Diagnostic Sonography Chp 14

Front 1

Normal measurement for kidney

Back 1

9-12 cm length

5cm wide

2.5 thick (AP) [but really ~5cm]

Front 2

Where are the kidney's located

Back 2

retroperitoneal cavity, near posterior wall

below diaphram

Rt. slightly lower than lt. kidney

Both move ~1 in w.inspirations

Front 3

Two primary functions of the urinary system

Back 3

excreting waste and regulating the composition of blood

Front 4

Urinary system consists of ...

Back 4

kidney's, ureters, bladder and urethra

Front 5

Job of the ureters

Back 5

carry urine from the kidneys to the bladder

Front 6

A cyst like enlargement of the distal end of the ureter

Back 6

ureterocele-

if ureterocele turns inside out it ,may be ome an obstruction

Front 7

A large muscular bag which urine collects

Back 7

bladder

Front 8

The bladder wall should measure

Back 8

3mm distended

and

~6 mm non-distended

Front 9

A membranous tube that passes from the ant. part of the urinary bladder that carries urine to the outside of the body

Back 9

urethra

Front 10

Closure of the urethra

Back 10

stricture

Front 11

Inflammation of the mucous membrane in the urethra

Back 11

urethritis

Front 12

Difficult urination or painful urination

Back 12

dysuria

Front 13

Inflammation of the bladder

Back 13

Cystitis

Front 14

Open bladder surgery

Back 14

cystostomy

Front 15

Removal of the bladder

Back 15

cystectomy

Front 16

What are some renal symptoms

Back 16

flank pain, polyuria, oliguria, fever, urgency, hematuria

Front 17

What are laboratory tests

Back 17

urinalysis,

blood urea nitrogen,

serum creatinine,

specific gravity,

hematocrit,

hemoglobin

Front 18

This laboratory test is essential to detect urinary tract disorders . The presence of an acute infection causes hematuria and pyuria

Back 18

urinalysis

Front 19

This laboratory test measures the kidney's ability to concentrate urine. Especially low in cases of renal failure, glomerular nephritis and pyelonephritis

Back 19

specific gravity

Front 20

A change in this Laboratory test occurs with acute hemorrhagic processes secondary to disease or blunt trauma

Back 20

hematocrit

Front 21

Laboratory test where the concentration of urea nitrogen in blood and is the end product of cellular metabolism.

Back 21

blood urea nitrogen

Front 22

A laboratory test where ________ is present in urine when extensive damage or destruction of the functioning erythrocyte occurs

Back 22

hemoglobin

Front 23

Laboratory test where blood serum creatinine levels are said to be more specific and more sensitive in determining renal impairment than BUN.

Back 23

serum creatinine

Front 24

Functional units of the kidney

Back 24

nephron

Front 25

Located at the base of the pyramids and separate the medulla from the cortex

Back 25

arcuate arteries

Front 26

The Bowman's capsule surrounds the

Back 26

glomerulus

Front 27

Renal fascia is aka _______ and it surrounds the true capsule

Back 27

Gerota's fascia

Front 28

Prominent invaginations of the cortex

Back 28

columns of bertin

Front 29

A bulge of cortical tissue on the lateral surface of the left kidney

Back 29

dromedary hump

Front 30

_______ is a triangular echogenic area typically located anteriorly and superiorly.

Result of partial fusion of two embryonic parenchymal masses called _______ during normal development.

Back 30

junctional parenchymal defect

renunculi

Front 31

Developmental variation that is usually present in children up to 5 years old and may be present in 51% of adults

surface of kidney indented between calyces, broccoli appearance.

