Chapter 14 Flashcards
(163 cards)
1
Q
What are the two principle functions of the urinary system?
A
Two principle functions- excreting wastes and regulating composition of blood.
2
Q
True or false: Kidneys are within the retroperitoneum
A
True
3
Q
Where are the renal pyramids located?
A
Renal pyramids are within the medulla
4
Q
What do the nephrons do?
A
Numerous collecting tubules (nephrons) bring the urine from its site of formation in the cortex to the pyramids.
5
Q
What is the relationship of the renal artery to the renal vein?
A
Renal artery is posterior and superior to the renal vein
6
Q
What is the Gerota’s Fascia?
A
Renal fascia, known as Gerota’s fascia surrounds the true capsule and perinephric fat.
7
Q
What do nephrons filter?
A
Nephrons filter the blood and produce urine
Consist of two main structures—renal corpuscle and renal tubule
8
Q
Where is blood filtered?
A
Blood is filtered in the renal corpuscle
9
Q
What is urine made up from?
A
Waste products, excess water, and other substances not needed by the body pass into the collecting ducts as urine
10
Q
Define urethra
A
Urethra is a membranous tube that passes from the anterior part of the urinary bladder to the outside of the body (not routinely visualized)
11
Q
What is the urinary bladder lined by?
A
Urinary bladder is lined by an elastic material, it is thin when the bladder is distended and a series of folds when empty (appears thicker)
12
Q
Where does the ureter leave from? and enters what?
A
Ureter leaves renal pelvis and at its distal end enters the bladder along the lateral wall
13
Q
What are the urinary bladder openings for?
A
Urinary bladder is a large muscular bag
Posterior and lateral opening for the ureters
Anterior opening for the urethra
14
Q
What is the arterial supply to the kidney?
A
Arterial supply to the kidney is provided by the main renal artery
Divides into branches as it enters the hilus of the kidney
15
Q
Where does the main renal vein drain into?
A
Emerges from the hilus anterior to the renal a. and drains into the lateral wall of the IVC
16
Q
What kind of blood does renal veins return?
A
Renal vein returns cleansed blood to the general circulation
17
Q
Where do lymphatic vessels follow?
A
Lymphatic vessels follow renal artery to the lateral aortic lymph nodes near the origin of the renal artery
18
Q
Physiology of the urinary system?
A
Remove waste from the blood and produce urine
Excretion- the disposal of metabolic waste
19
Q
Define excretion
A
the disposal of metabolic waste
20
Q
What kind of products does the urinary system remove?
A
This entails separating and removing substances harmful to the body—metabolic waste products are: water, carbon dioxide, and nitrogenous wastes ( urea, uric acid, and creatinine)
21
Q
What are some lab tests that are performed?
A
Lab Tests Urinalysis Urine PH Specific gravity Blood (Hematuria) Hematocrit Hemoglobin Protein Creatinine clearance Blood Urea Nitrogen (BUN) Serum Creatinine
22
Q
Sonographic evaulation can define what?
A
Renal masses
Perirenal fluid collections (hematoma or abscess)
Determine renal size and parenchymal detail
Detect hydronephrosis and dilated ureters
Detect congenital anomalies
23
Q
if two separate areas of renal sinus are seen, what would you question?
A
If two separate areas of renal sinus are identified then you must question a double collecting system (2 renal pelvis & 2 ureters)
24
Q
What does the renal parenchyma surrounds?
A
Renal parenchyma surrounds the fatty central renal sinus, which contains the calyces, infundibula, pelvis, vessels, and lymphatics
25
Kidneys are surrounded by what?
Kidneys- smooth outer contours surrounded by reflected echoes of perirenal fat
26
What are patient positions for a renal exam?
Supine or decubitus
| Subcostal or intercostal approach (try different windows)
27
What can obscure the renal detail?
Renal detail may be obscured if the patient has hepatocellular disease, gallstones, rib shadow or large habitus
28
from where to where is the parenchyma from?
The parenchyma is from the renal sinus to the renal surface
| Cortex is less echogenic than the liver
29
What vessels are found within the parenchyma?
