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175 Cards in this Set

  • Front
  • Back
what organ make up the urinary system?
kidneys
ureters
bladder
urethra
Where is a renal cyst most commonly located?
In the renal cortex
where are three places you can develop renal cysts
cortical
peripheral
central/parapelvic
Where is a parapelvic cyst located?
within the renal sinus
What should you do to prove the cyst is a parapelvic cyst and not hydronephrosis?
be sure it is not connected to the collecting system
Are parapelvic cysts usually symptomatic or asymtomatic?
asymptomatic
What is Adult Polycystic Kidney Disease (APKD)
multi cystic
genitic disorder,
bilateral,
kidney enlargement
can cause cysts in other organs
What are primary complications of APKD?
renal failure
hypertension
hemorrhagic cyst
ureteric obstruction
what is the most common cause of renal failure
APKD
what do Kidneys excrete?
nitrogenous waste
What is u/s appearance of kidneys with APKD
bilaterally enlarged kidneys
multiple cysts (bilateral)
corticomedulary differentiation
what are three common symtoms of APKD?
Hematuria
hypertension
abdominal flank pain
What is another name for infantile Polycystic Kidney Disease?
autosomal recessive Polycystic Kidney disease
What is another name for Adult Polycystic Kidney disease
Autosomal dominant PKD
Is IPKD seen in utero?
no, the cysts are too small
What are characteristics of IPKD?
bilaterally enlarged kidneys
causes renal insufficiency
lung hypoplasia
What is adult multicystic kidney disease?
multiple cysts of varying sizes, typically occuring unilaterally
What is the difference between AMKD and APKD?
AMKD is unilateral and APKD is bilateral
what are most cases of AMKD caused by?
urinary tract obstruction
with adult MKD will the kidney be enlarged?
can be normal or grossly enlarged to to compensation
What is the US appearance of Adult MKD?
Non communicating cysts
absense of normal renal parenchyma
cyst wall calcification
What is a medullary sponge kidney
bilateral, cystic dilitation of the collecting ducts, small cysts measuring <2cm.
Would the medullary sponge kidney have normal renal function?
yes
What is nephracalcin?
calcium deposits within the renal parenchyma
where can nephracalcin deposits occur?
within the cortex or medulla or both
would you have shadowing from a nephracalcin?
no, calcifications may be too small
What is another name for nephrolithiasis?
kidney stone
What is nephrolithiasis?
stone formation anywhere with in the collecting system
Is Nephrolithiasis unilateral or bilateral
either
Is nephrolithiasis more common in males or females
males
What is the average size of a kidney stone?
2-3 mm
What is a staghorn Calculi
large central renal stone
What are the symptoms of nephrolithiasis
renal colic (pain)
Hematuria
pyerurea
What is the US appearance of Nephrolithiasis
echogenic focus with shadow
would you always see a stone in the ureter?
no, could be impossible to see due to size, location and overlying bowel gas.
What is Hydronephrosis
dilitation of the renal collecting system due to the obstruction of the outflow of urine
Where are three locations that obstruction can occur with hydronephrosis?
ureter
bladder
urethra
When is it normal to have hydronephrosis?
in Rt. Kid during pregnancy
what are some causes of hydronephrosis
reflux from full bladder (goes away when bladder is empty)
What are some aquired organic causes of hydronephrosis
stones, prostate enlargement, tumor, inflammation, blood clots, full bladder
what are some intrinsic causes of hydronephrosis
calculus, blood clots, tumors, strictures, pyelnephritis
what are some congenital causes of hydronephrosis
puv, upj, bladder neck obstruction
Why does the appearance of hydronephrosis vary?
it is due to the dilitation and renal output of composition of collecting
If the hydronephrosis is very severe what will you not be able to see
you cannot see the renal cortex
What are three grades of hydro nephrosis?
mild
moderate
severe
What is grade I hydro?
Mild hydro with slight dilitation of the collecting system
What is grade II hydro?
further dilitation seen creating a cauliflower shape to the renal pelvis
what is grade III hydro?
gross dilitation producing one large sonolucent mass seen with kidney. You will note cortical thinning due to compression
What is pyelonephritis also known as?
Kidney infection
what is the most common disease of the urinary tract?
pyelonephritis
How does pyelonephritis typically occur
usually happens from an ascending UTI
what does ascending UTI mean
a UTI occuring in the bladder, urethra
Is Pyelonephritis bilateral or unilateral
unilateral
with acute pyelonephritis what is the echogenicity of the kidney
hypoechoic
as the pyelonephritis continues and becomes chronic what is the echogenicity
hyperechoic
Who is most likely to get pyelonephritis?
females 15-35yrs old
What are the clinical signs of pyelonephritis
flank pain, fever/chills, dysuria, pyuria, leukocytosis
What is Xantho-granuloma-tous pyelonephritis
chronic pyelonephritis w/ obstruction
What are some characteristics of xanthogranulomatous pyelonephritis
long standing calculi
inflammatory masses within kidney that can mimic renal CA
what do patients with xantho granulomatous pyeloephritis usually present with
UTI
What is pyonephritis?