Back 31

Fetal lobulation

Front 32

A condition characterized by deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy

This excess fat may affect renal tissue

Back 32

sinus lipomatosis

Front 33

Absence of the kidney or failure of the kidney to form, may be bilateral or unilateral

Back 33

renal agenesis

Front 34

Incomplete development of the kidney usually with fewer than five calyces

Often appears with one normal kidney

Back 34

renal hypoplasia

Front 35

Rare condition of a double collecting system,

1) which has two ureter per kidney that enters the bladder

2) Has two ureter leaving kidney but join together to form one before entering the bladder

Back 35

complete duplication

incomplete duplication

Front 36

A kidney is not located in its usual position. Kidney fails to ascend from its origin in the true pelvis

Back 36

renal ectopia

Front 37

The most common renal anomaly occurring in 1/400 births.

Fusion of the lower poles

Back 37

horseshoe kidney

Front 38

An uncommon variant of the horseshoe kidney. In a sigmoid kidney both the upper and the lower poles are fused.

[typical horseshoe kidneys fused only at lower poles]

Back 38

Sigmoid kidney

Front 39

The most common renal mass lesion with its origin unknown they are considered acquired probably arising form obstructed ducts or tubules

Back 39

simple renal cyst

Front 40

Originate from the renal sinus, does not communicate with the collecting system.

Most patients are asymptomatic

Back 40

parapelvic cysts

Front 41

Condition found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis

Back 41

acquired cystic kidney disease

Front 42

Polycystic kidney disease may present in one of two forms and they are

Back 42

infantile autosomal recessive '

and

adult dominant form

Front 43

Bilateral enlarged kidney, cysts too small to be seen.maybe seen in utero. lung hypoplasia.portal HTN.

Dilatation of the renal collecting tubules causes renal failure and in later form of the disease liver involvement is seen

A fairly rare genetic disorder.

Back 43

autosomal recessive polycystic kidney disease or infantile polycystic disease

Front 44

A common genetic disease that occurs in both men and women. It is a bilateral disease that is characterized by enlarged kidneys with multiple asymmetrical cysts varying in size

Pt. s/s HTN, renal failure, flank/abd. pain, fever chills, uremia, hematuria, palpable mass

Back 44

adult polycystic kidney disease

autosomal dominant polycystic kidney disease

Front 45

About 1/3 of patients with polycystic renal disease also have

Back 45

polycystic liver disease

Front 46

A developmental anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilatation of the distal collecting ducts (ducts of Bellini)

aka: intratubular renal calcification

Back 46

medullary sponge kidney

sono: hyperechoic pyramids

Front 47

The most common of all renal neoplasms and represents 85% of all kidney tumors. appears bilateral in 60-70 y.o.

aka

hypernephroma or Grawitz tumor

Back 47

Renal cell carcinoma or hypernephroma

Front 48

Accounts for 90% of malignancies that involve the renal pelvis, ureter and bladder and for up to 7-10% of all renal tumors

multifocal tumor

men (2x) > woman

Papillary or flat (papillarty more common)

Back 48

transitional cell carcinoma

Front 49

Rare with a 3% occurrence.

A secondary process more common

Non h\Hodgkin lipoma more common than Hodgkin

a bilateral invasion with multiple nodules

Back 49

renal lymphoma

Front 50

The most common peds. abd malignancy & most common solid renal tumor in peds pts. 1-8 y.o.

Peak incidence is seen at 2.5-3 years

90% < 5 y.o.

70% < 3 y.o.

ANOREXIA, PALPABLE MASS

Back 50

nephroblastoma or Wilms' tumor

Front 51

The most common benign renal tumor. it is composed of varying proportions of fat, muscle, and blood vessels

0.07- 0.3 % occurance however

80% cases female and rt kidney

tumor 1-20 cm

Back 51

renal angiomyolipoma

Front 52

Another uncommon renal tumor that is usually benign.

