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99 Cards in this Set
- Front
- Back
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BUN |
-blood urea nitrogen -Will rise from acute or chronic disease also in other not renal disease
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Creatinine |
-most sensitive -measures kidneys ability to get rid of waste -increase in renal disease in function |
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Urinalysis |
Urinalysis comprises of the battery of chemical and microscopic tests that help to screen for urinary tract infections, renal disease, and diseases of other organs that results in abnormal metabolites (break down products) appearing in urine. |
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Protein |
Test for kidney damage |
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Different laboratory tests |
BUN Creatinine urinalysis Hematuria Protein |
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Simple cysts |
-Increase with age -location can be anywhere -cortical location most common -asymptomatic unless large |
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Hemorrhagic cyst |
-Internal echoes/fluid-fluid level -May be complex from clot formation -increased risk in polycystic disease -may calcify |
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Infected cyst |
-internal echoes/thick walled/complex renal mass/may calcify -patient usually asymptomatic -pain -increased WBC |
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Parapelvis cyst |
-renal sinus cyst, pelvic cyst -patients are usually in their fifth or sixth decades and are almost always asymptomatic. There are rare instances of obstruction of the collecting system -rarely can they give rise to hypertension, hematuria, hydronephrosis, or may get infected |
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Sonography of parapelvic cyst |
-multiple echo free areas in the region of the renal sinus. Differentiation from hydronephrosis may be difficult and renal sinuses are one of the most common causes of a false positive diagnosis of hydronephrosis on ultrasound -A diagnosis of hydronephrosis is established without question when dilated calyces are seen to communicate with a dilated renal pelvis |
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Renal neoplasms associated with renal cysts |
Von Hippel-Lindau, tuberous sclerosis, angiolipomas |
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Von Hippel-Lindau |
-A rare, genetic multi system disorder characterized by the abnormal growth of tumors in certain parts of the body -individuals with von Hippel-Lindau may result in blindness and/or permanent brain damage. Death is usually caused by complications of brain tumors or kidney cancer called clear-cell carcinoma |
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ACKD |
-Nongenetic form -occurs in people on dialysis - persons with renal failure who were on long-term dialysis may develop cystic changes in their kidneys |
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Sonographic appearance of ACKD |
Cysts may be numerous, but never as large as with DPKD, and the kidneys are still generally small, because most diseases leading to renal failure produce small, shrunken kidneys with end-stage renal disease |
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Who are autosomal more recessive diseases inherited from? |
Both parents |
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Autosomes |
The nonsex chromosomes 1 to 22 are called autosomes. Both males and females normally have pairs of each autosome |
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What kind of disorder is adult polycystic disease? |
An inherited, autosomal dominant disorder |
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What kind of disease is infantile polycystic kidney disease? |
An inherited autosomal recessive disease |
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Why are autosomal recessive diseases relatively rare? |
To get the disease a person must inherit a bad gene from each parent, not just one bad gene. So both parents must have a bad gene. However, parents can be genetic carriers of the autosomal recessive disease, since they typically only have one bad gene themselves |
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Why is autosomal dominant PKD often called adult polycystic kidney disease? |
Many people live for decades without developing symptoms. -The disease is thought to occur equally and men and women and equally in people of all races. Some studies suggest that it occurs more often then whites than blacks and more often than females than males. High blood pressure occurs early in the disease, often before cysts appear |
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Tuberous sclerosis |
-A rare genetic neurological disorder primarily characterized by seizures, mental retardation, and skin and eye lesions -A multi system disease that can affect the brain, kidneys, heart, eyes, lungs, and other organs. Small benign tumors may grow on the face and eyes, as well as in the brain, kidneys, and other organs -renal involvement is typically early teens |
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Percent of individuals with cysts and angiomyolipomas associated with TSC |
40 to 80% |
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Appearance of cysts with TSC |
Small, appear in limited numbers, and cause no serious problems -2% of individuals with TSC developed large numbers of cysts in a pattern similar to polycystic kidney disease during childhood. In these cases kidney function is compromised and kidney failure occurs. In rare instances, the cysts may bleed, leading to blood loss and anemia. |
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Angiomyolipomas |
-Benign growth consisting of fatty tissue and muscle cells -are the most common kidney lesions in TSC -these growths, which are not rare or unique to TSC, are found in about one in 300 people without TSC -Angiomyolipomas caused by TSC are usually found in both kidneys and in most cases they produce no symptoms. However they can sometimes grow so large that they cause pain or kidney failure. Bleeding from angiolipomas may also occur, causing both pain and weakness |
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Sonographic findings of angiolipomas |
-multiple cysts -multiple small anechoic and hyperechoic lesions bilaterally -multiple -rare -no true capsule -commonly bleed -tumor composed of fat, smooth muscle, aggregates of thick walled blood vessels -highly echogenic tumor die to high fat content -less echogenic areas due to hemorrhage, necrosis |
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PKD |
Polycystic kidney disease -A genetic disorder characterized by the growth of numerous cysts in the kidneys. The cysts are filled with fluid. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure |
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Types of polycystic kidney disease |