Arcuate arteries and interlobar vessels are found within
30
What are the two diseases of the parenchyma?
Type I- Increase echogenicity of the cortex
| Type II- Any mass lesions, including cysts, tumors, abscesses, and hematomas
31
Where do the renal arteries extend from?
Renal arteries extend from the lateral walls of the aorta and enter the central renal sinus
Renal arteries are posterior to the veins
32
where do the renal veins extend from?
Renal veins extend from the central renal sinus and enter the IVC
Both are seen best in transverse as tubular structures
33
What does the medulla consists of?
Consist of hypoechoic pyramids
Should be uniform in distribution and separated by bands of parenchyma
Pyramids are also uniform in size and shape (triangular)
34
What does the apex and base adjacent to?
Apex points to the sinus and the base is adjacent to the renal cortex
35
Where do the interlobar and arcuate vessels lie?
Interlobar arteries lie alongside the pyramids and arcuate vessels lie at the the base
36
define columns of bertin
Prominent invaginations of cortex located at varying depths within medullary substance
Most exaggerated in patients with a complete or partial duplication
Sonographic findings
Echogenicity similar to cortex
37
define dromedary hump
A bulge of cortical tissue on the lateral surface of a kidney (usually left)
May resemble renal neoplasm
Sonographic Findings
Echogenicity identical to cortex
38
Define junctional parenchyma defect
Triangular, echogenic area typically located anteriorly and superiorly
Result of partial fusion of two ranunculi during normal development
Sonographic Findings
Best seen in sagittal
39
define fetal lobulation
Developmental variation that is usually present in children and may be persistent in adults
Surfaces of the kidney are indented between calyces
Giving a lobular appearance
40
define Sinus Lipomatosis
A condition characterized a deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy
Enlargement of the sinus with increased echogenicity
Occasionally a fatty mass is localized in only one area; this is called lipomatosis
41
define extrarenal pelvis
Larger with long major calyces
| Seen outside of the renal sinus
42
sonographic findings of extrarenal pelvis
Central cystic area that may be partially or entirely beyond the confines of the renal substance
Transverse is best for viewing continuity with renal sinus
Dilated extrarenal pelvis will usually decompress when the patient is placed in prone
43
define renal agenesis
Renal agenesis- absence of kidney
44
define renal hypoplasia
Renal hypoplasia- incomplete development of the kidney-usually fewer than 5 calyces
45
define incomplete duplication
Incomplete duplication- incomplete, or partial duplication- 2 collecting systems & 2 ureters that join prior to entering the bladder
46
define complete duplication
Complete duplication- rare, 2 collecting systems and 2 ureters that enter the bladder separately
47
define renal ectopia
Renal ectopia- a kidney that is not located in its usual position
Crossed renal ectopia- fused and nonfused—fused both kidneys on the same side
48
define horseshoe kidney
Horseshoe kidney- Most common anomaly, fusion of the lower poles occurs most often
49
What should you check prior to an exam?
Prior to the exam always review patient chart, labs, and look for previous exams
50
Renal masses are categorized how?
Renal masses are categorized as cystic, solid or complex
51
Define cystic mass
Smooth, thin well-defined border, round or oval, sharp interface between the cyst and renal parenchyma, anechoic, and increased posterior enhancement
52
define solid mass
Irregular borders, poorly defined interface between the mass and the kidney, low-level internal echoes, weak posterior border because of attenuation, and poor through-transmission
53
define complex mass
Cystic and solid—necrosis, hemorrhage, abscess, and calcification within the mass
54
Define lower urinary tract
Stricture with ureter
Narrowing due to fibrosis- common form
Other causes as well
55
define ureterocele
Cystlike enlargement of the lower end of the ureter caused by congenital or acquired stenosis of the distal end of the ureter
Usually small and asymptomatic, although they may cause an obstruction
56
define ectopic ureterocele
Ectopic ureterocele
Rare and found more commonly in children and young adults, typically females
Usually associated with complete ureteral duplication
57
TA sonography will allow visualization of most lesions greater than what?
Transabdominal sonography will allow visualization of most lesions greater than 5 mm
The bladder should be distended to evaluate
58
If outflow obstruction is a concern what should be done?
