Renal System II

Which RI value would indicate a normal Doppler evaluation for transplant rejection?

0.5-0.7

A duplicated collecting system shows:

2 hyperechoic renal sinus areas separated by a cleft

What is the normal thickness of the distended bladder wall?

3 mm

Descibe Von-Hippel-Lindau renal involvement?

3rd-5th decade, seen as bilateral cysts on ultrasound, RCC is most frequenct cause of death

You are performing a follow-up ultrasound study on a patient with a large left renal cyst. Which of the following most accurately describes the prevalence of renal cysts?

50% of people over age 50

Which age group is most affected by Transitional Cell Carcinoma?

50+ years old

What medical disease, to some extent, occurs with every renal transplant and is treated with diuretics and hydration?

ATN

What is related to hypernephroma?

Association with smoking, calcifications w/in mass

Which form of polycystic disease has a loss of reniform shape?

Autosomal Dominant

Which form of polycystic disease has bilateral enlarged kidneys?

Autosomal Dominant

Which form of polycystic disease has cysts found in liver, spleen and pancreas?

Autosomal Dominant

Which form of polycystic disease has 4 subcategories?

Autosomal Recessive

Which form of polycystic disease has bilateral enlarged echogenic kidneys?

Autosomal Recessive

Which form of polycystic disease has microscopic cysts?

Autosomal Recessive

You have been asked to identify the ureteral jets. Where are the ureteral orifices in the urinary bladder?

Base of the trigone along the posterior aspect

What is true about RCC?

Can occur is cyst wall of chronic dialysis patients, more common in older men, unilateral and well encapsulated

You are performing a Doppler study of a renal transplant to rule out stenosis of the renal artery. The renal artery is usually anastomosed to which vessel?

Common Iliac Artery

Metastases to the kidney are most commonly from a:

Contralateral kidney tumor

Which of the following 2 items are the major causes of renal artery stenosis?

Fibromuscular dysplasia, atherosclerosis

What are hormones produced by the pancreas?

Glucagon, insulin, somatostatin

The sonographic appearance of infantile polycystic kidneys includes:

Hyperechoic kidneys with micro cysts

ATN is associated with which of the following 4 things?

Increased renal size, ARF, Prominent medullary pyramids and anechoic, most common cause of failure in post-transplant patients

Which Doppler method evaluates the segmental and intralobar arteries?

Indirect

Bladder duplication:

Is a rare anomaly

The renal arteries are ____ branches off the Aorta?

Lateral

A neurogenic bladder is:

Loss of voluntary control of voiding

Which of the following describes the normal waveform of the main renal artery?

Low Resistance

Describe medullary cystic disease.

Marked by normal renal function, a variable number of renal cysts, often associated w/ polyuria and progressive azotemia

What is true about mesoblastic nephroma?

More common in males, most common solid benign mass in neonates, it is a fetal renal hamartoma, benign couterpart of Wilm's tumor

Describe nephrolithiasis.

More common w/ urinary stasis, tends to be small in size, CT is a good modality to evaluate, mainly in males

What is the most common renal tumor found in children?

Nephroblastoma

Angiomyolipomas are more commonly encountered in:

Patients with tuberous sclerosis

Which of the following conditions affect male children, is characterized by bilateral hydronephrosis, overly distended bladder, and dilated ureters?

Posterior urethral valves

You are scanning the urinary bladder and notice multiple artifactual bands in the near field at the anterior bladder wall. What is the source of these echoes?

Reverberation artifact

A patient has been referred to your ultrasound lab for an evaluation of a new renal transplant. Where should you look?

Right Lower Quadrant

The common hepatic duct is formed by the:

Right and left hepatic ducts

You are having difficulty identifying the renal arteries in a patient referred for questionable renal artery stenosis. Which vessel is most helpful as a landmark for the location of the renal arteries?

Superior Mesenteric Artery

What malignant tumor is most common in children aged 2-5?

Wilm's tumor

A ureterovesical junction is:

junction between the distal ureter and base of the bladder

During color Doppler evaluation of the kidney, inadequate fill is seen in the intrarenal vasculature. Which Doppler parameter will you adjust to improve sensitivity to flow?