Incidence is increased in the middle aged or elderly patient

Well defined mass w/Spoke wheel pattern of enhancement and central scar

Back 52

oncocytoma

extremely difficult to differentiate from RCC

Front 53

most common of the mesenchymal type of tumors

Consist of fat cells

Back 53

lipomas

Front 54

Necrosis or proliferation of cellular elements occurs in the glomeruli

Increased corticol echoes

many s/s: HTN, anemia, edema

Back 54

acute glomerulonephritis

Front 55

A connective tissue disorder

result of abnormal immune system

females > males

20-40 y.o. peak incidence

kidneys affected in 50% of cases

Back 55

lupus nephritis

Front 56

Unexplained uremia or azotemia may indicate renal dysfunction from ______

(a highly contagious disease spread mainly by unprotected sexual activity or infected needles)

Back 56

AIDS

Front 57

most commonly parenchymal disease

(the loss of renal function as a results of disease)

Back 57

chronic renal disease

Front 58

The separation of renal sinus echoes by interconnected fluid filled calyces

Back 58

hydronephrosis

sono: dilated renal collectingsystem

obstructive hydro has RI > 0.7, 6-72 hrs after onset

Front 59

What are the 4 grades of hydronephrosis

Back 59

Grade I- small fluid filled separation

Grade II- some(NOT ALL) calyces dilated

Grade III- complete pelvocaliectasis-echogenic line sepoarate parenchyma & collecting system

Grade IV- prominant dilation of collecting system, thinning of renal parenchyma

Front 60

Occurs when pus is found within the collecting renal system

secondary to long standing obstruction

Back 60

pyonephrosis

sono: low level echos, fluid-debris level

Front 61

Occurs when air is present in the parenchyma diffuse gas forming parenchyma

May be causes by Escherichia coli Bacteria (E.coli)

Back 61

emphysematous pyelonephritis

sono: enlarged kidney hypoechoic & inflammed

Front 62

An uncommon renal disease associated with chronic obstruction and infection

destruction of parenchyma and infiltration of lipid laden histiocytes

"Staghorn" calculus

female > male

Back 62

xanthogranulomatous pyelonephritis

sono: Staghorn anechoic, w/hyperecho border

Front 63

Elevated white count, irregular mass, may require aspiration

Back 63

renal abscess

Front 64

Associated with chronic obstruction and infection.

This overall renal size is increased

Renal parenchyma replaced by cystic spaces

Back 64

staghorn calculi

R/O Xanthogranulomatous Pyelonephritis

Front 65

Removal of donors left kidney, rotated and placed in recipient's right iliac fossa or groin region.

end to end anastomosis

Used to treat chronic renal failure or end stage renal disease

Back 65

renal transplant

Front 66

A stone located in the urinary system is called

Back 66

urolithiasis

Front 67

A herniation of the bladder wall

may be singular or multiple

Back 67

bladder diverticulum

Front 68

In adults 95% are transitional cell carcinoma (tcc). Usually are not detected until they have become advanced

Back 68

bladder tumors

Front 69

Rule of Weigert-Meyer

Back 69

In cases of complete double ureter, the ureter from the upper pole of the kidney usually enter the bladder below and medially to the one from the lower pole.

Front 70

Name 3 primary types of CRF (chronic renal failure)

Back 70

Nephron abnormalities

vascular abnormalities

interstitial abnormalities

Front 71

Range& duration of ereter Jet

Back 71

0.2 - 1.7 m/sec

0.6 - 4.1 sec (w. 30 sec interval)

Front 72

Name 3 distinct segment of the kidney

Back 72

Cortex

Medulla

Fatty Central Renal sinus

Front 73

Where are the renal arteries located?

what is the best view?

Back 73

Renal arteries are the most posterior sand superior structure with the Hilus

The arcuate arties are located at the base of the renal pyramids & Interlobular alongside

View supine and/or Lt. lateral decubitus

on a longitudinal scan Rt. renal art. anechoic structure posterior to IVC (* board ?)

Front 74

What is the sonographic appearance of the renal medulla?

Back 74

Hypoechoic pyramids are separated by bands of intervening parenchyma that extend toward the renal sinus

Smooth outer edge surrounded by reflected echoes of perirenal fat

Spleen & Liver acoustic window

Front 75

Describe Bertin's Column & how this can be confused with renal Mass

Back 75

Prominent invaginations of cortex at varying depths within medullary substance of kidneys.

