Kidneys and Urinary System Review (powerpoints)

decreased

(increased/decreased) BUN indicate overhydration, pregnancy, liver failure, or be secondary to smoking or decreased protein intake.

MCDK

**Multiple cysts of varying size (large enough to see) No renal parenchyma surrounding the cyst Enlarged kidney in children Small kidney in adults Absence of renal vascularity Unilateral disease (75% of the cases) Associated with ureteropelvic junction obstruction and malrotation

adenoma

*Asymptomatic *Flank pain *Gross hematuria

Renal Sinus Lipomatosis

*Obesity *Previous urinary obstruction *Chronic renal infection *Steroid therapy

Renal sinus lipomatosis

- increased sinus fat that replaces normal parenchyma - compresses calyces & pelvis

Renal pseudoaneurysm

- mimics a simple cyst - assoc w/ biopsies/trauma

congenital, intrinsic, extrinsic

3 causes of hydronephrosis

prerenal, intrinsic, postrenal

3 types of ARF

B

A 24-year-old man presented with weight loss, fever, and increased blood urea nitrogen. He underwent a kidney biopsy. Two hours after the procedure, an ultrasound was requested. Which of the following is MOST likely explanation for the ultrasound findings in this patient? A. fungal balls B. blood clot D. bladder tumor E. calculi

E

A 38-year-old man with a history of several attacks of abdominal pain has a renal sonogram done. A. Air in the collecting system B. Angiomyolipoma C. Renal cell carcinoma D. Papillary necrosis E. Nephrolithiasis

TCC

A 78-year-old patient presents to the ultrasound department to rule out an abdominal aortic aneurysm. An incidental mass was discovered in the urinary bladder. Blood flow was demonstrated within the mass using color Doppler imaging. This incidental finding is most suspicious for a bladder:

AML, Hamartoma

A lipoma consists of fat cells and is the most common of the mesenchymal type of tumors. More often in females than males.

strictures, focal masses, duplex collecting system

A localized hydronephrosis occurs as a result of _______ , calculi, ____ ____ , or the ____________ ____________ ____________

D

A patient has been referred for Doppler interrogation of the kidney. Which view provides the best color Doppler evaluation of the intrarenal vasculature? (letter only) A. patient supine, anterior view through liver B. patient supine, coronal view through liver C. patient prone, oblique view through back musculature D. patient in posterior oblique position, coronal view through posterior axillary line

infarction

A renal ____ occurs when part of the tissue undergoes necrosis after the cessation of the blood supply, usually as a result of artery occlusion.

lipoma

A(n) ______ appears as a well-defined echogenic mass, found more often in females.

nephritis

Ability to filter properly is reduced. The body accumulates both excess water and waste in the blood stream, while blood cells and protein are lost in the urine. Outcome and severity are entirely dependent on the underlying cause. In some cases, this goes unnoticed and may not cause any serious problems. In other cases, this is very serious and may lead to kidney disease.

MCDK

Acquired disorder Urinary obstruction in early embryology. Usually unilateral; bilateral is incompatible with life. Palpable abdominal mass. Flank pain

parapelvic cyst

Acquired: Found in renal hilum but does not communicate with the renal collecting system

benign

Adenomas Angiomyolipoma (Renal Hamartoma) Lipomas Oncocytoma Mesoblastic Nephroma

D

All of the following will increase the chance of documenting shadowing posterior to a small renal stone except A. decrease gain B. focal zone set at the level of the calculi C. increase the transducer frequency D. use a linear probe E. tissue harmonics

renal atrophy

Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with uniform loss of renal tissue in patients with ___ .

renal atrophy

Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with uniform loss of renal tissue in patients with ________

AML

An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is __

abscess

Anechoic, hypoechoic or complex, depending on its contents. Thick irregular wall margins Gas development within the abscess produces dirty shadowing or reverberation artifact.

Hamartoma

Angiomyolipoma is also known as __

5mm

Approximately 80% of stones smaller than ____ will pass spontaneously

Milk of Calcium Cyst

Are calyceal diverticula; Which may or may not have lost their communication with calyceal

increase

BUN levels will (increase/decrease) from acute or chronic disease, renal damage, renal failure, dehydration or urinary obstruction. It may also rise due to other disease such as GI bleeding, congestive heart failure, shock, starvation, etc.

ATN

Bilateral enlarged kidneys with hyperechoic pyramids; this can revert to a normal appearance. Increased resistive index.

ARPKD

Bilateral enlarged kidneys with multiple cysts of varied size. (sometimes cysts are too small to see)

no

Can a sonographer typically predict the type of renal tumor when found?