obstructed and infected collecting system displaying echogenic pus (composed of hydronephrosis)
What is glomerulonephritis
inflammation and necrosis of the Glomeruli
What happens to the vessels and tubules with glomerulonephritis
vessels and tubules become infected
What is the appearance of the kidneys with glomerulonephritis
enlarged and poorly functioning
what is the appearance of acute glomerulonephritis?
normal and asymtomatic
As glomerulonephritis turns chronic what is the appearance of the cortex
becomes hyperechoic
What are the clinical symptoms of glomerulonephritis
hematuria
hypertension
no urine output (urea gets reabsorbed back into the body)
what is another name for fungus balls
Mycetoma
what is a fungus ball
an echogenic , non shadowing mass within the kidney caused by candida
What type of patient usually gets fungus balls
patients with low resistance to disease, (malignancy, diabetes and neonates)
What is the sonographic appearance of a fungus ball?
looks like stone but does not shadow
what are three types of perinephric fluid collections
renal abscess
lymphocele
urinoma
what is a renal abscess?
infection inside or outside the kidney, usually due to inflammation, stone reflux, neurogenic bladder and diabetes
what is the appearance of a renal abscess?
complex mass with possible septations, dirty shadows, thick-irregular wall with enhancement
what are the symtoms of a renal abscess?
flank pain, fever , chills, elevated WBC
Lymphocele
largest fluid collection of the lymphatic fluid caused by renal damage/leakage
what is a lymphocele often confused with
a cyst
What is the appearance of a lymphocele
well defined cystic area with or without septations
when would a lymphocele contain echos
when it is hemorrhagic
a lymphocele is usually ________ in size than a abscess or urinoma
larger
what is a urinoma
encapsulated collection of anachoic extravasated urine
How does a urinoma occur?
urine escapes from vessels and leaks into surrounding tissues outside of kidney
where are urinomas usually located
near lower pole of kidney
what are causes of urinomas
renal injuries, transplants, tumor, calculus erosion, ureteral obstruction
What are three benign solid renal masses?
adenoma
oncocytoma
angiomyolipoma
Adenoma
a benign vascular tumor that attenuates sound
what is the typical size of an adenoma
<3cm
how is an adenoma usually found
usually incidental finding
What are the clinical symptoms of an adenoma
painless hematuria; but usually asymptomatic
Adenomas are believed to be the benign counterpart to...
renal cell CA
What is the us appearance of and renal adenoma?
highly vascular, internal echos, attenuating sound
Where is the renal adenoma ususally located
cortex
What is the most common benign kidney mass
a renal adenoma
what is oncocytoma
large vascular adenomas that grow very fast
A oncocytoma cannot be distinquished from __________?
Renal cell CA
What are the clinical symptoms of oncocytomas?
usually asymtomatic but if large can have pain and hematuria
Are Oncocytomas more common in men or women?
men
what is the us appearance of an oncocytoma?
well defined
smooth homogenious
stallate scar (central necrosis)
What is angiomyolipoma
benign tumor primarily composed of fat cells intermixed with smooth muscle and blood vessels
What is another name for angiomyolipomas
renal hamartoma
Where is a angiomyolipoma usually found?
renal cortex
is the angiomyolipoma hypoechoic or hyperechoic
hyperechoic due to fat content
What aged person is most likely to get angiomyolipoma
mid aged women
what does a angiomyolipoma look like on US
hemangioma of kidney
What are three types of malignant solid renal masses?
renal Cell CA
transitional cell CA
Nephroblastoma
What is another name for Renal cell CA
hypernephroma or adenocarcinoma
Waht is the most common primary malignant tumor of the kidney
renal cell CA
Where on the kidney is renal cell CA usually found?
cortical tumor
At what age are you most likely to develop renal cell CA
over 50
Is renal cell CA unilateral or bilateral?
unilateral
What are symptoms of Renal Cell CA
gross hematuria and pain when large
What are us characteristics of Renal cell CA
very vascular with calcification
area of necrosis, hemorrhage or degeneration
well delineated (encapsulated)
no enhancement
can be hyper, hypo or isoechoic to renal tissue
fast growing
what is the pattern of metastisis in renal cell CA
spreads by way of renal vein, most likely to spread to lungs
lymph nodes---lungs---bone---liver---brain
How many stages are there of renal cell ca
4
Stage 1 renal cell CA is described as
confined within capsule
stage 2 renal cell CA is described as
invasion into the perinephric fat
involvment into lymph nodes or venous structures (IVC and RV) decribes what stages of renal call CA
stage 3
Stage 4 renal cell CA is described as
invasion into adjacent organs or distant metastiasis
What is transitional cell CA
malignant tumor of the renal collecting system
what is the average age of someone developing tranisitonal cell CA
males 61 or older
What is the appearance for transitional cell CA
multiple, bilateral and hypoechoic
Where is transitional cell ca usually found?
