Renal Ultrasound Pathology

Front 1

Ectopic Kidney

Back 1

Failure of kidneys to ascend into the abdomen...aka pelvic kidney; increased incidence of UPJ obstruction, ureteral reflux, multicystic renal dysplasia

Front 2

Horseshoe Kidney

Back 2

lower poles typically connect across the midline anterior to aorta U shaped, mistaken for lymphadenopathy

Front 3

Crossed Fused Renal Ectopia

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2kidneys on one side fuse in pelvis and one ascends to norm postion carrying other one across the midline ureters connect 1 ureter in midline

Front 4

Fused Pelvic Kidney

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Fused to form round mass in pelvis aka discoid/pancake kidney

Front 5

Dromedary Hump

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common variant of cortical thickening on lateral aspect of left kidney

Front 6

Junctional Parenchymal Defect

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Triangular hyperechoic area on anterior aspect of upper pole of R.kid fetal lobulation/partial fusion of renunculi(embryonic kid)

Front 7

Duplex Kidney

Back 7

duplication of collecting system
complete- two ureters
incomplete one complete central cortical break w/in hyperechoic sinus

Front 8

Column of Bertin (septal cortex)

Back 8

normal variation of prominent renal cortical parenchyma between 2 medullary pyramids may give appearance of mass effect

Front 9

Renal agenesis

Back 9

Bilateral--oliohydraminos pulmonary hypoplasia don't survive
Unilateral assoc. w/ bicornuate uterus/ seminal vesicle agenesis hypertrophy of sole kidney to maintain normal function

Front 10

extrarenal pelvis

Back 10

extrarenal pelvis lies outside renal sinus sono appear as cystic collection medial to renal hilum

Front 11

Posterior Uretheral Valve

Back 11

Male neonatal Common cause of urinary obstruction ; due to flap of mucosa slit-like opening in area of prostatic urethra---large bladder, hydroureter, hydronephrosis, urinoma

Front 12

Autosomal Dominant (Adult) Polycystic Kidney Disease

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Bilateral renal enlargement; b/c of lots of cysts...20-30yrs destruction of residual renal tissue could lead to renal failure/hypertension...assoc. w/ arterial aneurysms esp..cerebral arterial (Berry) of circle of Willis
assoc. w/ cysts liver, pancreas, and spleen

Front 13

Infantile Polycystic Kidney Disease

Back 13

Enlarged kidneys; hyperechoic parenchyma loss of cortical medullary distinction; cystic dilation of collecting tubules secondary to hyperplasia of the interstitial portions of the ducts; assoc. w/ renal dysfunction, pulmonary hypoplasia, periportal fibrosis, portal hypertension; may be detected in utero w/ oligohydramnios

Front 14

Multicystic Dysplastic Kidney

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most common cause of abd. mass in newborns; unilateral typically; non-functioning has non-communicating cysts w/ absence of renal parenchyma; result of atresia of UPJ during fetal development; assoc renal anomalies..contralateral UPJ obstruction/renal agenesis or hypoplasia; horseshoe kidney

Front 15

Acquired Cystic Disease

Back 15

development of multip. cysts chronically failed kidneys during long-term hemodialysis- hemorrhage occurs into acquired renal cysts--pain/hematuria...assoc. w/ an increased incidence of Renal cell carcinoma

Front 16

Medullary Sponge Kidney

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Congenital dysplastic cystic dilation of medullary pyraminds due to tubular ectasia/dysplasia...may see ectatic collecting tubules...urinary stasis..calcium deposits form in dilated tubules...calcium deposits appear hyperechoic medullary pyramids

Front 17

Von-Hippel-Lindau Disease

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Inherited diease 2/3 decade of life w/ visual impairment....retinal/central nervous system hemangioblastomas, sonos aware of other related tumors can be found while performing abd; renal cell carcinomas, pheochromocytomas, islet cell tumors, renal/pancreatic cysts

Front 18

Angiomyolipoma

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hyperechoic benign renal tumor; echogenicity greater than/equal to that of renal sinus; propagation speed artifact may result from posterior displacement of structures due to slow acoustic velocity in fatty mass; Ct confirmation of fat in echogenic renal mass...80% involve right kidney

Front 19

Tuberous Sclerosis

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multi-system genetic disease causes benign tumors grown on organs--commonly affects central nervous system...increased incidence of renal cysts and angiomyolipomas---bilateral in patients w/ TS

Front 20

Renal Cell Carcinoma

Back 20

most common solid renal mass in the adult...unilateral encapsulated mass (nephrectomy)..hypoechoic relative to norm adj. renal paranencyma..hematuria(most common) flank pain palpably mass...lungs common site of distant metastases( also lymph nodes, liver, bone, adrenal glands, and contralateral kidney)..increase incidence assoc w/ acquired cystic diesase(chronic dialysis) Von-Hippel, tuberous sclerosis, ADPKD

Front 21

Renal Metastases

Back 21

renal parenchyma site of secondary tumors that metastasized from other primary organs, malignant cells from leukemia/lymphoma metastasize to kidney; sono. presents as hypoechoic masses/ diffusely enlarged inhomogeneous kidney

Front 22

Wilm's Tumor (nephroblastoma)

Back 22

most common childhood renal tumor mean age 3.5yrs patients present w/ large asymptomatic flank mass other symptoms include hypertension, fever, hematuria, metastasis seen to lungs, liver, bone, lymphnodes, & retroperitoneum 90%survival rate; must be differentiated from adrenal neuroblastomas; Wilms destroy renal contour; if renal contour maintained bilaterally prob adrenal neuroblastoma

