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ARDMS ABD PATHOLOGY > Urinary Tract Pathology > Flashcards

Urinary Tract Pathology Flashcards

1
Q

what is acute renal failure?

A

a sudden decrease in renal function

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2
Q

what is the most common cause of acute renal failure?

A

acute tubular necrosis

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3
Q

what is acute tubular necrosis?

A

ischemic damage to the renal tubule cells

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4
Q

other causes of acute renal failure (5)

A

renal infection
urinary tract obstruction
PKD
amyloidosis
Henoch-Schonlein purpura

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5
Q

ultrasound appearance of acute renal failure (3)

A

normal to enlarged kidneys
may appear more echogenic
hydronephrosis

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6
Q

signs/symptoms of acute renal failure (7)

A

increase BUN and creatine
oliguria
HTN
leukocytosis
hematuria
edema
hypovolemia

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7
Q

what is chronic renal failure?

A

gradual decrease in renal function over time

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8
Q

chronic renal failure will lead to _____,

____ and _____ may be needed

A

lead to end stage renal disease

dialysis and donor kidney may be needed

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9
Q

what is the most common cause of chronic renal failure?

A

diabetes

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10
Q

other causes of chronic renal failure (7)

A

glomerulonephritis
chronic pyelonephritis
metabolic disorders
chronic urinary tract obstruction
tuberculosis
renal vascular disease
infection

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11
Q

ultrasound appearance of chronic renal failure (4)

A

small, echogenic kidneys
thin cortex (<1cm)
no differentiation between cortex & sinus
renal cysts

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12
Q

signs/symptoms of chronic renal failure (5)

A

malaise
increase BUN and creatine
fatigue
HTN
hyperkalemia

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13
Q

what is dialysis?

A

removal of accumulated urea, other waste materials, and excess water from those with inadequate kidney function

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14
Q

what are the 3 forms of dialysis?

A

hemodialysis
hemofiltration
peritoneal dialysis

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15
Q

what is the most common renal mass?

A

simple renal cyst

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16
Q

simple renal cysts are usually located in the ____

A

cortex

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17
Q

what is a peripelvic cyst?

A

renal cyst that originates in the renal sinus

**lack a central communication between multiple small cysts
can be confused with hydronephrosis

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18
Q

peripelvic cysts are associated with the ____ and ____

A

renal pelvis and calyces

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19
Q

what is a parapelvic cyst?

A

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

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20
Q

parapelvic cysts can cause (3)

A

pain
HTN
obstruction

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21
Q

what are exophytic cysts?

A

renal cysts that appear to be projections out away from the kidneys

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22
Q

what is milk of calcium cyst?

A

colloidal suspension of calcium salts
(carbonate, phosphate, and oxalate)

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23
Q

milk of calcium cyst is related to (3)

A

urinary stasis
infection
immobility of the patient for extended periods of time

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24
Q

what differentiates milk of calcium cyst from renal calculi?

A

milk of calcium cyst will move with patient position, renal calculi will not move

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25
Q

ADPKD is also known as

A

adult polycystic kidney disease

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26
Q

ADPKD can lie dormant for years and full manifestation will occur in ____

A

the 4th decade of life

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27
Q

by age 60, 50% of patients with ADPKD will suffer from ____

A

end stage renal disease

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28
Q

40% of patients with ADPKD will also have polycystic ____, ____, and ____

A

liver
pancreas
spleen

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29
Q

ultrasound appearance of ADPKD (3)

A

bilateral enlarged kidneys
numerous cortical renal cysts
cysts in pancreas, liver, and spleen

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30
Q

ARPKD is also known as

A

infantile polycystic kidney disease

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31
Q

ARPKD is characterized by ____

A

dilation of the renal collecting tubules

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32
Q

ultrasound appearance of ARPKD (3)

A

bilateral enlarged kidneys
echogenic kidneys
loss of corticomedullary differentiation

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33
Q

what is MCDK is caused by?

A

early, 1st trimester obstruction of the ureter

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34
Q

what is the most common cystic disease in neonates?

A

MCDK

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35
Q

what is the most common cause of palpable abdominal mass in infants?

A

MCDK

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36
Q

what is acquired cystic renal disease?

A

result of chronic hemodialysis

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37
Q

patients with acquired cystic renal disease are at an increased risk for ___

A

RCC

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38
Q

ultrasound appearance of acquired cystic renal disease (2)

A

initially the kidneys will be small with some small cysts

with time the kidneys will enlarge and have numerous cysts throughout the renal parenchyma

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39
Q

what is tuberous sclerosis?

