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93 Cards in this Set
- Front
- Back
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How is TB spread to the kidneys
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hematogenously
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What is an infection of the kidneys by TB called
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TB pyelonephritis
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What is the initial finding of the kidney with TB pyelonephritis
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focal cavitary lesions
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What is seen on US as TB pyelonephritis progresses
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cavitation (look like multiple cyst)
calcification fibrotic infundibular stricture atrophy |
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What is it called when the entire kidney is full of cyst and mass like structure
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a puddy kidney
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What will eventually happen to TB pyelonephritis if left untreated
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autonephrectomy
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What does XGP stand for
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xanthogranulomatous pyelonephritis
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What infectious agents is xgp associated with
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ecoli, proteus, psuedomonas
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What are two predisposing factors to xgp
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diabetes, female
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What percent of xgp pts have a staghorn calculus
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70%
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What are 3 US characteristics of XGP
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renal enlargement
hypoechoic necrotic masses (for some reason the lipid laden macrophages are hypoechoic not hyperechoic) staghorn calculus |
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What is xgp often confused with
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hydronephrosis
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What causes the hypoechoic necrotic mass in XGP
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nectric masses with lipid laden macrophages
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What are 9 congenital renal anomalies
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UPJ obstruction
MCDK duplex collecting system ectopic location ureterocele ADPCKD ARPCKD Von Hippel AML |
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What is the cause of the 'bear paw' appearance of the renal pelvis
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UPJ obstruction (this is a large central cyst with small adjacent cyst that look like toes)
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What doe the cyst of multicystic dyplastic kidney look like (add this to cyst ddx)
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multiple cyst with the larger cyst being in the periphery
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Where are the larger cyst located in MCKD
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the periphery
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what will you see in a duplex collecting system
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a dilated upper pole of the kidney that is connect to a dilated ureter, also ectopic insertion of the ureter into the bladder
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What is a crossed ectopia
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congential anomaly, defined by a kidney that is located on the opposite side of midline from its ureter. The crossed kidney usually lies inferiorly to the normal kidney
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What are the two types of crossed ectopias
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fused or unfused
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What are ureteroceles associated with
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duplicate collecting system
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What is a ureterocele
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In this condition called ureteroceles, the distal ureter balloons at its opening into the bladder, forming a sac-like pouch.
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What are the major categories for a urinary bladder mass
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neoplasm
infection inflammatory trauma |
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What are the neoplastic causes of a bladder mass
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TCC (MC), SCC, adenocarcinoma
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What are infectious causes of a bladder wall mass
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TB, schistosomiasis
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What are inflamatory causes of bladder wall masses
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Malakoplakia, cystitis cystica/glandularis
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What is malakoplakia
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Malakoplakia is a rare inflammatory condition which makes its presence known as a papule, plaque or ulceration that usually affects the genitourinary tract
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Can a hematoma causse a bladder wall mass
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yes (no flow)
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What is the ddx for diffuse bladder wall thickening
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neurogenic bladder
BPH infections lymphoma mets interstial cystitis amyloidosis |
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Can amyloidosis and lymphoma cause enlargement of the kidneys, ureter and diffuse bladder wall thickening
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yes
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Is the ureter typically visualized on US
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no, it is difficult to see unless there is pathology
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What are 8 causes of urothelial thickening
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TCC, lymphoma, mets
TB shistosomiasis ureteritis cystica amyloidosis XRT |
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If there is a congenital abnormality should you always check the other side
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yes
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Where does the kidney usually get transplanted
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the RLQ
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What are the two types of vascular connections for a renal transplant
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end to end -- renal artery connected to a branch of the common iliac
end to side---renal artery into the side of the common iliac |
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What are two non-vascular complications of a kidney transplant
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hydronephrosis
peritransplant fluid collection |
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Is it uncommon to see a little fluid distending the collecting system in a transplant kidney
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no, this is normal since one kidney is taking on the job of two, also there may be a little reflux from the anastomosis with the ureter which also is expected
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What is the ddx of obstructive processes that may cause hydronephrosis in a transplant kidney
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edema at the anastomosis
ureteral kink clots calculi external compression (urinoma) ureteral stricturures |
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What is a urinoma and a complication of a urinoma
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leak of urine and this may compress on the ureter and cause obstruction and hydronephrosis
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What % of pt with kidney transplants will get a fluid collection
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50%
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What is the most commmon post op fluid collection
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hematoma
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What is the MC fluid collection 1-2wks post op in a pt with a kidney transplant
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urinoma
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What is the most common fluid collection 3-5 wks post op in a pt with a kidney transplant
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abscess
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What is the most common fluid collection 4-8 wks post op in a pt with a kidney transplant
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lymphocele
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What are the 4 potential post op fluid collections that occur following a kidney transplant in order
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hematoma
urinoma (1-2) abscess (3-5) lymphocele (4-8-1year) |