If outflow obstruction is a concern a residual bladder volume is done.
Measured in 3 planes at the largest dimensions
Residue of less than 20 ml of urine is considered normal
59
define renal cystic disease
The disease may be acquired or inherited
| May occur in the cortex, medulla, or renal sinus
60
Define simple renal cyst
Most common renal mass lesion is a simple cortical renal cyst
Acquired, unknown origin
Estimated they occur in 50% of the population over 50
Most are asymptomatic
Usually an incidental finding
Solitary or multiple, involving one or both kidneys
Unusual in children
61
Ultrasound findings of a simple renal cyst
Round or oval, posterior enhancement, thin walls
62
If it does not meet the criteria for a simple cyst then is it what?
If it does not meet the criteria for a simple cyst then it is complex and considered malignant until proven otherwise
Complex
Thick walls, may contain septation, calcifications, internal echoes, and mural nodularity
63
ultrasound findings of a complex cyst
Ultrasound findings
Thick walls- anything over 1mm—cystic form of renal cell carcinoma often presents this way
Most of the time internal echoes are a result of protein content, hemorrhage, and/or infection
Irregularity at the base of a cyst should be considered malignant growth
Vascularity within the cyst is concerning
64
define parapelvic cyst
Originates from the renal sinus and most likely lymphatic in origin
Does not communicate with the collecting system
65
Clinical findings of parapelvic cyst
Usually asymptomatic but may cause pain, hematuria, hypertension, or obstruction
66
sonographic findings for parapelvic cyst
Sonographic findings
Well-defined anechoic mass
May have irregular borders because it may compress adjacent renal sinus structures
May cause obstruction
Should be able to differentiate from hydro by trying to connect to a dilated central pelvis
67
Define Von Hippel-Lindau
Genetic disorder
Several areas of the body may be affected
Retinal angiomas
Cerebellar hemangioblastomas
Variety of abdominal cyst and tumors
Renal cell carcinoma in patients with this disease is multifocal and bilateral
High incidence of renal cyst with VHL
68
define tuberous Sclerosis
Genetic disorder characterized by mental retardation, seizures, and adenoma sebaceum
Associated renal lesions include multiple renal cysts or angiomyolipomas
May be difficult to separate from adult polycystic kidney disease
69
define Acquired Cystic Kidney Disease (ACKD)
Found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis
70
Patients with ACKD have a increase risk of what?
Patients with this condition have shown a slight increase risk in renal cyst, adenomas, and renal carcinoma
Incidence in having these masses increase with time, particularly after the first 3 years of dialysis
71
Ultrasound findings of ACKD
Small echogenic kidneys with several small cysts
May have internal echoes within cyst because of hemorrhage
Possible renal carcinoma- mass with internal echoes, nodularity and increased vascularity on color Doppler
72
Define Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Infantile polycystic disease
Rare genetic disorder
Dilation of the collecting tubules causes renal failure
Renal function is usually decrease secondary to hepatic problems when it appears later in life
73
Perinatal form is found where? and cause what?
Perinatal form is found in utero and usually progresses to renal failure—causing pulmonary hypoplasia and intrauterine demise
74
Define Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Adult polycystic kidney disease
Common genetic disease that occurs in both men and women
Bilateral disease and characterized by enlarged kidneys with multiple asymmetrical cyst varying in size and location in the renal cortex and medulla
Progressive and doesn’t usually clinically manifest until the fourth and fifth decades when hypertension or hematuria develops
75
Clinical symptoms of ADPKD
Clinical symptoms- pain, hypertension, palpable mass, hematuria, headache, urinary tract infection, and renal insufficiency
76
define Multicystic Dysplastic Kidney (MCDK)
Common nonhereditary renal dysplasia that usually occurs unilaterally
Kidney functioning poorly if at all
Most common form of cystic disease in neonates
Dysplastic changes usually involve the entire kidney
Bilateral (MCDK)- incompatible with life
77
If a MCDK kidney is not removed what kind of complications can occur?