A

autosomal dominant disorder that causes the development of tumors within various organs

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40
Q

tuberous sclerosis primarily affects the (6)

A

brain
eyes
heart
kidneys
skin
lungs

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41
Q

tuberous sclerosis is associated with (2)

A

renal cystic disease and angiomyolipomas

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42
Q

signs/symptoms of tuberous sclerosis (3)

A

epilepsy
skin lesions of the face
mental retardation

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43
Q

what is acute pyelonephritis?

A

inflammation of the kidneys

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44
Q

what causes acute pyelonephritis?

A

ascending infection

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45
Q

what is an ascending infection?

A

when bacteria begins the bladder and refluxes up through the ureters and into the kidneys

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46
Q

acute pyelonephritis is most common in ___

A

women

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47
Q

complications of acute pyelonephritis (5)

A

renal abscess
pyonephrosis
xanthogranulomatous pyelonephritis
emphysematous pyelonephritis
chronic pyelonephritis

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48
Q

what is pyonephrosis?

A

pus/purulent material within the collecting system

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49
Q

what causes pyonephrosis?

A

obstructive process or infection that leads to urinary stasis

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50
Q

ultrasound appearance of pyonephrosis (2)

A

hydronephrosis
layering, low-level echoes

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51
Q

what causes xanthogranulomatous pyelonephritis?

A

chronic urinary tract obstruction and subsequent infection

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52
Q

xanthogranulomatous pyelonephritis is associated with _____ in about 70% of cases

A

staghorn calculus (large stone)

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53
Q

what is emphysematous pyelonephritis?

A

life threatening infection of the kidneys that causes gas accumulation within the renal parenchyma

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54
Q

emphysematous pyelonephritis is caused by ____ infection

A

E. coli infection

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55
Q

emphysematous pyelonephritis is common in ___ and _____

A

diabetics and immunocompromised

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56
Q

what is chronic pyelonephritis?

A

recurrent infections of chronic obstruction that leads to scarring of the calices and renal pelvis

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57
Q

chronic pyelonephritis can cause ___ and ___

A

xanthogranulomatous pyelonephritis and end-stage renal disease

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58
Q

children with a history of ____ are at an increased risk for chronic pyelonephritis

A

vesicoureteral reflux (VUR)

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59
Q

ultrasound appearance of chronic pyelonephritis (3)

A

small, echogenic kidneys
lobulated borders
renal scar = echogenic area within the kidney that extends from the renal sinus through the parenchyma

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60
Q

what is the most common cause of renal fungal disease?

A

candida albicans

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61
Q

who are at risk for developing renal fungal disease? (4)

A

immunocompromised
diabetics
intravenous drug abuse patients
infants who have long standing, indwelling catheters

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62
Q

ultrasound appearance of renal fungal balls (3)

A

hyperechoic, nonshadowing, mobile structures

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63
Q

what causes glomerulonephritis?

A

distant infection like strep throat and autoimmune reaction

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64
Q

ultrasound appearance of acute glomerulonephritis (3)

A

normal to enlarged
increase echogenicity
prominent pyramids

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65
Q

ultrasound appearance of chronic glomerulonephritis

A

increase cortical echogenicity

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66
Q

sign/symptoms of glomerulonephritis (7)

A

smoky urine
azotemia (increase nitrogen levels)
hematuria
proteinuria
HTN
fever
leukocytosis

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67
Q

what is the most common parasitic infection of the kidneys?

A

schistosomiasis

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68
Q

ultrasound appearance of schistosomiasis

A

thick bladder wall

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69
Q

what is hydronephrosis?

A

dilation of the renal collecting system secondary to the obstruction of normal urine flow

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70
Q

causes of obstruction that result in hydronephrosis (3)

A

congenital
intrinsic cause
extrinsic cause

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71
Q

what happens in mild hydronephrosis?

A

distention of the renal pelvis

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72
Q

what happens in moderate hydronephrosis?

A

further calyceal separation

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73
Q

what happens in severe hydronephrosis?

A

thinning of the parenchyma

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74
Q

what is caliectasis?

A

dilation of the calices

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75
Q

what is pelviectasis/pyelectasis?

A

dilation of the renal pelvis

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76
Q

what is pelvicaliectasis/pyelectasis?

