Urinary Tract Penny Book

1. pararenal fat 2. gerotas fascia 3. perirenal fat 4. true capsule

4 layers of the kidneys from outermost to innermost

previous hx of hemorrhagic or infected cyst

A patient presents with a renal cyst with internal calcifications, what does this most likely mean?

ESRD

ADPKD can lead to ____ in 50% of patients over 60

1. ascending UTI infection 2. women 3. antibiotics

Acute pyelonephritis 1. Most common spread by _____ 2. More common in which gender? 3. Treatment?

1. MRA 2. Segmental a 3. interlobar a 4. arcuate a 5. interlobular a

After the main renal artery, name the branches of the infrarenal arteries

fluid fluid level w/in cyst and calcium will shadow

Describe how a milk of calcium cyst would look sonographically

1. lower pole 2. upper pole

Duplex collecting system 1. _____ pole is more prone to reflux 2. _____ pole is more prone to obstruction b/c of irregular angle of insertion into bladder causing ureterocele

1. pronephros 2. mesonephros 3. metanephros

Embryonic development 1. ____ is the forekidney, its transitionary & nonfunctional 2. ___ is the midkidney and is partially functional 3. ___ is the permanent kidney and is functional

1. Cortex 2. Medulla

Fill in blank for what's responsible for what 1. Filtration 2. Absorption

1. renal v 2. renal a 3. ureter

Fill in the blank for what's located where in the hilum 1. Anteriorly: 2. Middle: 3. Posteriorly:

chronic pyelonephritis

Following best describes this? - A 15 y/o with a history of vesicoureteral reflux presents with flank pain, bacteria, dysuria and leukocytosis - US shows small echogenic kidneys with lobulated borders and an echogenic are within the kidney that extends from the sinus through the parenchyma resembling a scar

tuberous sclerosis

Following best describes what - pt presents with history of epilepsy and skin lesions - US shows bilateral renal cysts and bilateral AML

Acute pyelonephritis

Following best describes what? - 16 y/o female presents with bacteria, pyuria, dysuria and leukocystosis - US of kidneys look normal

chronic renal failure

Following best describes what? - Pt with a history of diabetes and chronic UTIs presents with elevated BUN & creatinine, hypertension, hyperkalemia and fatigue - US shows bilateral small echogenic kidneys, cortical thinning and loss of corticomedullary differentiation

acute renal failure (most likely due to ATN)

Following is most likely the dx? - Patient presents in the ER with elevated BUN & creatinine, oliguria, hematuria, leukocytosis, hypertension and hypovolemia which have all just started the past 48 hours. There is also a history of drug abuse - Ultrasound shows normal looking kidneys, with just a little increase in echogenicity

duplex collecting system

If a patients kidney has what looks like 2 separated sinus fats, what is most likely the dx?

enzyme

Is renin a hormone or an enzyme?

ARPKD

Most likely the dx? - 4 day old patient presents with elevated LFTS and hematuria - US shows bilateral, enlarged echogenic kidneys with a loss of corticomedullary differentiation

ADPKD

Most likely the dx? - 50 yo presents with flank pain, hematuria and palpable abdominal mass - US shows bilateral, enlarged kidneys that contain numerous cortical renal cysts, there are also cysts present in the liver and pancreas

retrocaval

RRA travels _____ and is longer than the LRA

bladder & urethra

The lower urinary system consists of ___ & ___

posterior

The renal artery is ___ to the renal vein

kidneys and ureters

The upper urinary system consists of __ & ___

ARPKD

This is caused by dilation of the renal collecting tubules and if prenatal death doesn't occur, pts will die secondary to portal HTN or complications from renal failure

acquired renal cystic disease

This is often the result of chronic hemodialysis and increases the risk of RCC

1. Renal parenchyma 2. Renal sinus

What are the 2 main parts of the kidney?

medulla and cortex

What areas of the kidney are located in the renal parenchyma

cortical cysts

____ cysts are located within the cortex and can be difficult to differentiate from dilated pyramids

peripelvic cysts

____ cysts originate in the renal sinus

paraplevic cysts

____ cysts originates in the renal parenchyma and protrudes into the renal sinus

renal sinus

_____ contains the collecting system that's composed of minor and major calyces, pelvis and infundibula

renal parenchyma

_____ contains the medulla and cortex of the kidney

exophytic

_____ cysts project away from the kidneys

renal pelvis

_____ is the funnel like structure that collects urine before it moves onto the ureter

increase

a ____ in cortical echogenicity can indicate intrinsic renal disease

supernumary kidney

a third, smaller kidney is present

fibrolipomatosis

another name for renal sinus lipomatosis

adults

autosomal dominant polycystic kidney disease affects what age range?