If not kidney is not removed complications include- hypertension, hematuria, infection and flank pain. Slight increased risk of malignancy
78
Ultrasound findings of MCDK
Neonates and children- multicystic, absence of renal parenchyma, sinus and atretic renal artery
Adults- kidneys are small and echogenic (atrophic and calcified), may have ureteral atresia, contralateral ureteropelvic obstruction and a nonfunctioning kidney
79
Most common form of cystic disease in neonates
Multicystic Dysplastic Kidney (MCDK)
80
Define medullary sponge kidney (MSK)
Development anomaly that occurs in the medullary pyramids
Consist of cystic or fusiform dilation of the distal collecting ducts causing stasis of urine and stone formation
May be unilateral or segmental
Cause is unknown
81
Clinical symptoms of MSK
Many patients are asymptomatic, but patients with hematuria, infection, and renal stones should be evaluated for medullary sponge kidney.
82
What can MSK be associated with?
MSK may be associated with Beckwith-Wiedemann syndrome, polycystic kidney disease, Caroli’s disease, and congenital hepatic fibrosis
83
define Medullary Cystic Disease (MCKD) and Nephronophthisis (NPH)
Inherited disorders that eventually lead to end-stage renal disease
They share many features
Cyst are restricted to the renal medulla or corticomedullary border
Lead to scarring and cyst
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
(MCKD) occurs in older adults
(NPH) occurs in young children
84
Cysts of MCKD and NPH are restricted to what?
Cyst are restricted to the renal medulla or corticomedullary border
85
Ultrasound findings of MCKD and NPH
Small echogenic kidneys, with loss of corticomedullary differentiations, and multiple medullary small cyst
86
Define renal cell carcinoma
Also called hypernephroma or Grawitz’s tumor
Most common of all renal neoplasms and represents 85% of all kidney tumors
More common in males 2:1
Usually seen in the sixth and seventh decades
87
Clinical symptoms of renal cell carcinoma
Hematuria, flank pain, and palpable mass
88
What is renal cell carcinoma associated with?
An association with von Hippel-Lindau disease, dialysis patients, and tuberous sclerosis.
89
Sonographic findings of renal cell carcinoma
Sonographic findings
Most are isoechoic, but may be hyperechoic
The larger the tumor the more heterogeneous caused by hemorrhage and necrosis
Intratumoral calcifications
Could be cystic
Vascularity is appreciated in 92% of cases
Renal vein and IVC invasion occur in 5%-24% cases at the time of diagnosis
90
define transitional carcinoma (TCC)
Account for 90% of all malignancies that involve the renal pelvis, ureter, and bladder and up to 7-10% of all renal tumors
Tumor is often multifocal
Occurs in men 2:1
Peak occurrence in the seventh decade
Most commonly seen in the urinary bladder
Small TCC’s are generally high-grade malignancies and metastasize easily to other tissues and organs
91
clinical symptoms of TCC
Clinically
| May present with gross or microscopic hematuria and flank pain
92
ultrasound findings of TCC
Ultrasound Findings
Typically hypoechoic within collecting system
May invade adjacent renal parenchyma and form an infiltrating mass
93
define Squamous Cell Carcinoma
Rare, highly invasive with poor prognosis
94
clinical symptoms of squamous cell carcinoma
Gross hematuria, palpable kidney secondary to hydro
95
ultrasound findings of squamous cell carcinoma
Large mass in renal pelvis
| Obstruction from kidney stones may also be present
96
define renal lymphoma
Primary is rare, secondary form is more common
Hematogenous spread spread in 90% of cases, can be direct extension via the retroperitoneal lymph nodes
Lymphoma is more common as a bilateral invasion with multiple nodules
97
Ultrasound findings of renal lymphoma
Enlarged hypoechoic kidneys
Highly hypoechoic renal tumors with poorly defined margins without posterior enhancement (can be mistaken for renal cysts)
98
define Nephroblastoma or Wilms’ Tumor
Most common abdominal malignancy in children
