Ch. 15 Study Guide

Most common location for renal ectopic

"Pelvic" Kidney

Triangular structure & axis that points inferiorly and medially

(Normal) renal pelvis

What kind of Polycystic kidney disease applies to Adults, is considered dominant, common, and severity varies depending upon the genotype

Autosomal Dominant Polycystic Disease (ADPKD)

What kind of Polycystic kidney disease applies to Infantile, Rare disorder having to do with Chromosome 6

Autosomal Recessive Polycystic Disease (ARPKD)

______________ Are considered very rare; all renal tumors are assumed ___________ until proven otherwise

Benign renal tumors, Malignant

A duplication of the ureter that unite before emptying into the bladder

Bifid renal pelvis

Sonographic findings of Transitional Cell Carcinoma: Hypoechoic mass in the ____________ system, with low ___________ on color Doppler. Calcifications are rare Invade adjacent renal parenchyma and form an ___________ mass, usually preserves the renal __________.

Collecting, vascularity, infiltrating, contour.

Bands of cortical tissue extend inward to the renal sinus and separate the renal parenchyma.

Columns of Bertin

Must need to be a Complex Mass

Cystic and Solid lesions. & areas of necrosis, hemorrhage, abscess or calcification within the mass

Anatomy located posterior to the left kidney

Diaphragm, Psoas muscle, Quadratus Lumborum

Anatomy located posterior to the right kidney

Diaphragm, Psoas muscle, Quadratus Lumborum

Kidney Anomaly: A cortical bulge in the lateral border of the kidney is called a(n): *can resemble a renal neoplasm *on ultrasound the echogenicity is identical to the rest of the renal cortex

Dromedary Hump

Why is the outer cortex of the kidney darker than the inner medulla?

Due to increased blood perfusion

A type of renal anomaly:

Duplex collecting system

Acute Glomerulonephritis end result is ___________, poorly functioning kidneys

Enlarged

Sonographic finding of renal atrophy: Kidneys appear ____________ with a highly echogenic, enlarged __________ __________ and a thin cortical rim. Renal sinus fat is seen very easily as echogenic reflections

Enlarged, renal sinus

Sonographic findings of squamous cell carcinoma: Large mass is ____________ in the renal _________. Obstruction from kidney stones may be present

Evident, Pelvis

Cellular metabolic activities produce waste products that may reach toxic levels if not excreted from the body

Excretion

Extrarenal pelvis tends to be larger with long major calyces Pelvis appears central cystic area either partially or entirely beyond the confine of the bulk of the renal substance

Extrarenal Pelvis

This renal variant may persist in up to 51% of adults

Fetal Lobulation

Ureteral narrowing as a result of _____________ is a common form of ureteral ___________.

Fibrosis, Stricture

With renal cell carcinoma patient may report ____________, ________ ________ and palpable mass

Hematuria, flank pain

The Ureter emerges from the ____________ of the kidney and runs vertically downward behind the parietal ____________ along the __________ muscle (distal end)

Hilum, peritoneum, Psoas

Clinical findings of squamous cell carcinoma:

History of chronic irritation and gross hematuria Palpable kidney secondary to severe hydronephrosis

Sonographic findings of RCCs: Most are ______________; they may appear hyperechoic The larger the tumor, usually more ________________ it's echotexture, caused by _____________ hemorrhage and necrosis Tumors less than ___ CM are usually hyperechoic distinguishing them from echogenic fat-containing ___________ similar to angiomyolipomas is difficult

Isoechoic, heterogenous, intratumoral, 1cm

Kidney Anomaly: Triangular, echogenic area typically located anteriorly and superiorly

Junctional parenchymal defect

Metastases to the __________ is relatively common.

Kidneys

Produces a generalized increase in cortical echoes (echogenic cortex) Kids Love Smoking Pot

Kidneys, Liver, Spleen, Pancreas (Darkest to Lightest)

Tumor consist of fat cells

Lipomas

A hypoechoic vascular mass with _____ resistive index (RI) (Basket Sign)

Low (RCC)

Most common primary malignancies that metastasize to the kidneys include carcinoma of the: _______, __________, or renal cell carcinoma of the contralateral kidney

Lung, Breast

Any irregularity at the bottom of a complex cyst should be considered a ___________ growth. If septa is thicker than _____ mm with vascularity on color or power Doppler the lesion is presumed _____________.