within the bladder
What are the symptoms of Transitional cell CA
same as Renal Cell CA (gross hematuria)
Is it easy to detect transitional cell CA on US
no, too small
If transitional cell ca is seen on us what is the appearance?
solid mass centered in renal sinus
What is another name form Nephroblastoma
wilms tumor
What is the most common solid kidney or abdominal tumor found in children
nephroblastoma
what is the peak age of identification for nephroblastsoma
3-4 years old
a nephroblastoma is commonly associated wtih...
beckwith wiedemann syndrome
where does nephroblastoma metastasize too
nodes liver and lungs
what is the usual secondary CA to nephroblastoma
lungs, breast then other kidney
what are the clinical symptoms of nephroblastoma
pain, fever, malaise, weight loss, possibly palpable, possible hematuria and hypertension
What is the us appearance of nephroblastoma
well defined smooth echogenic mass
inhomogenious with age
necrosis and calcifications
hydronephrosis
What are the renal lab values
creatinine, BUN, UA-urinalyisis, urine Ph, hematuria
What is the standard long term treatment for end stage chronic renal failure
renal transplant
Why have the survival rates improved for renal transplants
immunology
therapy
more favorable selection of a donor
What is a sign of renal faillure on us
if the renal cortex is more hyperechoic than the liver.
Where is the donor kidney placed in the recipient?
they are placed in the retroperitoneum within the iliac fossa (anterior to fossas and iliac veins)
Why is the donor kidney placed "inverted" or backwards in the recipient
to bring the vessels closer to the bladder
the RA is Anastomased to the __________________,
external iliac artery
the ________ is anastomosed to the internal iliac vein
RV
The ureter is anasomosed to the ___________
bladder
T/F
in a transplant they remove the old kidney
false
Is it normal or abnormal to have ascites with a transplant?
normal
What is the role of US in a renal transplant?
1. Look for fluid collections around kidney
2. scan bladder full/empty
3. get doppler of RA, RV and thru out renal cortex
4. measure size and doc position
5. check for obstruction
When is first us usually completed after transplant
within 48 hours
What will a transplanted kidney look like initially?
initially it will be small then within a few weeks will be at it's normal size
What are some complications of renal transplant
fever
increased creatinine levels
fluid collections
rejection
drug toxicity
infection
obstruction
risk of malignancy
acute tubular necrosis
what are some signs of rejections
enlargement and decreased echo
hyperechoic cortex
distortion of renal outline
patchy sonolucent areas with in the cortex and medulla
What is acute tubular necrosis?
occurs when there is a loss of blood volume to the transplant tissues
ATN causes what 4 things
decrease in renal blood pressure
acute renal shut down
renal parenchyma is unchanged
kidney shut down if blood volume is not resored quickly enough
What is the most common cause of renal failure
Acute tubular necrosis (ATN)
What are Bladder Calculi
develop from upper UT and pass into bladder can be caused from prolonged use of catheter
What are the symptoms of Bladder Calculi?
Asymptomatic unless they obstruct the bladder neck
US appearance of bladder calculi
mobile
may not shadow
what is the normal msmt of the bladder wall fully distended
3 mm
what is the normal bladder msmt of a bladder wall not distended
5-6mm
What are the three areas of the bladder
apex, base and trigone
Do all stones originate in bladder
no. they can develop in the bladder or can develop in the kidney and migrate to bladder
what is cystictis?
infection or inflammation of the bladder
What are the causes of cystitis?
females: pregnancy, coital trauma and ascending UTI

Males: Prostate disease
what are the clinical symptoms of cystitis
freq. disurea, lower abd. pain in bladder region
On US you see a pouchlike invaginantion of the bladder wall or urine filled outpouching from bladder what would he dx most likely be?
bladder diverticulum
On US you note the appearance of thickened bladder wall fluid/fluid level
cystitis
Post Uretheral valve PUV
dilitation of the uretheral due to an obstruction
What is the most common cause of obstruction in male infants
PUV
On US you note the "keyhole sign", a thickened bladder wall, hydronephrosis, hydroureter. You are most likely seeing....
PUV
What is a neurogenic bladder
losing the ability to control voiding due to a disturbance in the neural passage to bladder
the following are causes of:
congenital anomaly
systemic disease
infection
trauma
brain and spinal tumor
neurogenic blader
When are bladder neoplasms usually found?
usually not detected until advanced stages
What is a papilloma
a benign, rare bladder tumor attached to the bladder wall by a stalk
Are papillomas usually large or small
small
Name the most aggresive malignant bladder tumor
squamous cell CA
which is larger, squamous cell or transitional cell tumors
squamous cell
What is transitional cell CA
bladder CA that arises from the transitional epithelium that lines the renal pelvis, ureter and bladder