Most common solid renal tumor in patients 1-8 years old
Peak incidence is seen at 2.5 to 3 years old
2-8 times more common in patients with horseshoe kidney
99
Most common abdominal malignancy in children
Wilms' Tumor
100
Most common solid renal tumor in patients 1-8 years old
Wilms' Tumor
101
Clinical symptoms of Wilms' Tumor
Abdominal flank mass, hematuria, fever, anorexia
102
Sonographic findings of Wilms' Tumor
Determine cystic or solid and confirm if it is renal in origin
Mass varies from hypoechoic to moderately echogenic
5-10% bilateral
Up to 40% have renal vein thrombosis and/or vena cava or atrial thrombus by the time of diagnosis
Venous obstruction may result in leg edema, varicocele, or Budd-Chiari syndrome
103
Define lipomas
Consist of fat cells
More common in females
Has been reported to cause hematuria
104
ultrasound findings of lipomas
Well-defined echogenic mases
105
Define lupus nephritis
Kidneys are involved in more than 50% of patients with lupus
| Females are affected more often and peak incidence is between 20-40 years of age
106
Clinical symptoms of lupus nephritis
Hematuria, proteinuria, hypertension, renal vein thrombosis, and renal insufficiency
107
ultrasound findings of lupus nephritis
Renal atrophy and increased echogenicity of the cortex
108
define Hypertensive Nephropathy
Uncontrolled hypertension can lead to progressive renal damage and azotemia
109
Ultrasound findings of hypertensive nephropathy
Small kidneys
| Scaring may be seen
110
define renal atrophy
Results from numerous disease processes
| Renal sinus lipomatosis occurs secondary to renal atrophy
111
ultrasound findings of renal atrophy
Kidneys appear enlarged
| Echogenic, enlarged sinus and a thin cortex
112
where can Acute Renal Failure occur?
May occur in prerenal, renal, or postrenal failure stages
113
What are the causes of acute renal failure?
```
Prerenal:
Hypoperfusion of the kidney
Renal:
Parenchymal diseases
Renal vein thrombosis or renal artery occlusion
Postrenal:
Result of outflow obstruction
Increased in patients with malignancy of bladder, prostate, uterus, ovaries or rectum
```
114
Ultrasound findings of acute renal failure
The cause can be determined—urinary outflow obstruction vs. parenchymal disease
Size- normal to enlarged
May be hypoechoic with parenchymal diseases
Most important issue is the presence or absence of urinary tract dilatation
Sonographer should try to determine the level of obstruction
A normal sonogram does not totally exclude a urinary obstruction
115
define Acute Tubular Necrosis (ATN)
Most common medical renal disease to produce acute renal failure—can be reversible
116
ultrasound findings of acute tubular necrosis (ATN)
Bilaterally enlarged kidneys
Hyperechoic pyramids
Can revert to a normal appearance
Differential- nephrocalcinosis- too much calcium deposited in the kidneys (similar ultrasound appearance)
117
Define Chronic Renal Disease
The loss of renal function, most commonly a result of parenchymal disease
118
what are the 3 primary types of chronic renal failure?
Nephron, vascular, and interstitial
119
What diseases can lead to renal failure?
Glomerulonephritis, chronic pyelonephritis, renal vascular disease, and diabetes are a few diseases that lead to renal failure
120
ultrasound findings of chronic renal failure?
Diffusely echogenic kidney
If chronic renal disease is bilateral, small kidneys are identified
May result from hypertension, chronic inflammation, or chronic ischemia
121
Define hydronephrosis
Dilatation of the pelvocalyceal system is called hydronephrosis
122
What are the grades of hydronephrosis?
Grade 1-Small amount of fluid in the renal pelvis
Grade 2- dilatation of some but not all calyces
Grade 3- complete pelvocaliectasis; echogenic line separating collecting system from renal parenchyma can be seen
Grade 4- prominent dilatation of the collecting system, thinning of renal parenchyma and no differentiation between collecting system and the parenchyma
123
With hydro, what should you always look for?
