
difficult to differentiate from RCC - biopsy
what is the second most common renal mass?
oncocytoma
renal hemangiomas are encountered during the ___ or ___ decade of life
3rd or 4th decade of life
___ may be observed sonographically in renal trauma
renal fracture
ultrasound appearance of renal fracture (2)
linear absence of echoes
linear anechoic or hypoechoic region in the parenchyma
in renal trauma, blood may accumulate in what 4 locations
subcapsular - under the capsule
perinephric - in Gerota’s fascia
pararenal - anterior or posterior
intramuscular - in psoas muscle
RCC is also known as
hypernephroma or adenocarcinoma of the kidney
what is the primary form of renal cancer?
RCC
RCC is most common in ___
males after 40 years old
risk factors for RCC (6)
smoking
HTN
obesity
tuberous sclerosis
von Hippel-Lindau
long term dialysis
RCC commonly invades ___ via the ___
invades IVC via the RRV
Grade I of RCC
confined to kidney
Grade II of RCC
spreads to the perinephric fat but within Gerota’s fascia
Grade III of RCC
spreads to RV, IVC, and regional lymph nodes
Grade IV of RCC
invasion of neighboring structures
what is renal TCC?
malignant tumor that is most often found in the renal pelvis
renal TCC may also be found within the ___ and ___
ureter and bladder
renal TCC can cause ___
focal dilation of the calices
metastases to the kidney is most often from the ___ or ___
lungs or breast
metastasis to the kidneys is less frequently from the (3)
prostate
pancreas
melanoma
what is nutcracker syndrome?
compression or entrapment of the LRV as it passes between the SMA and AO
in nutcracker syndrome, the LRV will reveal ____
elevated pressure with doppler evaluation
males with nutcracker syndrome may complain of ___
left testicular pain
what is a common cause of RA stenosis?
atherosclerosis
patients with existing RA stenosis often suffer from ____ that does not respond to treatment
HTN
in young females, _____ may be the cause of RA stenosis
fibromuscular disease
RA stenosis can lead to ___ and ___
renal infarction and irreparable renal compromise
ultrasound appearance of RA stenosis (3)
thickening and calcification of the RA
renal:AO ratio greater than 3.5
tardus-parvus spectral waveform downstream from the stenosis
what is tardus-parvus?
combination of a slow systolic upstroke and a decreased systolic velocity
causes of RV thrombosis (3)
renal tumors
trauma
renal infections
ultrasound appearance of RV thrombosis (3)
enlarged and heterogenous kidney
enlarged RV
no doppler signals in RV
____ is the best indicator of renal transplant rejection
renal biopsy
a transplanted kidney is also called an ____
allograft
donor vasculature of an allograft is anastomosed to the ____
external iliac artery and vein
mild _____ is normal in the allograft
mild pelviectasis
assessment of the allograft includes (2)
spectral analysis of the interlobar arteries (upper,mid, and lower)
color and spectral analysis of the main RA (anastomosis, prox, distal)
abnormal RI of an allograft
greater than 0.9
postrenal transplant fluid collections are common and include (4)
lymphocele
urinoma
hematoma
abscess
signs of renal transplant rejection (8)
infection
obstruction
vascular stenosis
RA stenosis
RA thrombosis
RV thrombosis
pseudoaneurysm
fistula
what is the most common vascular complication following renal transplantation?
RA stenosis
signs of RA stenosis (3)
PSV greater than 200 cm/s
RA:external iliac ratio greater than 2.0
poststenotic turbulence
what is the most common cause of congenital hydronephrosis?
ureteropelvic junction obstruction
3 other causes of congenital hydronephrosis
vesicoureteral reflux (VUR)
posterior urethral valves (PUV)
prune belly syndrome
what is vesicoureteral reflux?
backward flow of urine from the bladder into the ureters
VUR is most commonly caused by ___
incompetent valve at the UVJ
VUJ is diagnosed by ___ or ___
voiding cystourethrogram (VCUG)
nuclear cystogram
Grade I of VUR
urine refluxes into the ureter only
Grade II of VUR
urine refluxes into the ureter and renal pelvis WITHOUT hydronephrosis
Grade III of VUR
urine refluxes into the ureter and renal pelvis WITH hydronephrosis
Grade IV of VUR
moderate hydronephrosis
Grade V of VUR
severe hydronephrosis
what are posterior urethral valves (PUV)?
folds of excessive urethral tissue found exclusively in males
PUV causes dilation of (3)
bladder
both ureters
both renal collecting systems
prune belly syndrome is a result of
abdominal wall musculature being stretched by an extremely enlarged bladder (megacystis)
3 main problems of prune belly syndrome
poor development of abdominal muscles
cryptorchidism
urinary tract abnormalities
what is used to treat severe VUR?
synthetic bulking agent called subureteral Teflon injection (STING)
Wilm’s tumor is also known as ____
nephroblastoma
what is the most common solid malignant pediatric abdominal mass?