Decrease filter to a lower setting

What Doppler parameter should you measure to look for rejection in a renal transplant?

Resistive Index

Which of the following is an aggressive malignant bladder tumor?

SCC

Which of the following 2 organs are common primaries that metastasize to the kidneys?

Breast, liver

Which of the following is a differential diagnosis for a WIlm's tumor?

Neuroblastoma

If a patient is suspected of having RCC, what other 3 areas should be evaluated for tumor extension?

Renal vein, IVC, right atrium

You are performing a Doppler evaluation to rule out renal artery stenosis. You will compute a ratio comparing the velocity in the renal artery to what vessel?

Abdominal aorta above the level of the renal arteries

You are performing a renal sonogram and identify hydronephrosis in the right kidney. Which of the following is NOT a potential cause of hydronephrosis?

Acute pyelonephritis

A hypernephroma is a solid renal mass. It is known as:

Adenocarcinoma of the kidney, renal cell carcinoma, Grawitz's tumor

A renal mass that is highly echogenic due to its high fat content is:

Angiomyolipoma

During an abdominal ultrasound on a 52 year old female, a hyperechoic mass is noted on the left kidney. Her renal lab values are normal. What is the most likely diagnosis for this pathology?

Angiomyolipoma

Which form of polycystic disease has no renal parenchyma is identified at later stages?

Autosomal Dominant

Which form of polycystic disease has randomly placed cortical cysts?

Autosomal Dominant

Which form of polycystic disease maybe seen in utero?

Autosomal Recessive

Inflammation of the bladder is termed:

Cystitis

In infantile polycystic disease:

Cysts cannot be seen sonographically

You are scanning a patient with autosomal dominant polycystic kidney disease. What statements are true?

Cysts may be complicated by bleeding or infection, high blood pressure is common, liver cysts maybe present in up to 30% of patients, progressive renal failure is common

Which Doppler method can be hindered by the presence of multiple renal arteries?

Direct

Which of the following is an extrinsic cause of hydronephrosis?

Endometriosis

What is the sonographic appearance of renal vein thrombosis?

Enlarged kidneys with acute renal vein thrombosis

You have detected a solid mass in the right kidney of a 47 year old male. You should tailor your exam to evaluate which of the following three areas?

Evaluate for renal vein thrombus, retroperitoneal adenopathy, extension of tumor into the renal vein, liver mets

You are scanning a patient post renal biopsy and discover a cystic mass in the kidney. What should you do?

Evaluate the cyst with color Doppler

The term exstrophy is best defined as:

Failure of the mesoderm to form over the lower portion of the abdomen

The sonographic appearance of a porcelain GB:

Hyperechoic structure with a posterior shadow

What is a common songraphic appearance of mets to the liver?

Hyperechoic, hypoechoic, heterogenous

Which stage of RCC has spread to perinephric fat w/in Gerota's fascia?

II

Which stage of RCC has spread to renal vein, IVC, and/or regional lymph nodes?

III

Transplanted kidneys are usually placed:

In the pelvis along the ilopsoas muscle

Which is true of the sonographic appearance of chronic pancreatitis?

Increased echogenicity

Which renal artery courses between the pyramids?

Interlobar

You have been asked to evaluate an atypical renal cyst that was seen on CT. Which of the following 3 features are indicative of an atypical cyst?

Irregular walls, internal septations, wall calcifications

Adult polycystic disease may be characterized by:

Latent disease until the 3th-4th decade, HTN and impaired renal function, autosomal dominant disease, may have associated cysts in the liver, panc, spleen

The ligamentum venosum separates the:

Left lobe from the caudate lobe

You are scanning a patient with right flank pain and known polycystic kidney disease. You suspect the presence of hemorrhage within one of the renal cysts. What is the sonographic appearance of this finding?

Low-level echoes w/in the cyst

What is usually diagnosed in early childhood or in utero?

Multicystic dysplastic kidney

What cystic disease is non-hereditary and can be unilateral or bilateral?

