Week 12: Urinary System Pathologies Flashcards
1
Q
Ectopic Kidney
A
- abnormally positioned kidney that may be found in various locations (from the true pelvis/pelvic kidney to above the diaphragm/intrathoracic)
- usually functional
- radiographic appearance: kidney is in an unusual place
2
Q
Duplication
A
- also called duplex kidney
- common anomaly that has many different variations
- simple bifid pelvis: 2 collecting systems that join to make one renal pelvis and ureter
- complete double pelvis/duplex collecting system: 2 renal pelvis and ureters per kidney that enter bladder at separate ureterovesical orifices
- radiographic appearance: 2 collection systems or double kidney pelvis
2
Q
Horseshoe Kidney
A
- most common type of fusion anomaly
- both poles malrotated, lower poles are joined
- obstruction is common at uteropelvic junction
- complete fusion of kidneys can occur but is rare (looks like one big bizarrely shaped structure)
- radiographic appearance: kidneys joined at lower pole, showing a horseshoe shape
3
Q
Ureterocele Radiographic Appearance
A
- intravenous urography and ultrasound used
- dilated ureter
- radiolucent halo of prolapsed contrast filled ureter in contrasts filled bladder
- cobra head sign: distal ureters look like cobra
- ectopic ureterocele (in duplication) appears as filling defect
3
Q
Vesicoureteral Reflux (VUR)
A
- abnormal flow of urine from the bladder back into the ureters
- usually congenital but can be from nerve damage or urethral blockage
- due to failure of the vesicle-uteral valve linking ureter to bladder
- may be unilateral or bilateral
- may cause swelling in the ureter and kidney
- urinary tract infection (UTI) is a common symptom of VUR
3
Q
Vesicoureteral Reflux (VUR) Radiographic Appearance
A
- voiding cystourethrogram show reflux under flour
- may show hydrometer, hydronephrosis or pyelonephritis
4
Q
Ureterocele
A
- stenosis of distal ureter leads to prolapse into the bladder
- the prolapsed section then becomes abnormally dilated
- often leads to hydronephrosis
5
Q
Pyelonephritis
A
- inflammation of the kidney, may be chronic or acute
- may be from bloodstream or lymphatics, but usually die to bacterial infection that moves up the urethra into the bladder, then up the ureter from the bladder to the kidney
- often occurs due to urinary tract obstruction (ex. a stone) which prevents frequent urination
- back pain, pus in urine (pyuria)
- may become emphysematous pyelonephritis in diabetic patients = necrotizing infection that can permanently damage or destroy kidney
- diagnosis = urinalysis, us, mri, ct and/or xray
6
Q
Cystitis
A
- inflammation of the urinary bladder
- may be caused by bacterial infection, instrumentation, catheterization or sexual intercourse
- more common in women (shorter urethra)
- keep urine bags lower than patties bladder to prevent retrograde flow and infection potential
- in diabetic patients, emphysematous cystitis can occur, gas bubbles in wall
6
Q
Pyelonephritis Radiographic Appearance
A
CT: modality of choice
- abscess (well defined dense area)
- hydronephrosis (enlarged kidney due to urine pressure)
- gas bubbles if emphysematous
Urography
- enlarged kidney
- kidney stone
- rounded or clubbed calyces
- gas bubbles if emphysematous
7
Q
Cystitis Radiographic Appearance
A
- voiding cystogram demonstrates decreased bladder size and irregular of bladder wall with chronic cystitis
- CT: bladder wall filled with gaseous material if emphysematous
8
Q
Renal Calculi Radiographic Appearance
A
- 80% of renal stones contain enough calcium to be radiopaque
- common exams to assess are CT and us
- KUB: radiopaque calcium renal stones
- CT: demonstrates location of stone
- contrast CT: non calcium stones cause filling defects
- US: an echogenic region with acoustic shadowing
8
Q
Renal Calculi (Kidney Stones)
A
- form in kidney
- made of calcium, uric acid, cystine (amino acid) or struvite (a phosphate = stag horn calculus)
- symptomatic until move and dislodge in ureter
- may end up in bladder, may pass
9
Q
Phleboliths
A
- calcified clot within a vein that appears radiographically as rounded densities
- common in lower part of pelvis
- mimic kidney stones
9
Q
Phleboliths Radiographic Appearance
A
- tend to be calcified around the outside
- tend to be lateral and below ischial spines
10
Q
Renal Colic
A
- severe pain that can present suddenly and without warning