A

dilation of the calices and renal pelvis

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77
Q

false-positives of hydronephrosis (4)

A

over distention of the bladder
parapelvic cysts
prominent renal vein
extrarenal pelvis

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78
Q

what is urolithiasis?

A

kidney stones located anywhere within the urinary system

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79
Q

what is nephrolithiasis?

A

kidney stones

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80
Q

what are kidney stones made of?

A

calcium oxalate

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81
Q

kidney stones form in the ___ and ___

A

kidneys and bladder

82
Q

where is the most common location for a kidney stone to become lodged?

A

UVJ

83
Q

what is the twinkle sign?

A

increased color doppler signal posterior to a kidney stone

84
Q

what is nephrocalcinosis?

A

accumulation of calcium within the renal parenchyma

85
Q

what are the two forms of nephrocalcinosis?

A

medullary nephrocalcinosis and cortical nephrocalcinosis

86
Q

medullary nephrocalcinosis is caused by ___ and ____

A

hyperparathyroidism and hypercalcemia

87
Q

what is the most common cause of medullary nephrocalcinosis?

A

medullary sponge kidney

88
Q

what is medullary sponge kidney?

A

accumulation of calcium within abnormally dilated collecting ducts located within the medulla

89
Q

ultrasound appearance of medullary nephrocalcinosis

A

echogenic renal pyramids

90
Q

causes of cortical nephrocalcinosis (3)

A

hyperparathyroidism
AIDS
associated with some malignancies

91
Q

ultrasound appearance of cortical nephrocalcinosis

A

echogenic foci within the cortex

92
Q

angiomyolipoma is also called

A

renal hamartoma

93
Q

what is the most common benign renal tumor?

A

angiomyolipoma

94
Q

angiomyolipomas are composed of (3)

A

blood vessels
muscle
fat

95
Q

95% of patients with tuberous sclerosis have multiple, bilateral _____

A

angiomyolipomas

96
Q

ultrasound appearance of angiomyolipoma (2)

A

solid, hyperechoic mass
20-30% will produce shadowing

97
Q

what is oncocytoma?

A

benign renal tumor often found in men in their 60s

**stellate central scar
difficult to differentiate from RCC - biopsy

98
Q

what is the second most common renal mass?

A

oncocytoma

99
Q

renal hemangiomas are encountered during the ___ or ___ decade of life

A

3rd or 4th decade of life

100
Q

___ may be observed sonographically in renal trauma

A

renal fracture

101
Q

ultrasound appearance of renal fracture (2)

A

linear absence of echoes
linear anechoic or hypoechoic region in the parenchyma

102
Q

in renal trauma, blood may accumulate in what 4 locations

A

subcapsular - under the capsule
perinephric - in Gerota’s fascia
pararenal - anterior or posterior
intramuscular - in psoas muscle

103
Q

RCC is also known as

A

hypernephroma or adenocarcinoma of the kidney

104
Q

what is the primary form of renal cancer?

A

RCC

105
Q

RCC is most common in ___

A

males after 40 years old

106
Q

risk factors for RCC (6)

A

smoking
HTN
obesity
tuberous sclerosis
von Hippel-Lindau
long term dialysis

107
Q

RCC commonly invades ___ via the ___

A

invades IVC via the RRV

108
Q

Grade I of RCC

A

confined to kidney

109
Q

Grade II of RCC

A

spreads to the perinephric fat but within Gerota’s fascia

110
Q

Grade III of RCC

A

spreads to RV, IVC, and regional lymph nodes

111
Q

Grade IV of RCC

A

invasion of neighboring structures

112
Q

what is renal TCC?

A

malignant tumor that is most often found in the renal pelvis

113
Q

renal TCC may also be found within the ___ and ___

A

ureter and bladder

114
Q

renal TCC can cause ___

A

focal dilation of the calices

115
Q

metastases to the kidney is most often from the ___ or ___

A

lungs or breast

116
Q

metastasis to the kidneys is less frequently from the (3)

A

prostate
pancreas
melanoma

117
Q

what is nutcracker syndrome?

A

compression or entrapment of the LRV as it passes between the SMA and AO

118
Q

in nutcracker syndrome, the LRV will reveal ____

A

elevated pressure with doppler evaluation

119
Q

males with nutcracker syndrome may complain of ___

A

left testicular pain

120
Q

what is a common cause of RA stenosis?