-Autosomal dominant PKD -Autosomal recessive PKD -acquired cystic kidney disease (ACKD) |
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Autosomal dominant PKD |
-about 90% of PKD cases -typically symptoms age 30 to 40 but can occur in childhood |
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Autosomal recessive PKD |
-symptoms start immediately in babies |
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Features of ADPKD |
-Usually bilateral -associated with liver, pancreatic, and splenic cysts -associated with Berry's aneurysms -increase in renal calculi and infection |
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Sonographic appearance of ADPKD |
-enlarged kidneys with numerous variable-size cysts -cyst can hemorrhage or calcify |
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ARPKD or IPKD |
-seen in utero -The kidneys are affected bilaterally, so that in utero, there is typically oligohydramnios because of poor function and failure to form significant amounts of fetal urine. The most significant results from oligohydramnios is pulmonary hypoplasia, so that newborns do not have sufficient lung capacity to survive, irrespective of any attempts to treat renal failure |
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MCDK |
Multicystic dysplastic kidney -most common palpable mass in neonates -not hereditary -condition is usually unilateral -other kidney may be enlarged |
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Sonographic appearance of MCDK |
Cysts vary in size, absence of renal parenchyma -ultrasound over the palpable mass reveals multiple noncommunicating cysts that occupy the entire renal fossa with no evidence of renal parenchyma. The cysts are variable in size with the largest system located in the periphery |
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Medullary cystic disease |
-A disorder involving the formation of cyst in the kidney medulla. The condition is inherited in most cases. The disorder causes an inability to concentrate the urine. -this results in excessive fluid loss from the body, which is accompanied by loss of sodium -in most cases, the first symptoms of this disorder appear during childhood or adolescence. Other affected individuals may not experience any symptoms or onset of symptoms may occur later in childhood. |
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Sonographic appearance of medullary cystic disease |
Bilateral small cysts in pyramids under 2 cm or increased medullary echogenicity due to microscopic cysts -normal or small kidneys |
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Medullary sponge disease |
An adult disease, which is characterized by dilatation of collecting ducts in the kidneys. -There could be numerous cysts associated with these ducts. -A significant number of the patients with MSK are asymptomatic, and their condition is never diagnosed. -The most common symptom associated with MSK is renal colic followed by urinary tract infection and bloody urine |
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Sonographic appearance of MSK |
-.1-.5 cm cysts - involves inner medullary and papillary regions - cortex appears normal -pyramids appear echogenic due to microscopic cysts -usually bilateral -medullary nephrocalcinosis
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Angiomyolipoma |
-benign -renal hamartoma composed of fat, blood vessels, and smooth muscle tissue -solitary -small cortical lesions -more in R kidney -more in females 40-60 |
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Sono appearance of angiomyolipoma |
-more echogenic than renal sinus -mixed hyperechoic lesion -may see low velocity blood flow -can be large |
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Adenoma |
-most common cortical renal mass -benign counterpart of renal cell CA -males 3:1, greater than 31 years old -increase with smoking, long-term dialysis -asymptomatic or painless hematuria -incidental finding |
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Sono appearance of Adenoma |
-well-defined, isoechoic or hyperechoic mass -commonly in cortex close to the renal capsule -may have calcifications -usually 3cm or less (over 3 should be malignant) |
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Oncocytoma |
-rare type of adenoma -presence of a central stellate scar composed of fibrous tissue which is often detectable on CT, US, or MRI -more in males than females -in the 6th and 7th decades of life |
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Mesoblastic nephroma |
-most common neonatal solid renal tumor -benign but with malignant potential -cannot be distinguished from Wilms' tumor on imaging -presents as n abdominal mass, more commonly in males in the first year of life with a mean age of 3 months |
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Renal cell CA |
-most common renal cancer -usually unilateral -affects males more than females -occurs in 6th and 7th decades of life -usually symptomatic- pain hematuria, palpable mass, weight loss, hypertension |
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Metastatic sites |
Liver, opposite kidney, adrenal and IVc |
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Sono appearance of renal cell CA |
-variable, from solid mss to multiocular cyst -most are echogenic -calcifications are common -renal vein or IVC thrombosis -hypervascular with high systolic and diastolic flow |
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Transitional cell carcinoma |
-a tumor that arises from the uroepithelium anywhere in the renal collecting system -accounting for between 5-10% of all renal neoplasms -most common in bladder, pelvis in kidney
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Symptoms of transitional cell CA |
Painless hematuria, weight loss, flank pain |
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Sono appearance of transitional cell CA |
Isoechoic or hypoechoic mass within the collecting system with dilation of the renal pelvis |
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Renal lymphoma |
-involved in 1/3 to 1/2 of patients during autopsies -may present as multiple bilateral, intrarenal masses or can present as solitary intrarenal mass (difficult to differentiate between other primary renal neoplasms) |
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Sono appearance of renal lymphoma |
Enlarged kidneys with multiple bilateral hypoechoic masses |
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Wilms' tumor |
-nephroblastoma -most common tumor in children 6-8 -childhood equivalent of RCC -usually unilateral |
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Symptoms of Wilms' tumor |
Fever, hematuria, palpable mass |
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Soon appearance of Wilms' tumor |
-Homogeneous and echogenic -May have areas of necrosis that will be cystic -large -calcifications -may extend into perirenal area, renal vein, IVC -mets to liver, lung, nodes, brain, bone -may be confused with neuroblastima due to close relation to adrenal gland |
