Urology (KIDNEY 1) Flashcards
Kidneys develop from the
Metanephrine buds
In horseshoe kidney assent is restricted by the
Inferior mesenteric vessels
Physiological lobulations in kidney, that are persist in adult are known as
Dromedary Humps
Which kidney is preferred as donor kidney and why
left kidney because Left renal vein is longer
What is nutcracker syndrome?
Left renal vein is compressed between superior, mesenteric artery and aorta
What is renal collar?
Left renal vein splits to encase the aorta
IOC for duplication of ureteric system
IVU ( Intravenous urogram )
What is Weigert Meyer Rule
Ureter draining the upper pole/ectopic ureter will open more medially and distally in an ectopic location as compared to normal ureter
Males : open into urethra
females : open into vagina
Drooping Lily sign is seen in
Duplication of malrotated pelvis
Infantile PCKD is Autosomal……
Recessive
In Infantile PCKD , PKHD is o chromosome
6
Adult PCKD is autosomal
Dominant
In adult PCKD , PKD 1 is on chromosome ….. and PKD 2 is on chromosome…..
16 & 4
Prenatal scan diagnosis for PCKD should have
If more than 3 cysts weather unilateral or bilateral
two or more cyst in both kidneys
Fused portion in the horseshoe kidney lies at the level of
L3–L4
On IVU which sign can be seen in horseshoe kidney
Flower vase appearance,
handshake sign
Management in asymptomatic, patient with horseshoe kidney
No management require
Management in presence of hydronephrosis or malrotated pelvis with stone formation in patient of horseshoe kidney is
Pyeloplasty
What is hydronephrosis?
Aseptic dialatation of pelvi-calyceal
system due to intermittent partial/complete block to flow of urine
 Most common cause of acquired hydronephrosis is
Renal stone (sloughed papillae)
Intra luminal cause
Most common congenial cause of hydronephrosis
PUJ obstruction
Intramural cause (within the wall)
IOC in pelvi-ureteric Justin obstruction
MAG-3 scan (can assess the function in the left kidney)
Management of symptomatic patients of PUJ obstruction
Anderson -Hynes dismembered pyeloplasty
TCC of ureter in IVU shows
Goblet sign
What is Ureterocele
Dilution of the terminal end of the ureter
IVU sign in the ureterocele shows
Cobra head/Adder head
Management of Aberrant renal vessel
Pyeloplasty
Never cut the aberrant vessel bc it can devascularize a portion of kidney
Retrocaval ureter
 Right sided ureter goes behind the IVC
IVU SHOWS WHICH SIGN In retrocaval ureter
Fish hook / reverse J sign
What is the management of retrocaval ureter
Lateralization of ureter. If lateralization fails uretero-ureterostomy is done after cutting the segment
Retroperitoneal Fibrosis is also known as
Ormond’s disease
Name drug induced retroperitoneal fibrosis
Methysergide , bromocriptine
IgG4 mediated retroperitoneal fibrosis associated with
Dupuytren’s contracture and Peyronie’s disease
IVU sign in retroperitoneal fibrosis
Maiden’s waist anomaly
Which renal isotopes scan is the best to asses the function?
MAG3 scan Is the BEST
Others: DTOA
Which renal isotopes scan assess the structure or scarring
DMSA
What is Nephrostomy
Surgery to make an opening from the outside of the body to the renal pelvis
When should we save the hydro nephrotic kidney
If the Hydro nephrotic kidney contributes to greater than 20% to total GFR
What is consecration product
Amount of solute in a solution
What are the stone inhibiting factor?
Citrate
Tamm Horsfall proteins
Stone formation can occur if
Concentration product is >formation product
What are the most common renal stones?
Calcium oxalate stones
Formed in acidic urine
Crystals of monohydrated stones are
Dumbbell shaped
They’re very hard stones
Crystals of dihydrated stones are
Enveloped shaped
They’re known as mulberry stones due to spiculated margins
What are the dietary advice we should give to patient to prevent recurrent calcium oxalate stones
Decrease fat content
Increase calcium intake
Large dose of pyridoxine
Triple phosphate stones also known as
Staghorn / Struvite stones
Formed in alkaline urine, usually infected with Proteus
Triple phosphate stones crystals are
Coffin lid type
What is the medical management for recurrent triple phosphate stone
Aceto-hydroxamic acid
Which stones are very hard to break by ESWL
Cystine stone(radio opaque )
Recurrent cysteine stones are managed with
D-penicillamine
radiolucent stone are
Ammonium urate stone
Uric acid crystals
Most common radiolucent stones is
Uric acid stone
form in acidic / noninfected urine
Uric acid stones are seen conditions with
Tumor lysis syndrome and gout
Recurrent uric acid stone can be managed with
Allopurinol 
Which type of pain is present if the stone is in renal pelvis or upper ureter?
Loin to Groin
Upper ureter stone pain can radiate to
Inner aspect of the thigh
Upper or Mid ureter stone pain can radiate to
ilio-hypogastric nerve
Lower ureter stone pain can radiate to
ilio-inguinal nerve
What is Stranguary?