A

atherosclerosis

121
Q

patients with existing RA stenosis often suffer from ____ that does not respond to treatment

A

HTN

122
Q

in young females, _____ may be the cause of RA stenosis

A

fibromuscular disease

123
Q

RA stenosis can lead to ___ and ___

A

renal infarction and irreparable renal compromise

124
Q

ultrasound appearance of RA stenosis (3)

A

thickening and calcification of the RA
renal:AO ratio greater than 3.5
tardus-parvus spectral waveform downstream from the stenosis

125
Q

what is tardus-parvus?

A

combination of a slow systolic upstroke and a decreased systolic velocity

126
Q

causes of RV thrombosis (3)

A

renal tumors
trauma
renal infections

127
Q

ultrasound appearance of RV thrombosis (3)

A

enlarged and heterogenous kidney
enlarged RV
no doppler signals in RV

128
Q

____ is the best indicator of renal transplant rejection

A

renal biopsy

129
Q

a transplanted kidney is also called an ____

A

allograft

130
Q

donor vasculature of an allograft is anastomosed to the ____

A

external iliac artery and vein

131
Q

mild _____ is normal in the allograft

A

mild pelviectasis

132
Q

assessment of the allograft includes (2)

A

spectral analysis of the interlobar arteries (upper,mid, and lower)

color and spectral analysis of the main RA (anastomosis, prox, distal)

133
Q

abnormal RI of an allograft

A

greater than 0.9

134
Q

postrenal transplant fluid collections are common and include (4)

A

lymphocele
urinoma
hematoma
abscess

135
Q

signs of renal transplant rejection (8)

A

infection
obstruction
vascular stenosis
RA stenosis
RA thrombosis
RV thrombosis
pseudoaneurysm
fistula

136
Q

what is the most common vascular complication following renal transplantation?

A

RA stenosis

137
Q

signs of RA stenosis (3)

A

PSV greater than 200 cm/s

RA:external iliac ratio greater than 2.0

poststenotic turbulence

138
Q

what is the most common cause of congenital hydronephrosis?

A

ureteropelvic junction obstruction

139
Q

3 other causes of congenital hydronephrosis

A

vesicoureteral reflux (VUR)
posterior urethral valves (PUV)
prune belly syndrome

140
Q

what is vesicoureteral reflux?

A

backward flow of urine from the bladder into the ureters

141
Q

VUR is most commonly caused by ___

A

incompetent valve at the UVJ

142
Q

VUJ is diagnosed by ___ or ___

A

voiding cystourethrogram (VCUG)
nuclear cystogram

143
Q

Grade I of VUR

A

urine refluxes into the ureter only

144
Q

Grade II of VUR

A

urine refluxes into the ureter and renal pelvis WITHOUT hydronephrosis

145
Q

Grade III of VUR

A

urine refluxes into the ureter and renal pelvis WITH hydronephrosis

146
Q

Grade IV of VUR

A

moderate hydronephrosis

147
Q

Grade V of VUR

A

severe hydronephrosis

148
Q

what are posterior urethral valves (PUV)?

A

folds of excessive urethral tissue found exclusively in males

149
Q

PUV causes dilation of (3)

A

bladder
both ureters
both renal collecting systems

150
Q

prune belly syndrome is a result of

A

abdominal wall musculature being stretched by an extremely enlarged bladder (megacystis)

151
Q

3 main problems of prune belly syndrome

A

poor development of abdominal muscles

cryptorchidism

urinary tract abnormalities

152
Q

what is used to treat severe VUR?

A

synthetic bulking agent called subureteral Teflon injection (STING)

153
Q

Wilm’s tumor is also known as ____

A

nephroblastoma

154
Q

what is the most common solid malignant pediatric abdominal mass?

A

Wilm’s tumor

155
Q

nephroblastoma is usually discovered before the age ___

A

5 years old

156
Q

Wilm’s tumor tend to metastasize to the ___ and ___

A

liver and lungs

157
Q

patients with ____ have a tendency to develop Wilm’s tumor

A

Beckwith-Wiedemann

158
Q

ultrasound appearance of Wilm’s tumor (2)

A

large, solid, mostly echogenic masses
may contain anechoic or hypoechoic areas

159
Q

what is a ureterocele?

A

cystic dilation of the ureter as it enters the bladder

160
Q

ureterocele is often associated with ___

A

duplicated collecting systems

161
Q

ultrasound appearance of ureterocele

A

anechoic, balloon-like structure within the bladder lumen near the UVJ

162
Q

what is a neurogenic bladder?