ARPKD

Children. High blood pressure Urinary tract infections Frequent urination Palpable abdominal mass Portal hypertension Hepatic fibrosis GI hemorrhage

function

Chronic renal disease is loss of renal ____ as a result of disease, most commonly parenchymal disease.

RCC

Classical clinical presentation is nonspecific, however, the patient may report hematuria, flank pain, and palpable mass. Uncontrolled Hypertension

XGPN

Clinically the patient presents with a large nonfunctioning kidney, staghorn calculus, and multiple infections. usually unilateral.

metastases

Due to the large volume of blood flowing through the kidneys, it is a frequent site of ___ but not usually detected clinically or sonographically.

pyelonephritis

Flank pain Fever Pyuria Bacteremia dysurea (i.e., painful urination) Urinary frequency leukocytosis

renal stones

Frequent urination Hematuria Flank, pelvic or back pain Nausea / vomiting Fever

TCC

Gross hematuria Weight loss Fatigue Fever Flank pain

Von Hippel Lindau

Hemangioblastoma of the cerebellum and hereditary renal cell carcinoma

Lupus nephritis

Hematuria, proteinuria, hypertension, renal vein thrombosis, and renal insufficiency. Increased cortical echoes Renal atrophy.

decrease

Hemorrhagic cysts will cause (increase/decrease) in hematocrit

II

Hydronephrosis Grade (I, II, III, IV): "bear claw" or "cauliflower" fluid extending into the major and minor calyceal system and thinning of the renal parenchyma

III

Hydronephrosis Grade (I, II, III, IV): "blown out" a huge anechoic cystic sac with marked thinning of the parenchyma

IV

Hydronephrosis Grade (I, II, III, IV): Thinning of renal parenchyma, and no differentiation between collecting system and renal parenchyma

I

Hydronephrosis Grade (I, II, III, IV): splaying: small fluid-filled separation of the pelvis

ureterovesical, urethra

Hydronephrosis with a dilated ureter and bladder indicates obstruction of the ____ junction or of the ____ .

bladder

If hydronephrosis is suspected, the sonographer should evaluate the . ____________

MCKD

Inherited disease causing tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine. Medullary cysts usually not visualized; shrunken kidneys on ultrasound. Poor prognosis.

ARPKD

Inherited disorder (autosomal-recessive) leads to renal failure Normal renal parenchyma is replaced with cysts

yes

Is sonography the best modality for renal stones?

Multilocular Cystic Nephroma

It represents 3-10% of all pediatric renal tumors. Occurring almost exclusively in the first 6 months of life, with 90% being diagnosed during the first year of life.

rarely

Kidneys are (commonly/rarely) a site of primary lymphoma

AIDS

Kidneys are either normal in size or enlarged. Echogenic increased cortical echoes Renal dysfunction. Causes of renal dysfunction include acute tubular necrosis, nephrocalcinosis, interstitial nephritis, and focal segmental glomerulonephritis.

Non-Hodgkin's Lymphoma

Kidneys are enlarged and anechoic to relative hypoechoic. Usually no definite mass is identified.

RCC

Masses often have contiguous, highly vascular with high systolic and diastolic arterial flow. Calcifications are a common finding.

Mesoblastic nephroma

Most common solid renal mass in neonates. Even if it looks like Wilms, if they're under 1 year old its this.

TCC

Most common tumor of the renal collecting system.

MCDK

Multicystic Dysplastic Kidney

perinatal, neonatal, infantile, juvenile

Name the four forms of autosomal recessive polycystic kidney disease.

peripelvic cyst, extrarenal pelvis

Name two conditions that might mimic hydronephrosis

MSK

Normal or small echogenic kidneys with echogenic parenchyma (cysts too small to be resolved on a sonogram). or Normal or increased echogenicity of pyramids due to areas of echogenic foci that may not shadow..

MCKD

Normal renal function Anemia Salt loss Progressive azotemia Polyurea Pain infection

drop

One of the major indications for an ultrasound scan for hematoma may be a ___ in the hematocrit value

Wilm's tumor, nephroblastoma

Palpable mass Abdominal pain Nausea/vomiting Gross hematuria hypertension Usually unilateral, but may be bilateral (5% - 10%) and multiple. It is rare in the newborn.

lymphocele

Perinephric Fluid Collection Mass effect from perinephric fluid can result in hydronephrosis; or edema of the leg, abdominal wall, labia or scrotum

hematoma

Perinephric Fluid Collection complication of transplant biopsy

acute hematoma

Perinephric Fluid Collection echogenic and decrease in echogenicity with time

urinoma

Perinephric Fluid Collection well-defined anechoic collections without septations, unless infected or mixed with blood. Urinomas can rapidly increase in size