Hypertrophied columns of Bertin contain renal pyramids; may be difficult to differentiate from avascular renal neoplasm.

Columns are more exaggerated in pts w/ complete or partial duplication.

Front 76

What is a Dromedary Hump?

Where is it found?

Back 76

A bulge of cortical tissue can occur on the lateral border of the kidney; may resemble a renal neoplasm.

Usually Lt.

Shape of left kidney is affected by the spleen
On sonography, the echogenicity is identical to

the rest of the renal cortex, and a renal pseudotumor needs to be considered.

Front 77

Where is the junctional parenchymal defect most commonly found?

What is its appearance on sonographic examination?

Back 77

Triangular, echogenic area typically located

anteriorly and superiorly

Result of partial fusion of two embryonic

parenchymal masses called renunculi during normal development

Front 78

Fetal Lobulation:

who is most affected?

sonographic appearance.

Back 78

Usually present in children up to 5 years of age May persist in up to 51% of adults

Surfaces of the kidneys are generally indented in between the calyces, giving the kidneys a slightly lobulated appearance.

Front 79

Why does sinus lipomatosis produce such an echogenic renal image?

Back 79

Characterized by the deposition of a moderate amount of fat in the renal sinus, with parenchymal atrophy

sinus fat hyperechoic

Front 80

What is the sonographic appearance of an extrarenal pelvis?

Back 80

Extrarenal pelvis tends to be larger, with long

major calyces.

Pelvis appears as a central cystic area that is

either partially or entirely beyond the confines of the bulk of the renal substance.

Front 81

Describe S/S of patient with renal infection or disease process

[see box 14-3 p.374 & Text p. 358]

Back 81

Flank pain

Increased Temp

Hematuria

pyuria

Increquency in urination

Hestitency w/urination

Incomplete urination

Difficulty urinating

Elevated WBC

vomiting Wt. loss

Front 82

Hematuria significance

Back 82

May be associated w/ early renal disease

Large amounts of blood may be trauma related i.e. stone

Front 83

Presence of Hemoglobin

Back 83

Presnt w/extensive damage or destruction of renal function

Front 84

What does BUN abbreviation stand for and how does this test work?

Back 84

A common laboratory test used for renal disease stands for: Blood urea Nitrogen.

Urea Nitrogen should be excreted in urine by kidney. If elevated amounts in blood may signify kidney not doing it's job.

urea nitrogen is metabolic waste an end product of cellular metabolism

Front 85

What are the clinical symptoms of renal cystic disease?

Back 85

Encompasses a wide range of disease processes
− Typical, complicated, or atypical

May be acquired (nongenetic) or inherited (genetic)

Can occur in the renal cortex, medulla, or renal sinus

Front 86

Describe the sonographic appearance of a simple renal cyst

Back 86

Solitary or multiple

One or both kidney involvement

May be complicated by hemorrhage, infection, or

calcification and become a complex cyst

Cyst in the pediatric patient

Differentiate a benign cyst from a cystic form of nephroblastoma (Wilm’s tumor).

Front 87

Simple Renal cyst stats

Back 87

Acquired lesions, probably from obstructed ducts or tubules

Estimated incidence: 50% of the population

older than 50 years of age

Asymptomatic; incidental finding

Front 88

Chronic renal failure

Back 88

Loss of renal function

s/s:

Increased concentration of urea in blood, high urine protein excretion, elevated creatinine, presence of granulocytes

Front 89

Renal Cell Carcinoma (RCC)

s/s:

Back 89

Erythrocytosis, leukocytosis, red blood cells in urine,

pyruia,

increased lactic acid dehydrogenase

Front 90

Acute tubular necrosis

s/s:

Back 90

Moderate-to-severe intermittent flank pain,

vomiting,

hematuria,

infection, leukocytosis with infection

Front 91

Most Common Disease of the Bladder?