Wilm’s tumor
nephroblastoma is usually discovered before the age ___
5 years old
Wilm’s tumor tend to metastasize to the ___ and ___
liver and lungs
patients with ____ have a tendency to develop Wilm’s tumor
Beckwith-Wiedemann
ultrasound appearance of Wilm’s tumor (2)
large, solid, mostly echogenic masses
may contain anechoic or hypoechoic areas
what is a ureterocele?
cystic dilation of the ureter as it enters the bladder
ureterocele is often associated with ___
duplicated collecting systems
ultrasound appearance of ureterocele
anechoic, balloon-like structure within the bladder lumen near the UVJ
what is a neurogenic bladder?
poorly functioning bladder secondary to any type of neurologic disorder
what muscle is affected in a neurogenic bladder?
detrusor muscle surrounding the bladder
ultrasound appearance of neurogenic bladder (4)
wall thickening
trabeculated bladder
post void excessive urinary retention
distended bladder with the lack of urgency to void
what is bladder diverticulum?
outpouching of the bladder wall
bladder diverticulum may be associated with ___
urethral obstruction
complications of bladder diverticulum (4)
bladder infection
urethral obstruction
tumor development
spread of infection to the upper urinary tract
what is cystitis?
inflammation of the bladder
cystitis appears as ___
bladder wall thickening
> 4mm
chronic cystitis can lead to ___ and ___ of the bladder wall
scarring and trabeculation
what is the most common malignant tumor of the bladder?
bladder TCC
ultrasound appearance of bladder TCC
smooth or papillary hyperechoic mass that projects into the lumen of the bladder
when an intraluminal bladder object or bladder wall mass is suspected, place the patient into _____ position to determine the mobility of the mass
decubitus
PUV is a common cause of ____ in male neonates
urinary obstruction
simple renal cysts occur in 50% for people over the age of
50
Bosnian classification of renal cysts
1 = simple cyst (0% malignancy)
2 = (1-3) few septa < 2mm (0% malignancy)
2F = (>4) many septa < 2mm (5% malignancy)
3 = thick or irregular septa 3mm (55% malignancy)
4 = clearly malignant > 4mm(100%)
ADPKD is associated with _____ aneurysms of the circle of Willis
cerebral arterial (Berry) aneurysm
Potter Syndrome refers to
a group of findings associated with a lack of amniotic fluid (oligohydramnios) and kidney failure in an unborn infant
what 3 structures should be evaluated in patients with von hippel-lindau?
kidneys
adrenal glands
pancreas
80% of angiomyolipomas involve the ____ kidney
right
the most common finding associated with RCC is
hematuria
patients with Wilm’s tumor typically present with
a large asymptomatic flank mass
what is the most common renal tumor in neonates and infants?
mesoblastic nephroma
____ is reported in 71% of pregnancies associated with mesoblastic nephroma
polyhydramnios (too much amniotic fluid around the fetus during pregnancy)
when acute pyelonephritis is focal it is called (2)
acute focal bacterial nephritis
lobar nephronia
renal fungal balls are also known as
mycetoma
acute renal failure is suspected within urine output ____ or serum BUN and creatinine ___
urine output decreases
BUN and creatinine increase
3 main mechanisms of ARF
prerenal failure
intrinsic renal failure
postrenal failure
____ indicates postrenal failure
____ suggests intrinsic renal failure
hydronephrosis = postrenal
abnormal RI = intrinsic
acute glomerulonephritis presents as a sudden onset of (3)
hematuria
proteinuria
RBC casts in urine
a RI of greater than ____ is suggestive of obstructive hydronephrosis
greater than 0.7
an increased risk of congenital anomalies of the kidney and urinary tract are associated with the presence of (2)
outer ear abnormalities
single umbilical artery
what is the most common cause of pediatric hydronephrosis?
occurs more commonly in ___ on the ____ kidney
UPJ obstruction
more common in males on the left kidney
a megaureter is a wide ureter greater than ____ in diameter
7 mm
primary megaureter is related to
distal adynamic segment with proximal dilation
secondary megaureter results from
abnormalities that involve the bladder or urethra
nephrocalcinosis is also known as
Albright’s calcinosis or Anderson-Carr kidneys
what is Anderson-Carr-Randall?
now known as nephrocalcinosis
calcium deposits in the renal pyramids
what is papillary necrosis?
necrosis of the renal medullary pyramids
papillary necrosis is associated with (3)
diabetes
analgesic abuse
sickle cell disease
most acquired bladder diverticula are associated with longstanding bladder outlet obstruction due to
BPH
what is a urachal cyst?
cystic dilation of the fetal urachus