Wilm's tumor, nephroblastoma

Predominantly solid, well-defined renal mass Usually unilateral, may be bilateral Variable echo pattern Generally appears homogeneous and echogenic on ultrasound. However, appearance varies according to amount of necrosis and/or hemorrhage that has occurred. Echogenic rim The tumor may be large and have calcifications. Young children.

basket sign

RCC

IV

RCC Stage (I, II, III, IV): Invasion of neighboring structures; distant metastases

III

RCC Stage (I, II, III, IV): Spread to RV, IVC, or regional lymph nodes

II

RCC Stage (I, II, III, IV): Spread to perinephric fat but within Gerota's fascia

I

RCC Stage (I, II, III, IV): confined to the kidney

glomerulonephritis

Recent throat infection (acute) Hematuria Proteinuria Fever Hypertension Smoky urine Proteinuria Fatigue Edema Nausea Vomiting

Malignant

Renal Cell Carcinoma Transitional Cell Carcinoma Squamous Cell Carcinoma Renal Lymphoma Wilm's Tumor Metastases

3

Renal cancer comprises approximately __% of all cancers in the United States

calcified cyst

Renal cyst with internal calcifications. Smooth round borders that are echogenic or have echogenic foci. Posterior shadowing from the calcification within the cyst.

renal atrophy

Renal failure Small echogenic kidneys

renal atrophy

Renal sinus lipomatosis occurs secondary to ___.

12

Renal stones affect __% of people, most commonly white men

Pyelonephritis

Retrograde flow of bacteria up the ureter results in __

corticomedullary

Sonographic findings include one or more fluid spaces at the _____ junction that corresponds to the distribution of the renal pyramids

Mesoblastic Nephroma

Sonographically appears as solid renal mass with possible areas of cystic degeneration. Calcification is not typical Hemorrhage, necrosis, and cyst formation can be seen in larger masses. Neonate

fungal balls

Sonographically, ___ appear as echogenic, mobile, nonshadowing structures within the renal collecting system.

septated

Sonographically, it is difficult to differentiate between a(n) ____ cyst and a small adjacent cortical cyst.

5mm

Stones greater than ___ were detected with 100% sensitivity sonographically

ARPKD

Symptoms of ___ can begin before birth. In most cases, the earlier the onset, the more severe the outcome.

bladder

TCC Most commonly occurs within the ___.

prone oblique decubitus

The best view of the area of a hematoma in the psoas muscle is __ __ __, using the kidney as an acoustic window

UVJ

The majority of renal stones will lodge at the __

diabetes

The most common cause of chronic renal failure

candida

The most common cause of fungal urinary tract infections is __

hydronephrosis

The most common cause of nonvisualization of a kidney (unilateral) on IVP is __

ATN

The most common medical renal disease that produces acute renal failure is . ____________

hilum

The parapelvic cyst is found in the ___ but does not communicate with the renal collecting system.

MCKD

The patient presents with normal or small echo-dense (echogenic) kidneys with widening of the renal sinus after 2 cm in the medulla or corticomedullary junction. Loss of corticomedullary differentiation, and multiple medullary small cysts (smaller than 2 cm).

CT

The preferred method of imaging RCC

nephron, vascular, interstitial

There are three primary types of chronic renal failure: ____________, ____________, and ____________ abnormalities

Nephrocalcinosis

Tiny deposits of calcium phosphate dispersed throughout the renal parenchyma.

higher

To best evaluate the composition of a cyst, one should change the transducer to a (higher/lower) frequency.

abscess

UTI Symptoms of pyelonephritis Flank pain Fever or chills Leukocytosis

C

Ultrasound findings in a patient with hypertension include a left kidney measuring 6.8 cm and a right kidney measuring 11.7 cm. Which of the following is most consistent with these findings? A. Acute pyelonephritis in the left kidney B. Acute glomerulonephritis in the right kidney C. Occlusion of the left main renal artery D. Amyloidosis of the right kidney

adenoma

Unilateral small cortical lesions are found more commonly in women 40-60 years of age, often incidentally, and more co

Interstitial Nephritis

Uremia Hematuria Rash Fever Eosinophilia

color doppler

Ureteral jets are best visualized by __ imaging

abnormal

Usually a(n) ____ renal contour is the first finding that a mass may be present and require further investigation.