(Dr.P)

Back 91

Cystitis/UTI

Front 92

Most Common Malignancy of the Adult Bladder?

(Dr.P)

Back 92

TCC-Transistional Cell Carcinoma

Front 93

Most Common Pediatric Neoplasm of the Bladder?

(Dr.P)

Back 93

Rhabdosarcoma

Front 94

Most Common Renal Disease?

(Dr.P)

Back 94

CRF- Chronic Renal Failure

Front 95

Most Common Tumor of the Kidney?

(Dr.P)

Back 95

Benign

Front 96

Most Common Malignant Renal Tumor in Adults?

(Dr.P)

Back 96

RCC- Renal Cell Carcinoma

Front 97

Most Common Malignant Renal Tumor in Pediatrics?

(Dr.P)

Back 97

Nephroblastoma

a.k.a Wilms'

Front 98

Most Common Renal Cystic Disease in Pediatrics?

(Dr.P)

Back 98

MCDK-

MultiCystic Dysplastic Kidney Disease

Front 99

AML

Back 99

AngioMyoLipoma

Most common benign CA

Distinct hypoechoic area

80% female

80% Rt. side

AML NO VASCULARITY on color Doppler

D.Dx. RCC=basket sign

Front 100

NephroCalcinosis

Back 100

Parenchymal calcification

usually medulla, infreq. cortex

Bilateral

Increased corticol echoes w/spared pyramids

In Medullary nephrocalcinosis=pyramids hyperechoic to surrounding tissues

Front 101

Characteristic of Malignant cystic mass

Back 101

Wall thickness > 1 mm

Irregularity at Base of cyst

Septations

Calcifications

Vascularity at sepations and/or wall

Front 102

Name 4 kinds of ARPKD

Back 102

Perinatal

neonatal

infantile

juvenile

Front 103

ARPKD

sono

Back 103

enlarged

echogenic cortex & medulla

multiple cyst's ~1-2 mm

hepatic fibrosis

spleenomegaly

Front 104

ADPKD

sono

Back 104

BILATERAl enlarged kidney

assymetrical cysts

cyst's in liver, spleen, pancrease, thyroid, ovary, testicle and breats

Front 105

MCDK

multicystic dysplastic kidney

sono

Back 105

Ureter atresia, contralat. ureteropelvic obstruction, non fx. kidney

peds:

Multicystic with an absence of renal parenchyma, sinus & atretic renal artery

Adults:

small kidney, atrophy, calcified

Front 106

Atresia:

Back 106

Absence of a normal opening, or failure of a structure to be tubular

Front 107

MSK

medularry sponge kidney

sono:

Back 107

May be unilateral or segmental

Occurs in medullary pyramids cystic or fusiform dilation of distal collecting ducts

maybe associated with many congenital and inherited disorders that should be R/O i.e. MCD, PCD, Caroli's and congenital Hepatic fibrosis

Front 108

MCD

Medullary Cystic Disease

Back 108

Hyperechoic calycys with or without stones

sm. echogenic kidney

loss of corticomedullary differentiation

multiple medullary cysts

Front 109

RCC

Back 109

Most isoechoic

the larger the tumor the more heterogengous

lesion < 3 cm usually hypoerechoic

High systolic & high Diastolic artial flow w/ low resistive index

Front 110

TCC`

Back 110

papillary or flat

hypoechoic mass in collecting system

low vascularity on Doppler

Rare calcification

May invade adjacent renal parenchyma

Front 111

Squamous Cell CA

Back 111

Paplable kidney 2nd to hydronephrosis

Large mass is evident in renal pelvis

may have obstruction from kidney stones

Front 112

Renal lymphoma

Back 112

Rare primary

common as secondary: maybe hematogenous spread or direct via retroperitoneal lympharic channels

Common as bilateral invasion

enlarged kidney, hypoechoic, cyst without enhancement,

Front 113

Benign Renal tumors

Back 113

Ademoma & Oncocytoma