Front 23

Acute Pyelonephritis

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renal enlargement; hypoechoic parenchyma; abscence of sinus echoes usu cause bacilli from intestinal tract

Front 24

Chronic Pyelonephritis

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Renal injury induced by recurrent renal infection- anatomic anomalies, obstructive lesions, ureteral reflux; small hyperechoic kidney w/ cortical thinning

Front 25

Xanthogranulomatous Pyelonephritis (XGPN)

Back 25

type of chronic phelonephritis results from chronic infections due to long term obstruction
assoc. findings include:
Renal enlargement, parenchymal abscesses, staghorn calculus, papillary necrosis, hydronephrosis, pyonephrosis, loss of coritcal-medullary boundry- cortical thinning

Front 26

Pyonephrosis

Back 26

Purulent material in collection system of kidney assoc. w/ an infection secondary to renal obstruction; Requires percutaneous/surgical drainage; hyperechoic debris in dilated renal collecting system

Front 27

Mycetoma(Fungal Ball)

Back 27

Candidiasis morst common renal fungal disease. F. infections hematogenus seeding/ascend from bladder; fungus balls hyperechoic-nonshadowing masses

Front 28

Acute Renal Failure (ARF)

Back 28

abrupt decrease in renal filtration increase in serum creatinine/ blood urea nitrogen (azotemia) only sign at first decrease in urine production
Main mechanisms
Prerenal Failure/ Intrinsic/Postrenal....sono determine hydro(indicates post)..abnormal resistive index (suggest intrinsic).. Lab blood urea nitrogen, serum creatinine, urinalysis, urine output ..serum creatinine changes in glomerular filtration rate determine ARF

Front 29

Renal Vein Thrombosis

Back 29

assoc. w/ extrinsic compression; nephrotic syndrome, renal tumors, renal transplants, trauma...sono-- dilated thrombosed renal vein, absent intrarenal venous flow, enlarged hypo kid, high-resistance renal artery waveform

Front 30

Renal Artery Thrombosis

Back 30

Occulusion sudden cause of prerenal failure present w/ acute flank pain, hematuria, sudden rise in blood pressure..sono focal hypoechoic areas of infarct, abscence of intrarenal arterial flow, renal enlargement

Front 31

Acute Tubular Necrosis

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most common cause of medical renal disease/intrinsic(intrarenal) acute failure...prolonged ischemia/nephrotoxins can be reversed...sono renal enlargement...increased RI resistive index

Front 32

Acute Glomerulonephritis

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Inflammatory response to glomerular damage caused by autoimmune reaction, infection, toxins...symp--onset hematuria, proteinuria, azotemia, red blood cell in urine sono renal enlargement, RI

Front 33

Hydronephrosis

Back 33

Dilatation of renal pelvis & calyces produces separation of normal sinus echo by an anechoic urine collection could lead to hypertension, loss of renal fx, sepsis.. common cause most (calculi) . prostate cancer, pelvic issues, preg, UPJ UvesicalJ UPJ Pelvic brim (stone areas) evaluate intrarenal vascularity RI greater than .7 suggestive of hydro

Front 34

Nephrocalcinosis

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Disorders of calcium metabolism formation of calcium renal stones/deposit calcium salts in renal parenchyma

Front 35

Nephrolithiasis

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arise in collecting system.. acute back/flank pain radiating to ipsilateral groin fever, chills, dysuria, cloudy urine, hematuria hyperechoic w/shadowing

Front 36

Papillary Necrosis

Back 36

Ischemia of medullary pyramids..assoc w/ cirrhosis, diabetes, Renal vein thrombosis...sono include...echogenic material w/in collecting system--sloughed papillae....triangular cystic collections (absence of medullary pyramids) bright echoes produced by arcuate arteries visualized at periphery of cystic space

Front 37

Renal Sinus Lipomatosis

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Increased renal sinus fat replaces normal pearenchyma...increase in central sinus echo complex w/ cortical thinning...compression of calyces & renal pelvis by renal sinus fat

Front 38

Urinalysis

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microscopic examination of sediment & qualitative evaluation of protein, glucose, ketones, blood, nitrites, and WBCS

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Serum creatinine

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break-down product of skeletal muscle. filtered out of blood by kidneys vary from 1.2 to 2.0mg/dL

Front 40

BUN blood urea nitrogen

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Urea product of protein metabolism..7-21mg of Urea nitrogen per 100ml

Front 41

Azotemia

Back 41

decrease in glomerular filtration rate increases in BUN & creatinine

Front 42

most common neonatal abdominal mass

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Multicystic Dysplastic Kidney

Front 43

MC neonatal adrenal mass

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adrenal hemorrhage

Front 44

MC childhood adrenal

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neuroblastoma

Front 45

Most common neonatal renal mass

Back 45

multicystic dysplastic kidneys

Front 46

Most common childhood renal mass

Back 46

Wilm's tumor

Front 47

Most common renal fungal disease

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Mycetoma

Front 48

Most common cause of medical renal disease/intrinsic/intrarenal acute renal failure

Back 48

Acute Tubular Necrosis

Front 49

most common fusion anomaly

Back 49

Horseshoe kidney

Front 50

Renal Cysts

Back 50

Pylogenic--calyceal diverticula sono appear as simple; Parapelvic--cortical cysts bulge into central sinus
Peripelvic-lymphatic cysts in central sinus
Cortical/parenchymal cysts located in periphery of kidney
Peripelvic--located in center rennal sinus