MSK

Usually asymptomatic unless calculus is present, then hematuria and infections. Pain Hydronephrosis This condition is prone to nephrocalcinosis, particularly at the outer edges of the pyramids, and stone formation.

adenoma

Vascular, well-defined, isoechoic, hypoechoic or hyperechoic cortical mass. Can have calcifications

Nephrocalcinosis

Very echogenic pyramids with or without associated shadowing. Both kidneys

Oncocytoma

Well defined, smooth margins Homogeneous hypoechoic solid mass Larger masses may undergo hemorrhage and central necrosis leading to central stellate fibrotic scarring. Resemble spoke-wheel pattern.

non-visualization

What effect do renal vein thrombosis, renal artery occlusion, pyonephrosis, and end-stage kidney disease have on IVP?

posterior urethral valves

What is the most common cause of urinary obstruction in male neonates?

RV, IVC

When a solid renal mass is identified by sonography it is important to extend the examination to include the __ and __ to evaluate these vessels for the presence of tumor thrombus.

tumor thrombus

When a solid renal mass is identified by sonography it is important to extend the examination to include the renal vein and inferior vena cava to evaluate these vessels for the presence of __ __

C

When encountering TCC, which of the following questions is most important for the sonographer to ask the patient? (letter only) A. Do you have high blood pressure? B. How often do you urinate each day? C. Have you noticed any blood in your urine? D. When was your last physical examination? E. How much water do you drink each day?

pyonephrosis

When pus is found within the obstructed renal system, the condition is called _____

parathyroid

When scanning renal stones, consider checking the ___ gland

A

You are performing a follow-up study on a patient diagnosed with emphysematous pyelonephritis. Which of the following best describes the sonographic appearance of this condition? A. multiple echogenic foci within the renal sinus or parenchyma with "dirty" posterior acoustic shadows. B. multiple distinct hyperechoic foci with discreet, well-defined posterior acoustic shadows. C. multiple indistinct, hazy foci within the renal sinus with posterior acoustic enhancement. D. large area of posterior acoustic shadowing which is not associated with any defined echoes.

e

You suspect hydronephrosis in a 42-year-old female who complains of vague abdominal discomfort. Which of the following is a cause of false-positive determination of hydronephrosis? A.overdistention of the urinary bladder B. parapelvic cysts C. prominent hilar vessels D. large extrarenal pelvis E. all of the above

Perinephric absces

__ __ is suspected when a tx patient presents with fever and increased WBC.

RCC

__ is most common of all renal neoplasm in the adult.

Nephrocalcinosis

___ is characterized by diffuse foci of calcium deposits that are usually located in the medulla but infrequently can be seen also in the renal cortex.

hydronephrosis

___ is when the dilated pyelocalyceal system appears as separation of the renal sinus echoes by fluid-filled areas that conform anatomically to the infundibula, calyces, and renal pelvis. .

MCKD, NPH

___ occurs in older patients and is inherited in an autosomal dominant pattern. __ occurs in young children and is usually due to autosomal recessive inheritance. It is characterized by salt-wasting nephropathy in young adults.

MCKD

____ is very similar to the childhood disease familial juvenile nephronophthisis (NPH). Both lead to scarring of the kidney and formation of fluid-filled cavities (cysts) in the deeper parts of the kidney.

Oncocytoma

a benign renal tumor that is often found in men in their 60s. Color Doppler ultrasonography may show central radiating vessels.

Lupus Nephritis

a connective tissue disorder believed to be the result of an abnormal immune system, attacking the kidneys

Interstitial Nephritis

a kidney disorder in which the spaces between the kidney tubules become swollen (inflamed). The end result is enlarged, poorly functioning kidneys.

renal lymphoma

a malignant neoplasm of lymphoid tissue.

XGPN

a rare chronic form of pyelonephritis that is typically the result of a chronic obstructive process

Neurogenic bladder

a urinary problem caused by interference with the normal nerve pathways associated with urination

ACKD

abbreviation: Acquired cystic kidney disease

AML

abbreviation: Angiomyolipoma

XGPN

abbreviation: Xanthogranulomatous Pyelonephritis

ARF

abbreviation: acute renal failure

ATN

abbreviation: acute tubular necrosis

ARPKD

abbreviation: autosomal recessive polycystic kidney disease

MCKD

abbreviation: medullary cystic kidney disease

MSK

abbreviation: medullary sponge kidney

NPH

abbreviation: nephronophthisis

PKD

abbreviation: polycystic kidney disease

RCC

abbreviation: renal cell carcinoma

TCC

abbreviation: transitional cell carcinoma

VUR

abbreviation: vesicoureteral reflux

Pyonephrosis

abnormal condition of pus from the kidney

VUR

abnormal flow of urine from the bladder back into the ureters

MCKD

adult kidneys do not concentrate the urine enough, leading to excessive urine production and loss of sodium and other chemical changes in the blood and urine.

perinephric abscess

an abscess that surrounds the kidney

end stage renal failure

an extreme failure of kidney function due to nephron loss.