Always look for Ureteral Jets– complete vs. partial obstruction can be evaluated—patients who have recently voided may not see jets
124
ultrasound findings of hydronephrosis
Whenever the renal collecting system is dilated, scan the ureters and bladder to locate the level of obstruction
Ureteropelvic junction obstruction- collecting system dilated without dilation of the ureter
Ureterovesical junction obstruction- hydronephrosis with dilated ureter
Posterior urethra obstruction- hydroureteronephrosis with a dilated bladder- posterior urethral valves
A mildly distended pelvis can be caused by overhydration
You should always take post-void images after your exam is complete if a patient has hydro
125
define ureteropelvic junction obstruction
collecting system dilated without dilation of the ureter
126
define Ureterovesical junction obstruction
hydronephrosis with dilated ureter
127
define Posterior urethra obstruction
Posterior urethra obstruction- hydroureteronephrosis with a dilated bladder- posterior urethral valves
128
define Nonobstructive Hydronephrosis
Dilation of the renal pelvis without obstruction
129
causes of nonobstructive hydronephrosis
Dilation of the renal pelvis without obstruction
Reflux
Infection
Large extrarenal pelvis
Distended bladder
Pregnancy (more often on the right in 3rd trimester)
130
What are the renal infections?
Pyonephrosis- pus is within the collecting system- requires urgent IV antibiotics and/or percutaneous drainage
Ultrasound- low level echoes with a fluid-debris level
Emphysematous Plyelonephritis- air is seen in the parenchyma (diffuse gas-forming parenchymal infection)—may cause for emergency nephrectomy
Ultrasound- enlarged kidneys appear hypoechoic and inflamed
Xanthogranulomatous Pyelonephritis- uncommon, associated with chronic obstruction and infection. Parenchyma destruction occurs, more common in females and poorly understood
131
Define Pyonephrosis
pus is within the collecting system- requires urgent IV antibiotics and/or percutaneous drainage
132
define Emphysematous Plyelonephritis
air is seen in the parenchyma (diffuse gas-forming parenchymal infection)—may cause for emergency nephrectomy
133
define Xanthogranulomatous Pyelonephritis
uncommon, associated with chronic obstruction and infection.
134
Ultrasound findings of renal infections
Ultrasound- Bright echogenicity from staghorn calculus, renal parenchyma is replaced by cystic spaces. Increased renal size
135
Define renal calcifications
Localized parenchymal calcifications- scar tissue caused by bacterial infection, renal abscess, infected hematoma, urinoma, lymphocele, tuberculosis (TB), infarction, or post percutaneous procedures
Malignant solid and/or cystic lesions often have calcifications
Benign renal masses may also calcify
Linear vascular calcifications are associated with renal artery atherosclerosis or vascular malformation
Most intraluminal calcifications are renal calculi
136
Define nephrocalcinosis
Parenchymal calcification is usually located in the medulla but can be seen in the renal cortex
Disorder where too much calcium is deposited in the kidney
Both kidneys are affected
Medullary nephrocalcinosis occurs with many disorders- hyperparathyroidism (40%)
137
what does ultrasound evaluate for nephrocalcinosis?
Ultrasound- Cortical & medullary
Cortical- increased echogenicity of the cortex with spared pyramids
Medullary- pyramids are more echogenic than cortex
Corticomedullary form exist as well
138
Define Renal Artery Stenosis
Most common correctable cause of hypertension
139
Most common causes of renal artery stenosis (RAS) is
atherosclerosis and fibromuscular dysplasia
140
What is associated with hypertension?
Atherosclerosis is associated with hypertension, more common in older adults--1/3 of cases of RAS
141
What is associated with renal artery stenosis that involved 2/3 cases?
Fibromuscular dysplasia- 2/3 of cases of RAS, in younger patients.
May involve in layer of the renal artery wall- medial layer involvement is seen most often
Replacement of smooth muscle with ridges occurs and causes stenosis “string of beads” on CT angiography
Progressive and may involve other vessels
142
ultrasound findings of renal artery stenosis
Ultrasound Findings
Selective renal arteriography is the gold standard for visualizing RAS
With sonography accuracy depends on operator, patient habitus, and adequacy of technique
Color Doppler and PW are used in sonography
Evaluation of MRA (Direct) and arcuate and intralobar renal arteries (indirect)
MRA increased velocity > 150 to 190 cm/sec and turbulence distal to narrowing
RI > .70- abnormal
Tardus-parvus has been used to describe a waveform with a decreased acceleration time and decreased peak Fig. 14-86 D
Review RAS pages 404-405 and images
143
What RI is considered abnormal for RAS?