infacts

autosomal recessive polycystic kidney disease affects what age range

dromedary hump

bulge on lateral border of kidney (of each echogenicity)

fetal lobulation

bumpy outlines of the kidneys, more prominent in infants but can be seen in adults

perinephric abscess

collection of purulent material that has leaked through the capsule into the tissue surrounding the kidney

renal agensis

congenital absence of kidney

1 cm

cortex should be at least ____ thick

2 cm

difference in kidney lengths should not exceed __

duplex collecting system

division of renal sinus, two ureters draining separate portions of the kidney and the kidneys are usually larger in size

left

dromedary hump is most often on which side

10-18

each kidney has ___ pyramids

renanculi

each kidney is formed when two embryonic parenchyma masses called _____ combine

columns of bertin

enlargement of renal columns seen as indentations into the sinus

compensatory hypertrophy

enlargement of unaffected contralateral kidney w/ unilateral agenesis

renal sinus lipomatosis

excessive fat within the renal pelvis

MCDKD

following best describes what? - unilateral, smooth walled noncommunicating cysts of various sizes within the renal fossa

pyonephrosis

following best describes? - 25 y/o female presents with pyuria, bacteriuria, fever, leukocytosis and flank pain - US shows moderate hydronephrosis with internal ,low level echoes within the dilation

chronic renal failure

gradual decrease in renal fx over time, months to years

pyonephrosis

having pus within the renal collecting system

anterior

horseshoe kidneys - the isthmus travels ____ to the AO & IVC

junctional parenchyma defect

hyper echoic, wedge shaped structure on the anterior section of the kidney that results from incomplete fusion of the two ranunculi

hilum

indentation on the medial surface of each kidney

pyelonephritis

inflammation of the kidneys

von hippel Lindau syndrome

inherited disorder characterized by tumors of CNS and orbits, these patients have the propensity to develop cysts within the kidneys, RCC and pheochromocytomas

true capsule

innermost layer of the kidney

perirenal

kidneys are located in which retroperitoneal space

12

kidneys develop within the pelvis and ascend into the abdomen by ___ weeks GA

renin

kidneys regulate BP by producing the enzyme ___

medullary pyramids

least echogenic part of the kidney

ATN

medical condition involving the death of tubularepithelial cells that form the renal tubules of the kidneys

acute tubular necrosis

most common cause of acute renal failure

diabetes

most common cause of chronic renal failure?

MCDKD

most common cystic disease in neonates?

pelvic kidney

most common location for an ectopic kidney

simple renal cyst

most common renal mass?

duplex collecting system

most common variant of urinary system

renal sinus

most echogenic part of the kidney

1. maintains homeostasis 2. detoxifies and filters blood 3. excretes metabolic waste 4. reabsorbs amino acids, ions, glucose and water 5. maintains normal pH, iron and salt level in blood 6. regulates BP by producing enzyme renin

name 3 fx of the kidneys

- low BP - nephrotoxic drugs - severe bodywide infection

name 3 most common causes of acute tubular necrosis

9th

nephron begins to function by the ___ week GA

1. 8-13 cm 2. 2-3 cm 3. 4-5 cm

normal measurements of the kidneys?

chronic pyelonephritis

recurrent kidney infections or chronic obstruction that leads to scarring of the calices and pelvis

acute renal failure

sudden decrease in renal function, typically over the course of days or weeks

tuberous sclerosis

systemic disorder that leads to the development of tumors within the various organs, its associated with epilepsy and skin lesions on the face, as well as bilateral renal cysts and bilateral angiomyolipoma

ao and sma

the LRV travels in-between the ___ & ___ to drain into IVC

pararenal fat

the ______ covers the gerotas fascia

hypoechoic

the cortex should be ___ to the liver

nephron

the functional unit of the kidney

medulla

the inner part of the kidney responsible for absorption

cortex

the outer part of the kidney responsible for filtration

MCDKD

this cystic disease is thought to be caused by an early, 1st try obstruction of the ureter

horseshoe kidneys

two kidneys that cross midline and are connected by the lower poles

renal hypoplasia

underdevelopment of kidney w/ too few nephrons, will be smaller in size than normal kidney

more worrisome for malignancy

when a cyst has characteristics of separations, internal debris, mural nodules, irreg. border or papillary projects it becomes ______

crossed fused ectopica

when both kidneys are fused on the same side of the body

cortical thinning

when the cortex measures less than 1 cm in thickness

malrotated kidney

when the kidney is in the renal fossa but sits off normal axis

in the medulla

where in the kidney parenchyma are the pyramids located?

arcuate a

which infrarenal artery lies parallel to cortex capsule

interlobar a

which intrarenal artery lies alongside the pyramids

arcuate a

which intrarenal artery lies as the base of the pyramids

LK

which kidney is usually more superior and longer

left

which renal vein is longer?