Multicystic dysplastic kidney disease

A 1-week-old male infant presents with left flank mass. An IVP demonstrates a normal right kidney but fails to demonstrate the left kidney. The ultrasound examination demonstrates many noncommunicating spherical cystic structures in the left renal fossa, the largest of which is located laterally. No true renal parenchyma is identified. The right kidney is normal sonographically. This most probably represents:

Multicystic kidney

The sonographic appearance of Caroli's disease is:

Multiple cystic structures in the liver, cystic structures communicate with the biliary tree, stones maybe identified in the ducts

You have been asked to perform an ultrasound evaluation of a child with multicystic dysplastic kidney (MCDK). What are signs of this condition?

Multiple variable sized cysts, males are at greater risk, reniform shape, no identifiable renal sinus

A renal ultrasound was performed on an infant male. The right kidney had multiple anechoic areas noted. The left kidney was slightly enlarged, but otherwise normal. What is the most likely diagnosis?

Mutlticystic dysplastic kidney disease

You're completing a renal ultrasound on a 4 year old female. A large renal mass with areas of necrosis is found. What is the most likely diagnosis?

Nephroblastoma (Wilm's tumor)

A patient has been referred to your lab with a history of acute pyelonephritis. What is the most common ultrasound appearance of this condition?

Normal appearance

During routine surveillance of the urinary bladder, you detect the presence of periodic ureteral jets. This is a sign of:

Normality

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 consistent with these findings?

Occlusion of the left main renal artery

Describe medullary sponge kidney.

Occurs in adults, complications include stone formation and infection, normal renal function, multiple cystic dilatations of collecting ducts in medulla

What type of cyst can give the false appearance of hydronephrosis?

Parapelvic cyst

Which cause of acute renal failure does ultrasound play a key part in diagnosing?

Postrenal

Which of the following structures lies anterior to the bladder?

Pubic symphysis, abdominal wall, Space of Retzuis

Which of the following results from an ascending UTI?

Pyelonephritis

A patient is referred for ultrasound evaluation to rule out the presence of renal malignancy. What is the most common (malignant) solid renal mass in the adult?

RCC

A renal mass was noted during the abdominal scan on a 50 year old male. Doppler examination showed pulsatile flow within the mass. The mass shown is suspicious for what finding?

RCC

A malignant solid renal tumor mass can be all of the following:

RCC, TCC, SCC

Doppler analysis of intrarenal waveforms performed during renal sonography reveal a resistive index of 1.0. This finding is consistent with what three findings?

Renal obstruction, renal vein thrombosis, chronic medical disease

You are scanning a patient with suspected lymphoma of the kidney. Which ultrasound appearance is associated with renal lymphoma?

Solitary or multiple bilateral hypoechoic masses in enlarged kidneys

You are scanning a 69 year-old male with hematuria. Your ultrasound findings include right-sided hydronephrosis and a mass within the urinary bladder. Which of the following tumors most commonly occurs within the urinary bladder?

TCC

You detect irregular thickening of the bladder wall in a 53 year-old male with hydronephrosis and a dilated ureter. Which of the following would you suspect?

TCC

The functional unit of the kidneys is:

The nephron

You are scanning a 69 year old male with hematuria. Your ultrasound findings include right-sided hydronephrosis and a mass with urinary bladder. Which of the following tumors most commonly occurs within the urinary bladder?

Transitional cell carcinoma

If renal artery stenosis is suspected with a stenosis greater than 60%, which 3 Doppler findings would be visualized with spectral or color Doppler?

Turbulent flow, tardus parvus waveform, RAR greater than 3.5

What is the indication for a Doppler renal study to rule out renal artery stenosis?

Uncontrolled HTN

During a routine abdomen and pelvic ultrasound study, you detect a small, round cystic structure projecting into the urinary bladder. This most likely represents:

Ureterocele

Which of the following fluid collections will develop first following a renal transplant?

Urinoma

A 3 year old boy presents with hematuria and a palpable left flank mass. Sonographically depicts a solid renal mass. This finding would most likely represent:

Wilm's tumor