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Pathology > Week 12: Urinary System Pathologies > Flashcards

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
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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
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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
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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
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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
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3
Q

Vesicoureteral Reflux (VUR) Radiographic Appearance

A
  • voiding cystourethrogram show reflux under flour
  • may show hydrometer, hydronephrosis or pyelonephritis
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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
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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
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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
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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

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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
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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
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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
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9
Q

Phleboliths

A
  • calcified clot within a vein that appears radiographically as rounded densities
  • common in lower part of pelvis
  • mimic kidney stones
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9
Q

Phleboliths Radiographic Appearance

A
  • tend to be calcified around the outside
  • tend to be lateral and below ischial spines
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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

Pathology (14 decks)

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