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Common sites for kidney mets |
Lung and breast |
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Sono appearance of liver mets |
Hypoechoic to hyperechoic mass -may be multiple -contralateral kidney |
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Renal Disease |
-presents itself in many ways from increased cortical echoes from acute tubular necrosis to loss of distinguish between cortex and medulla area from chronic pylenephritis -end stage is renal failure |
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Acute pyelonephritis |
-inflammation of the renal parenchyma -usually secondary to lower UTI -affect females more than males -common age 15-30 -unilateral or bilateral -flank pain, fever |
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Acute pyelonephritis labs |
-increased WBC -bacteremia -microscopic hematuria |
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Sono findings of acute pyelonephritis |
Normal or enlarged kidneys, compression of renal sinus |
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Emphysematous pyelonephritis |
-life-threatening infection, pus and gas formation in tissue or collecting system -females 2:1, average age 54 -fever,Milano pain, lethargy, confusion, dehydration, acidosis
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Sono appearance of emphysematous pyelonephritis |
Gas within parenchyma and/or collecting system -comet tail reverb |
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Test of choice for emphysematous pyelonephritis |
CT |
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Chronic pyelonephritis |
-interstitial nephritis resulting from ongoing or recurring UTI's -asymptomatic, renal failure |
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Soon appearance of chronic pyelonephritis |
Decreased renal size, focal areas of cortical thinning, increased echogenicity |
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Acute tubular necrosis |
-ATN -caused by ischemia of the kidneys (lack of oxygen) or by exposure to materials that re poisonous to the kidney -most caused by an acute allergic reaction to a medication -usually reversible ischemic damage |
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Sono appearance of acute tubular necrosis |
Mostly normal (89%) or increased echogenicity 11% RI greater than .7 |
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Glomerulonephritis |
-caused by specific problems with the body's immune system, but precise cause in unknown -blood in urine, foamy urine, fever |
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Sono appearance of glomerulonephritis |
Increase in cortical echoes |
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Candidiasis |
Systemic fungal infection in immune compromised patient -multiple focal abcesses |
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Pyonephrosis |
Pus in obstructive collecting system -secondary to obstruction of the ureter
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Sono appearance of pyonephrosis |
Hydro, low-level mobile echoes with dilated calyces |
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Schistosomiasis |
-Parasitic infection of schistosomes organism, affects 8% of the world (Africa, Egypt, Puerto Rico) -skin exposed to infected water -urinary frequency, urgency, flank pain
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Sono finding of schistosomiasis |
Normal kidneys, bladder wall thickness, filling defects and irregularities |
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Urinary tuberculosis |
-infestation to the kidney of tuberculosis from extraordinary source usually lung -affects males less than 50% -asymptomatic, frequency |
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Labs for urinary tuberculosis |
gross hematuria |
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Sono appearance for acute urinary tuberculosis |
-usually unilateral, enlarged kidney, multiple focal lesions of varying echogenicity |
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Sono appearance of chronic urinary tuberculosis |
-decrease in renal size, eventually shrunken and calcified |
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Abcesses |
Focal collection of inflammatory and necrotic debris -usually a complication of untreated pyelonephritis -caused by ascending infection from gram negative organisms (E Coli) -predisposing factors include stone disease, diabetes, or AIDS. -clinical fever, localized tenderness
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Labs for abcesses |
Hematuria, bacteremia, pyuria |
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AIDS |
Increased cortical echoes, normal or enlarged kidneys |
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Acute interstitial nephritis |
Interstitium is the tissue that surrounds and I beds the glomeruli and tubules within the kidneys |
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prerenal acute renal failure |
Diminished renal blood flow (60-70%) |
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Intrinsic acute renal failure |
Damage to renal parenchyma (25-40%) |
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Post renal acute renal failure |
Due to urinary tract obstruction (5-10%) |
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Most commonly encountered diagnoses? |
Prerenal acute renal failure and acute tubular necrosis |
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prerenal causes of renal failure |
Loss of perfusion caused by renal vascular thrombosis, renal artery stenosis, sepsis, heart failure |
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Intrarenal causes of renal failure |
Chronic infections such as glomerulonephritis, chronic pyelonephritis |
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Sono appearance of acute renal failure |
Hydronephrosis, enlarged hypoechoic kidney |
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Sono appearance of chronic renal failure |
Bilateral small echogenic kidneys |
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Who does tuberous sclerosis affect? |
People in early teens |
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What is the most significant result of oligohydramnios? |
Pulmonary hypoplasia. |
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Who does medullary cystic disease affect? |
People in early childhood. Inherited |
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Who does medullary sponge disease affect? |
Adults |
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Most common symptom associated with MSK |
Renal colic |
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Most common cortical renal mass |
Adenoma |
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Most common neonatal solid renal tumor |
Mesoblastic nephroma |
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The first sign of PKD? |
High blood pressure |