Pyelonephritis

an infection of a portion (focal) of or the complete kidney (diffuse). May be unilateral or bilateral

nephritis

an inflammation of the kidneys

Glomerulonephritis

an inflammatory response resulting in glomerular damage caused by an autoimmune reaction, distant infection

Subcapsular hematoma

as a perirenal fluid collection that flattens the underlying renal contour.

RCC

associated with von Hippel-Lindau disease, acquired cystic disease (dialysis patients), and tuberous sclerosis.

Sickle Cell Nephropathy

asymptomatic hematuria loss of concentrating ability renal papillary necrosis pyelonephritis

Renal Lymphoma

bilateral invasion with multiple modules, nonspecific except kidneys are enlarged and hypoechoic

Hodgkin's lymphoma

chronic malignant cancer of the lymphatic system

Peripelvic cyst

cyst around the renal pelvis; does not obstruct the kidney. Acquired condition which may develop from the lymphatic system or an obstruction.

Multilocular cystic nephroma

cystic mass with septations that herniates into the pelvis --> can lead to hydronephrosis can not diff from cystic RCC in adults and cystic wilms in children

AIDS

destroys T cells and then replicates rapidly within the body. The virus affects many organs within the body. Patients have various symptoms.

pyelocaliectasis

dilatation of the renal pelvis and calyces, but not always necessarily due to obstruction or infection.

renal stones

echogenic foci with sharp distal acoustic shadowing.

Hydronephrosis

general term that is defined as the dilatation of the renal collecting system secondary to the obstruction of normal urine flow

PKD

genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys.

diverticulum

herniation of the bladder wall

Emphysematous Pyelonephritis

infection of the renal parenchyma characterized by gas formation.

Cystitis

inflammation of the bladder

Renal abscess

localized infection within the medulla or cortex of the kidney

Extraperitoneal fluid collections

lymphocele, seroma, urinary fistula, urinoma, perinephric abscess, hematoma

Acute Glomerulonephritis

may be suspected when the echogenicity of the renal parenchyma exceeds that of the liver

AML, Hamartoma

more echogenic than the renal sinus. May be encountered in patients with: a. Tuberous sclerosis b. Postmenopausal women.

diabetes

most common cause of kidney disease in the United States.

hemmorhage

most common complication from ACKD

infection

most common disease of the urinary tract.

MCDK

most common palpable mass in neonates

simple cyst

most common renal mass

UPJ

most common site of obstructive hydronephrosis

hydronephrosis

most common urinary tract anomaly

PKD

most frequent genetic cause of renal failure in adults

shattered kidney

multiple fragments of disorganized tissue with associated hemorrhage and urine collection in the renal bed. Color Doppler may be helpful in the assessment of vascular pedicle injuries.

Wilm's tumor

nephroblastoma is also known as __

ARF

oliguria Fluid retention, causing swelling in your legs, ankles or feet Drowsiness Shortness of breath Fatigue Confusion Seizures or coma in severe cases Chest pain related to pericarditis, an inflammation of the sac-like membrane that envelops your heart

adenoma

one of the most common benign renal tumors is a(n) ___

ARPKD

one of the most common hereditary renal cystic diseases in children.

renal failure

produces no symptoms early in the course of the disease

MSK

rare, benign (acquired) renal disease found in children. Renal function usually remains normal.

Hypertensive Nephropathy

resulting from unmanaged chronic hypertension

UVJ

second most common site of obstructive hydronephrosis

TCC

solid hypoechoic mass within the collecting system, with low vascularity on color Doppler, and extremely rarely calcificatons. Irregular mass with echogenicity ranging from hypoechoic to hyperechoic. Indistinct borders. Hypervascular mass. Metastasis to the lung, liver and long bones.

ARF

sudden loss of your kidneys' ability to perform their main function - eliminate excess fluid and electrolytes as well as waste material from your blood.

ACKD

the development of multiple cysts in the kidneys and is seen frequently in patients on long-term renal dialysis or peritoneal dialysis.

Wilm's tumor

the most common solid mass of childhood who are one to eight years of age. (90% less than 5 years of age).

Nephrostomy

the placement of a catheter to maintain an opening from the pelvis of one or both kidneys to the exterior of the body

staghorn calculus

the stone conforms to the shape of the renal pelvis

Non-Hodgkin's Lymphoma

the term used to describe all lymphomas other than Hodgkin's lymphoma