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If there is a fluid collection at 3-5 weeks what is the MC cause
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abscesss
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If there is a fluid collection at 1-2 weeks what is the most likely cause
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urinoma
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What fluid collection may occur up to one year
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lymphocele
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What is an enlarging fluid transplant fluid collection until proven otherwise
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an abscess (pt are immunocompromised so may not appear infected)
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What are vascular complications
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renal vein thrombosis and artery thrombosis, post biopsy complications
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What happens to the RI in a pt with renal vein thrombosis
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increases
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What is the most common cause of renal vein thrombosis
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kinking of the vein, or hypovolemia during transplant both of which lead to thrombus
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What is the typical clinical scenario for a pt with renal vein thrombosis
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pt is post op in the pacu and has no urine output
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What are 4 findings that may present in a pt with renal vein thrombosis
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swelling of the kidney
increased RI reversed diastolic flow absent venous flow |
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What is the formula for resistive index (RI)
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S=peak systolic velocity
D=peak diastolic velocity (S-D)/S |
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What number RI is an indication of kidney dysfunction following a transplant
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greater than 0.7
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When does RAS occur following a transplant
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with in 1st 3 years
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Where does stenosis typically occur
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at the anastomosis
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Can a patient with rejection develop RAS
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yes and this is typically not at the anastomosis and is more distally due to scarring
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What should the velocity be a the anastomosis to diagnose RAS in a transplant
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greater than 2m/s
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What should the MRA/EAI velocity be a the anastomosis to diagnose RAS in a transplant
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greater than 3-3.5
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Is turbulent flow found in patients that have RAS
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yes
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Where do you see tardus parvus in transplant patient with RAS
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the arcuate vessels
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What is the SAT at the arcuate vessels
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SAT is greater than 1 sec
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What are the numbers that are need to diagnose RAS
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MRA velocity greater than 2m/s
MRA/EIA ratio greater than 3.5 SAT greater than 0.1 at the arcuate |
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Where do you see the tardus parvus waveform in a kidney with RAS
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arcuate vessels
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What are potential complications from kidney transplant biopsy
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psuedoaneurysms
AV fistulas |
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If a cyst is seen in a renal transplant does this raise concern
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yes, bc it is unlikely they would transplant a kidney with a cyst and this may be a pseudoaneurysm
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What are the doppler findings with an AV fistula
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feeding artery- high velocity and low resistance (diastolic) wave form
draining vein: pulsatile wave form |
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What does the higher peak of the doppler respresent
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peak systolic velocity
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What does the trough of the doppler wave represent
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peak diastolic velocity
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What are 4 medical causes of renal transplant malfunction
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ATN
Rejection infection drug toxicity |
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When does ATN tend to occur
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POD 1-3
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What causes ATN to occur in a transplant patient
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ischemia
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What is a major factor that determines if there will be ATN of a renal transplant
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the length of time to get the kidney from the donor to the recipient
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What are the 3 types of kidney rejection
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hyperacure (less than 24h)
acute (first 3 months) chronic (greater than 12 months) |
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What drug leads to toxicity in renal transplant
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cyclosporin
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Can you differentiate between the different types of kidney rejections on US
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no
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What are the sonographic appearance of medical complications of renal transplant
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swelling
prominent pyramids decreased sinsus fat pelviinfundibular wall thickeining |
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What is an indication of swelling of a transplant
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it looks more round than oval
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What is pelviinfundibular wall thickening
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the walls of the collecting system are thick
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If a pt has a normal shaped kidney and a normal RI does this exclude rejection
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no
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If there are sonographic findings by some of the 4 of the criteria that rejections is occuring what is the next step
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biopsy
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How often does post transplant lymphoproliferative disorder occur
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1-2% of cases
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What is the cause of PTLPD
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EBV secondary to T-cell suppression
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What is the spectrum of PTLPD
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this can be simply a lymphoid hyperplasia but at its worse may become a non-hodgkins lymphoma
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What should be suspected if there is a perirenal-hilar hypodense region with flow in it
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PTLPD
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What is the appearance of PTLPD on US
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heterogeneous/hypoechoic
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Where is PTLPD often located
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anywhere in the body but in regards to the kidney around the hilum
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What does PTLPD in the hilum of the kidney mimic
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peritransplant fluid collection but with flow
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What are two things that can cause an elevated RI in a post transplant patient
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obstruction
medical complication (RI >0.7 is abnormal) |
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Why should you always put color doppler on a peritransplant fluid collection
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to exclude PTLPD
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If you see a cyst in the kidney transplant what should you always do
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put color doppler to make sure it is not a psuedoaneursym or AVF
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