Malignant, 1mm, malignant

Complex cyst may contain separations, thick walls, calcifications, internal echoes and mural nodularity Are considered _____________ until proven __________.

Malignant, Benign

What Anomly is being described: Small echogenic kidneys Loss of corticomedullary differentiation Multiple medically cysts under 2cm Hyperechoic calyces with or without stones

Medullary Sponge Kidney (MSK)

Developmental anomaly occurring in the medullary pyramids

Medullary sponge Kidney (MSK)

Pouch located anterior to the right kidney

Morison's Pouch

Considered to be nonhereditary renal dysplasia, most common common form of cystic disease in neonates

Multicystic Dysplastic Kidney (MCDK)

Most common abdominal malignancy and most common solid renal tumor of pediatric patients

Nephroblastoma (Wilms tumor)

Medullary sponge kidney show ________________________ and an echogenic medullary renal parenchyma

Nephrocalnosis

Renal rubles or __________ are the functional units of the kidney

Nephrons

Etiologic bases of chronic renal failure maybe be obstructive _______________, parenchymal diseases, renovascular disorders or any process that progressively destroys nephrons

Nephropathies

Renal sinus parapelvic cyst are largely asymptomatic unless they occasionally cause all of the following EXCEPT for: Pain Hematuria Hypertension Obstruction Oliguria

Oliguria.

Prerenal failure is caused by: & can be diagnosed clinically by labatory data and color Doppler

Perfusion of the kidneys -renal vein thrombosis, CHF, renal artery occlusion.

Acute Renal Failure may occur in _____ renal, renal or ________ renal failure stages

Pre, Post

The inner surface of the medulla is folded into projections called _____________ and the ____________ empty into the renal __________

Pyramids, pyramids, Pelvis

All of the above describe the _______________ Hilum 1. Vertical indentation on the medial surface of each kidney 2. Where renal vessels and ureter enter and exit 3. Other vascular structures, a ureter and the lymphatics also within hilum.

Renal

May be indistinguishable from RCC.

Renal Adenomas

Most common benign renal tumor:

Renal Angiomyolipoma (AML)

Result of numerous disease processes Intrarenal anatomy is preserved within a uniform loss of renal tissue Severe Lipomatosis results from a huge increase in renal sinus fat content in cases of significant renal atrophy because of significant renal atrophy b/c of hydronephrosis

Renal Atrophy

The most common type of all renal neoplasms

Renal Cell Carcinoma (RCC)

Twice as common in men Develops in the sixth or seventh decade of life Clinical presentation is often nonspecific

Renal Cell Carcinoma (RCC)

Hypoechoic pyramids are separated by bands of intervening parenchyma that extend toward the renal sinus that are known as ____ ____.

Renal Medulla

Bases are directed toward the outer circumference of the kidney & Apices converge toward the renal sinus

Renal Pyramids

Vary from 8 to 18 in number

Renal Pyramids

Small cyst, originates in from the renal sinus, most likely lymphatic, do not communicate with the collecting system.

Renal Sinus Parapelvic cyst

Composed of fat, muscle, and blood vessels and found in 80% of patients with ___________ sclerosis

Renal angiomyolipoma, tuberous

Causes a loss of normal anatomic detail, resulting in the inability to distinguish the cortex and medullary regions

Renal disease

Up to 40% of patients with Wilm's tumors have _______ __________ ________ and or vena cava or atrial thrombus at the time of diagnosis

Renal vein thrombosis

Acquired lesions, probably from obstructed ducts or tubules 50% incidence in the population older than 50 y/o Asymptomatic; incidental finding Solitary or multiple Unilateral or Bilateral

Simple Renal Cyst

May be complicated by hemorrhage, infection Or calcification and become a ________ cyst.

Simple Renal Cyst

Characterized by deposition of a moderate of amount of fat in the renal sinus, With parenchymal atrophy (smaller)

Sinus Lipomatosis

Must need to be a Cystic Mass (STAR)

Solid Through transmission Anechoic ( not internal echoes) Round or oval & sharp interface between the cyst and renal parenchyma

Rare, highly ______________ tumor with a poor prognosis.