It is seen if the stone is impacted in the intramural portion, intense painful urge to pass urine, but on trying to can only pass one or two drops of bloody urine most common acquired cause of hydronephrosis

What is dietl crisis
intermittent ureteropelvic junction (UPJ) obstruction causing episodic abdominal pain, most often due to an aberrant accessory renal artery or vein
Patient with renal stones can present with this
IOC for a patient presented with renal stones
NCCT Abdomen or NCCT KUB
When should ESWL should done
When stone is >5-6 mm and/or in symptomatic patients 
Complications of ESWL
Pain (most common)
Hematuria
Stone street- multiple fragments are generated and it clogs the ureter. Also known as Steinstrasse.
Stone is …….. in size. It is contraindications of ESWL.
1.5 cm
Why lower calyx stones are contraindicated for ESWL?
Because the fragments will have to travel in antigravity direction to be removed via Urine
Which basket is used to retrieve the stone. ?
Dormia basket
Which lasers can be used to shatter stones?
Holmium: YAG laser
How to differentiate between gallbladder stones and ureteric stones
In the lateral view, gallbladder stones are anteriorly placed, and ureteric stones are posteriorly placed 
What is the first line management in symptomatic patient or > 5 to 6MM size ureteric stone
URS
If URS fails/stone is impacted ureterolithotomy is done
What is the most common stones in the bladder?
Mixed Urate stones
What is jack stones
Spiculated margins which are calcium oxalate stones
What is the first line management for bladder stones?
Perurethral cystolithotomy
If it is contraindicated, suprapubic, cystolithotomy is done
VUR is most commonly seen in
3 -5 % girls, and 1 to 2% boys
<3 months of age more common in boys and >3 months of age more common in girls
Grades of VUR is assessed by
IVU/MCU
What is pyelonephritis
Inflammation of the kidney due to a bacterial infection.
Which endoscopic methods are used in management of grade IV & V VUR
Sting and Hit procedure
Which investigation is best to document renal scarring due to VUR
DMSA scan ( remember S for Scarring)💡
Which zone of the peritoneum is associated with maximum mortality
ZONE 1 (it is associated with major vessels)
Which zone injuries are most common
Zone 3
What is the IOC in stable patient with suspected renal injury
CECT
What is the IOC in unstable patient with suspected renal injury
Single shot intravenous urogram
Not FAST as bowel gas will obscure the retroperitoneum
IOC for vascular injury
Single shot intravenous urogram
What is urinoma
urinoma is a collection of urine that forms in the back of your abdomen.
What is meteorism?
48-72 hours after retro peritoneal Hematoma. Can develop colonic distention due to pressure over splanchnic nerves
What is boari flap repair
Bladder flap for reconstructing lower end of ureter
Putty kidney is
Kidney filled with pus
Earliest lesion in renal TB is
Papillary ulcer
If uretero pelvic junction is affected it is known as
Kerr’s kink
What is the earliest manifestation of bladder
Paleness of bladder mucosa
MC organism responsible for pyelonephritis
E. coli
Which classification is used for renal Cyst (benign tumor)
Bosniak Classification
Name benign tumor of the kidney
- Angiomyolipoma
- Oncocytoma
Massive retroperitoneal hemorrhage Wunderlich syndrome - Lenk’s triad includes
Pain , Flank mass , Hypotension (no hematuria).
MC benign tumor of the ovary is
Oncocytoma
Familial relation of oncocytoma includes
Birt Hogg Dube syndrome
CECT findings in oncocytoma are
Central stellate scar(also in focal nodular hyperplasia of liver, also in chromophobe RCC)
Other name for RCC are
Grawitz tumor / Hypernephroma /Internist tumor
Most common syndrome associated with RCC
Von Hippel Lindau (chr 3)
Psammoma bodies are seen in
Papillary carcinoma
Which RCC has the best prognosis
Chromophobe RCC
Which RCC has the worst prognosis
Collecting duct / Bellini.
Triad seen in RCC are
Hematuria , Pain , Mass
Most common site of distant metastases in RCC
Cannonball metastasis to lung
What is the MC presentation patient will present with in RCC
Hematuria
MC increased lab value in PNS
Increased ESR
What is Stauffer syndrome
Non metastatic hepatic dysfunction: inc in IL-6 , inc in bilirubin , ALP , Liver emzymes
What is lambert-eaton syndrome
A condition in which the body’s immune system attacks the connection between nerves and muscles 
Which structures removed in radical nephrecromy
Removal of kidney With gerota fascia , para aortic LN , ureteric removal till pelvic brim +/- ipsilateral adrenal glands (in T4 tumor)
What does mTOR inhibitor do
Blocks a protein called mTOR which helps control cell division
Sirolimus , Everolimus
What is the Most common pediatric renal malignancy
Wilm’s tumor
What is 2nd most common abdominal malignancy
Wilm’s tumor (most common is Neuroblastoma)
Familial association of Wilm’s tumor are
Beckwidth weidmann syndrome
Denys-Drash syndrome
WAGR syndrome
Most important prognostic factor in Wilm’s tumor is
Histology
Boggy granulomatous prostatitis is aka
Watermelon prostate
Gas in and around kidney on CECT is seen in
Emphysematous pyelonephririts
MC organism causing renal carbuncle
Staph . Aureus
Bear’s claw appearance on CT is seen in
Xnathogranulomatous pylonephritis
Angiomyolipoma is bosniak type
3
What bleed is associated with autosomal dominant polycystic kidney disease?
Subarachnoid
Coliky abdominal pain from loin to goin is characteristic of what condition?
Renal colic