A

poorly functioning bladder secondary to any type of neurologic disorder

163
Q

what muscle is affected in a neurogenic bladder?

A

detrusor muscle surrounding the bladder

164
Q

ultrasound appearance of neurogenic bladder (4)

A

wall thickening
trabeculated bladder
post void excessive urinary retention
distended bladder with the lack of urgency to void

165
Q

what is bladder diverticulum?

A

outpouching of the bladder wall

166
Q

bladder diverticulum may be associated with ___

A

urethral obstruction

167
Q

complications of bladder diverticulum (4)

A

bladder infection
urethral obstruction
tumor development
spread of infection to the upper urinary tract

168
Q

what is cystitis?

A

inflammation of the bladder

169
Q

cystitis appears as ___

A

bladder wall thickening

> 4mm

170
Q

chronic cystitis can lead to ___ and ___ of the bladder wall

A

scarring and trabeculation

171
Q

what is the most common malignant tumor of the bladder?

A

bladder TCC

172
Q

ultrasound appearance of bladder TCC

A

smooth or papillary hyperechoic mass that projects into the lumen of the bladder

173
Q

when an intraluminal bladder object or bladder wall mass is suspected, place the patient into _____ position to determine the mobility of the mass

A

decubitus

174
Q

PUV is a common cause of ____ in male neonates

A

urinary obstruction

175
Q

simple renal cysts occur in 50% for people over the age of

A

50

176
Q

Bosnian classification of renal cysts

A

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%)

177
Q

ADPKD is associated with _____ aneurysms of the circle of Willis

A

cerebral arterial (Berry) aneurysm

178
Q

Potter Syndrome refers to

A

a group of findings associated with a lack of amniotic fluid (oligohydramnios) and kidney failure in an unborn infant

179
Q

what 3 structures should be evaluated in patients with von hippel-lindau?

A

kidneys
adrenal glands
pancreas

180
Q

80% of angiomyolipomas involve the ____ kidney

A

right

181
Q

the most common finding associated with RCC is

A

hematuria

182
Q

patients with Wilm’s tumor typically present with

A

a large asymptomatic flank mass

183
Q

what is the most common renal tumor in neonates and infants?

A

mesoblastic nephroma

184
Q

____ is reported in 71% of pregnancies associated with mesoblastic nephroma

A

polyhydramnios (too much amniotic fluid around the fetus during pregnancy)

185
Q

when acute pyelonephritis is focal it is called (2)

A

acute focal bacterial nephritis
lobar nephronia

186
Q

renal fungal balls are also known as

A

mycetoma

187
Q

acute renal failure is suspected within urine output ____ or serum BUN and creatinine ___

A

urine output decreases
BUN and creatinine increase

188
Q

3 main mechanisms of ARF

A

prerenal failure
intrinsic renal failure
postrenal failure

189
Q

____ indicates postrenal failure
____ suggests intrinsic renal failure

A

hydronephrosis = postrenal
abnormal RI = intrinsic

190
Q

acute glomerulonephritis presents as a sudden onset of (3)

A

hematuria
proteinuria
RBC casts in urine

191
Q

a RI of greater than ____ is suggestive of obstructive hydronephrosis

A

greater than 0.7

192
Q

an increased risk of congenital anomalies of the kidney and urinary tract are associated with the presence of (2)

A

outer ear abnormalities
single umbilical artery

193
Q

what is the most common cause of pediatric hydronephrosis?

occurs more commonly in ___ on the ____ kidney

A

UPJ obstruction
more common in males on the left kidney

194
Q

a megaureter is a wide ureter greater than ____ in diameter

A

7 mm

195
Q

primary megaureter is related to

A

distal adynamic segment with proximal dilation

196
Q

secondary megaureter results from

A

abnormalities that involve the bladder or urethra

197
Q

nephrocalcinosis is also known as

A

Albright’s calcinosis or Anderson-Carr kidneys

198
Q

what is Anderson-Carr-Randall?

A

now known as nephrocalcinosis

calcium deposits in the renal pyramids

199
Q

what is papillary necrosis?

A

necrosis of the renal medullary pyramids

200
Q

papillary necrosis is associated with (3)

A

diabetes
analgesic abuse
sickle cell disease

201
Q

most acquired bladder diverticula are associated with longstanding bladder outlet obstruction due to

A

BPH

202
Q

what is a urachal cyst?

A

cystic dilation of the fetal urachus

ARDMS ABD PATHOLOGY (13 decks)

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