RI > .70- abnormal
144
define renal infarction
Occurs when part of the tissue undergoes necrosis—usually a result of arterial occlusion
Renal function is usually normal
145
What can renal infarction result from?
May result from: thrombus, tumor infiltration or obstruction, or be iatrogenic.
146
Ultrasound findings of renal infarction
Ultrasound Findings
Infarcts within the parenchyma- irregular areas, somewhat triangular along the periphery of the renal border
Irregular area may be slightly more echogenic than parenchyma
147
Why is renal transplant used?
Renal transplantation and dialysis are currently used to treat chronic renal failure and end-stage renal disease
148
What is the most frequent complication of renal transplant?
Most frequent complication is rejection
149
Sonographic evaluation of renal transplants
Sonographic Evaluation
Size, parenchyma, presence of abnormal fluid collections and Doppler assessment should be done
Baseline scan is done 48 hours after surgery to determine—renal size, calyceal pattern, and extra renal fluid collections
Serial scans may be done at 3 to 6 month intervals to detect fluid collections at an early, asymptomatic stage
150
What is the method used to determine renal rejection?
Renal biopsy is the only method to accurately determine whether or not there is rejection
151
What are the types of rejections?
4 types of rejection
Hyperacute-within hours of transplant
Acute- within days to months after transplant
Immunologic-causes: pre-formed antibodies, immune complexes, and cell-mediated responses
Chronic-can occur months after a transplant with gradual onset
152
Define kidney stones
One of the most common kidney problems that occur
May cause obstruction which can be extremely painful
Most stones are small and can pass through the urinary system without treatment. Stones that are large and fill the collecting system are called staghorn calculi
More common in men, once someone develops a kidney stone they are at an increased risk of developing them in the future
153
Clinical symptoms for kidney stones
Clinically- initially extreme pain, cramping on the side with the stone, N/V, pain may subside as it travels down the ureter
154
What are the treatments for kidney stones?
Treatment- lithotripsy (shock waves) or surgery if a stone is obstructing and cannot pass
155
Ultrasound findings for kidney stones
Echogenic with posterior shadowing
Stones less than 3 mm may not shadow, the use of harmonics can be helpful in appreciating an acoustic shadow
Color and Power Doppler have an increased sensitivity and can show a “twinkling sign” posterior to the stone—rapidly changing mixture of red and blue colors posterior to the stone
If a stone is causing an obstruction hydro and possibly dilated ureter can be appreciated depending on the level of obstruction
156
Define twinkling sign and what is it used for?
Color and Power Doppler have an increased sensitivity and can show a “twinkling sign” posterior to the stone—rapidly changing mixture of red and blue colors posterior to the stone
157
Define bladder diverticulum
Herniation of the bladder wall. These outpouchings may be singular or multiple
Congenital or acquired
158
ultrasound findings of bladder diverticulum
A neck of varying size connect the adjacent fluid-filled structure to the bladder
Diverticulum may still be filled with fluid after the patient empties their bladder
Urine stasis leads to recurrent infections and stone formation
159
define Cystitis
inflammation of the bladder
| Usually secondary to another condition that causes stasis of urine in the bladder
160
Causes of cystitis
```
Urethral stricture
Benign and malignant neoplasms
Bladder calculi
Trauma
Tuberculosis
Pregnancy
Neurogenic bladder
Radiation therapy
```
161
ultrasound findings of cystitis
Wall may appear normal in early stages
Diffuse or nondiffuse hypoechoic thickening of the wall over time
As the inflammatory process progresses the bladder wall becomes fibrotic and scarred becoming echogenic
162
define bladder tumors
95% in adults are transitional cell carcinoma (TCC)
Usually not detected until they become advanced
Patients present with gross hematuria, dysuria, urinary frequency, or urinary urgency
Biopsy is necessary to determine benign vs. malignant
163
ultrasound findings of bladder tumors
Appearance varies
Sonography, CT, or MRI may be used for staging
All primary bladder tumors have the same appearance-irregular echogenic mass that projects into the lumen