- usually caused by stone stuck in the kidney, renal pelvis, or ureter
- pain is caused by dilation, stretching and spasm of the ureter
- hematuria (blood in the urine) often present
- radiographic appearance: stones present in kidney, renal pelvis or ureter
11
Q
Hydronephrosis
A
- dilation/distention of the renal pelvic and calyces as urine is trapped
- caused by obstruction such as calculi in ureter, urethral strictures, pelvic tumours, enlarged prostate
- bilateral hydronephrosis if most often indicative of obstruction at the base of the urinary bladder or urethra
- hydronephrosis can completely and permanently destroy kidney function
- radiographic appearance: urography, CT, US. enlarged, dilated renal calyces and pelvis
12
Q
Hydroureter
A
- dilation of the ureter caused by obstruction such as renal calculi
- unilateral: obstruction above bladder
- bilateral: blockage at or below bladder
- radiographic appearance: urography, dilated ureters
13
Q
Renal Cyst
A
- common fluid filled benign mass, usually unilocular (one chamber/compartment, but may have separations)
- may be unifocal (one site) or multiple, in one or both kidneys
- some have wall calcification
- often incidental finding
14
Q
Renal Calculi Treatment Procedures
A
- hydrate and wait (manage pain)
- lithotripsy (extracorporeal shock wave)
- laser lithotripsy (laser wave)
- hemolysis (medication introduced to break up stone)
- surgery
- percutaneous nephtolithotomy/lithotripsy: small incision, tube passed through stone to visualize then remove or break up. follow up in flour department
- cystoscopic retrieval (ureteroscopy basket): retrieval device introduced through urethra under fluoro guidance
15
Q
Renal Cyst Radiographic Appearance
A
- US: modality of choice. fluid filled mass
- CT: also good. round hypodense region
- non contrast CT shows same HU as water, contrast CT shows lack of contrast enhancement
- other conditions, sometime malignant, can mimic cyst so may need biopsy for definitive diagnosis
16
Q
Polycystic Kidney Disease
A
- an inherited disorder in which multiple cysts of varying size cause lobulated enlargement of kidneys and progressive renal impairment due to compression of nephrons
17
Q
Polycystic Kidney Disease Radiographic Appearance
A
- CT: cysts appear similar to simple cysts, but there are many. some become hemorrhagic and become hyper dense
- IVU: demonstrates enlarged kidney and mottled presence of multiple scent lesions, like Swiss cheese.
18
Q
Adenocarcinoma/Renal Cell Adenocarcinoma
A
- adenocarcinoma = any malignancy that involves glandular tissue in epithelium
- most common cancer of the kidneys is RCC/hypernephroma
- often only symptom is painless hematuria
19
Q
Adenocarcinoma/Renal Cell Adenocarcinoma Radiographic Appearance
A
CT: modality of choice
- enhanced Ct will show contrast uptake into the tumour (cyst will not) but less than normal parenchyma
- localized bulging and renal enlargement
- distortion of kidney shape
US: solid mass with internal echoes
20
Q
Bladder Carcinoma Radiographic Appearance
A
- historically cystograms/IVU were used to diagnose bladder cancer
- CT is better because it can help stage the cancer
- CT and MRI: mass projecting not bladder lumen, thickening of the bladder wall
- KUB may show calcification in and on tumour
20
Q
Bladder Carcinoma
A
- bladder tumour arising from epithelium
- males over 50
- often only symptom is painless hematuria
21
Q
Acute Renal Failure
A
- quick onset, sudden damage
- rapid deterioration of kidney function, nitrogen containing wastes accumulate in blood
- may be pre-renal, intrarenal (intrinsic), or post-renal
- US recommended, shows dilation of ureters, pelves from hydronephrosis
22
Q
Chronic Renal Failure
A
- slow progression over months, slow damage
- may be pre-renal, intrarenal (intrinsic) or post-renal
- US recommended, shows kidney deceased in size
22
Q
Renal Hypertension
A
- also called renovascular hypertension = elevated blood pressure caused by narrowing in the arteries that deliver blood to the kidneys
- asymptomatic other than really high blood pressure as kidneys produce hormone to increase the pressure (to try and get more blood) and retain water and salt
- high blood pressure damages the nephrons (kidney filtering unit)
- usually controlled by blood pressure medication
- angioplasty, stenting or surgery can be done for the blood vessels in the kidney