Squamous cell Carcinoma

Layer of connective tissue encapsulating the kidneys

The renal fascia, also known as Gerota fascia,

Considered to be a low-grade malignancy: tends to have a more ________ course.

Transitional Cell Carcinoma, Benign

Interior lined with a highly elastic ____________ epithelium that allows urine to collect and then ____________ to expel urine through the ___________.

Transitional, contract, Urethra

ADPKD-1 is not progressive True or False

True

Segmental or Focal Changes are rare in MCDK True or False

True

True or False Sonographic appearance of most RCCs is solid with no predilection for either right or left kidney or it's location in the organ

True

Renal cyst associated with renal neoplasms

Tuberous Sclerosis

MCDK usually occurs _________________, with poor function. _________________ involvement is in compatible with life.

Unilateral, Bilateral

A 25-cm tubular structure

Ureter

Proximal end is expanded and continuous with the renal pelvis

Ureter

Renal pelvis lies within the hilum of the kidney and receives major calyces

Ureter

This part of the urinary system located in the retroperitoneal cavity is obscured by bowel gas

Ureter

Cystlike enlargement of the lower of the distal end and of the ureter. Caused by congenital or acquired stenosis of the distal end of the ureter.

Ureterocele

This part of the urinary system is not routinely visualized sonographically

Urethra

Described as a large muscular bag, has posterior and lateral openings from the Ureters, anterior opening from the urethra:

Urinary Bladder

1. Located in the retroperitoneum 2. Two kidneys: remove waste from blood and produce urine. 3. Two ureters: tubal ducts leading from hilus of the kidneys into the urinary bladder 4. Bladder: collects and stores urine, which eventually discharged through the urethra

Urinary System

In MSK Dilation causes stasis of ___________ and ___________ formation.

Urine, Stone

MCDK is thought to be caused by early in ____________ urinary tract ___________ obstruction.

Utero, obstruction

acute renal failure (ARF) is a common medical condition caused by a variety of _________ or ____________ mechanisms

diseases, pathophysiology

The right kidney lies slightly ___ than the left kidney because the large right lobe of the ___ pushes it ___.

lower; liver; inferiorly

Most posterior and superior structure

renal artery

Renal sinus lipomatosis occurs secondary to ____.

renal atrophy

Parenchyma of renal cortex lies beneath the:

renal capsule

The parenchyma of renal cortex lies beneath the ____.

renal capsule

ARF May also be caused by: renal vein ______________ or renal artery _____________.

thrombus, Occlusion

Both kidneys move downward approximately __ ___ upon respiration.

1 inch

Sonographic characteristics of a malignant mass: name them Wall thickness greater than ____ mm _____________ at the base of the cyst Separations evident Calcifications evident __________________ present in the septa and or cystic wall

1, irregularity, vascularity

Bladder Prep & Eval

1. Bladder distended 2. Right or lateral left decub position 3. TGC adjusted to reduce anterior wall artifacts 4.asymmetry wall 5. Eval residual volume 6. Ureteral Jets

Renal masses can be categorized with sonography as 1. 2. 3.

1. Cystic 2. Solid 3. Complex

Must need to be a solid Mass

1. Irregular borders 2. Poorly defined interface between the mass and kidney 3. Low-level internal echoes 4. Weak posterior border 5.poor through transmission

List the 3 constrictions along the ureters course from the kidney to bladder

1. When leaving the renal pelvis 2. Kinked as it crosses the pelvis brim 3. Pierced the bladder wall

Bladder Wall should be smooth and measure ____________ MM or CM

3-6mm

The kidneys measure ____________ cm long

9-12

Most common type of Polycystic kidney disease: is bilateral, results in enlarged kidneys with multiple asymmetrical cysts varying in size, location cortex and medulla

ADPKD-1

Necrosis of proliferation of cellular elements, or both occur in glomeruli

Acute Glomerulonephritis

Prerenal stage is secondary to the hypoperfusion of the kidney

Acute Renal Failure

excretory and regulatory functions of the kidneys are __________ in both ____________ and __________ renal failure

Acute and chronic