Area of kidney where vessels, ureter, and lymphatics enter and exit
hilus
Another term for the renal fascia; the kidney is covered by the renal capsule, perirenal fat, Gerota’s fascia, and pararenal fat
Gerota’s fascia
Functional unit of the kidney; includes a renal corpuscle and a renal tubule
nephron
Carries blood into the glomerulus of the nephron
afferent arteriole
Receive urine from the renal pyramids; form the border of the renal sinus
minor calyces
Part of the nephron that consists of Bowman’s capsule and the glomerulus
renal corpuscle
Area in the midportion of the kidney that collects urine before entering the ureter
renal pelvis
Site of filtration in the kidney; contains water, salts, glucose, urea, and amino acids
Bowman’s capsule
Receives urine from the minor calyces to convey to the renal pelvis
major calyces
Small, membranous canal that excretes urine from the urinary bladder
urethra
Space behind the peritoneal lining of the abdominal cavity
retroperitoneum
Portion of a renal tubule lying between the proximal and distal convoluted portions; reabsorption of fluid, sodium, and chloride occurs here and in the proximal convoluted tubule
loop of Henle
One of several conical masses of tissue that form the kidney medulla; each consists of the loops of Henle and the collecting tubules of the nephrons
renal pyramid
Retroperitoneal structures that exit the kidney to carry urine to the urinary bladder
ureters
Inner portion of the renal parenchyma that contains the loop of Henle
medulla
Small vessels found at the base of the renal pyramids; appear as echogenic structures
arcuate arteries
Muscular retroperitoneal organ that serves as a reservoir for urine
urinary bladder
Part of the collecting system adjacent to the pyramid that collects urine and is connected to the major calyx
calyx
Network of capillaries that are part of the filtration process in the kidney
glomerulus
Central area of the kidney that includes the calyces, renal pelvis, renal vessels, fat, nerves, and lymphatics
renal sinus
Right posterior subhepatic space located anterior to the kidney and inferior to the liver where fluid may accumulate
Morison’s pouch
Small vessel that carries blood from the glomerulus of the nephron and conducts blood to the peritubular capillaries that surround the renal tubule
efferent arteriole
Area in the midportion of the kidney where the renal vessels and ureter enter and exit
renal hilum
Laboratory measurement of the amount of nitrogenous waste and creatinine in the blood
blood urea nitrogen (BUN)
A product of metabolism; laboratory test that measures the ability of the kidney to get rid of waste
creatinine
Maintenance of normal body physiology
homeostasis
Laboratory tests that measure how much dissolved material is present in the urine
specific gravity
Normal variant that occurs on the left kidney as a bulge on the lateral border
dromedary hump
Located outside of the normal position, most often in the pelvic cavity
ectopic kidney
Stone within the urinary system
urolithiasis
First layer adjacent to the kidney that forms a tough, fibrous covering
renal capsule
Bands of cortical tissue that separate the renal pyramids; may mimic a renal mass on ultrasound
columns of Bertin
Dilation of the renal collecting system
hydronephrosis
Congenital malformation in which both kidneys are joined together by an isthmus, most commonly at the lower poles
horseshoe kidney
Interruption in the normal development of the kidney resulting in absence of the kidney; may be unilateral or bilateral
renal agenesis
The urinary system has two principal functions: excreting _______________ and regulating the composition of _______________.
wastes, blood
The right kidney lies slightly _______________ than the left kidney because the large right lobe of the _______________ pushes it _______________.
lower, liver, inferiorly
The kidneys move with respiration; on deep inspiration, both kidneys move _______________ approximately 1 inch.
downward
Within the hilus of the kidney are other _______________ structures, a ureter, and the _______________.
vascular, lymphatics
A fibrous capsule called the ________________ surrounds the kidney.
true capsule
Outside of this fibrous capsule is a covering of _______________.
perinephric fat
The _______________ fascia surrounds the perinephric fat and encloses the kidneys and adrenal glands.
perinephric
The renal fascia, known as _______________ fascia, surrounds the true capsule and perinephric fat.
Gerota’s
The medullary substance consists of a series of striated conical masses, called the renal _______________.
pyramids
A nephron consists of two main structures, a renal _______________ and a renal _______________.
corpuscle, tubule
Nephrons _______________ the blood and produce _______________.
filter, urine
The renal corpuscle consists of a network of capillaries, called the _______________, which is surrounded by a cuplike structure known as _______________.
glomerulus, Bowman’s capsule
Blood flows into the glomerulus through a small _______________ arteriole and leaves the glomerulus through a(n) _______________ arteriole.
afferent, efferent
There are three constrictions along the ureter’s course: (1) _______________, (2) _______________, and (3) _______________.
where the ureter leaves the pelvis, where it is kinked as it crosses the pelvic brim, and where it pierces the bladder wall
The main renal artery is a lateral branch of the aorta and arises just inferior to the _______________.
superior mesenteric artery
The renal vein drains into the _______________ of the inferior vena cava.
lateral walls
The urinary system is located posterior to the peritoneum lining the abdominal cavity in an area called the _______________.
retroperitoneum
The kidneys adjust the amounts of _______________ and _______________ leaving the body so that these equal the amounts of substances entering the body.
water, electrolytes
The principal metabolic waste products are _______________, _______________, and nitrogenous wastes.
water, carbon dioxide
Both urea and uric acid are carried away from the liver into the kidneys by the _______________ system.
vascular
The presence of an acute infection causes _______________, which is _______________ in the urine; pyuria means there is _______________ in the urine.
hematuria, red blood cells, pus
The pH refers to the strength of the urine as a partly _______________ or _______________ solution.
acidic, alkaline
The _______________ is the measurement of the kidney’s ability to concentrate urine.
specific gravity
The specific gravity is especially _______________ in cases of renal failure, glomerular nephritis, and pyelonephritis.
low
A decreased _______________ occurs with acute hemorrhagic processes secondary to disease or blunt trauma.
hematocrit
Impairment of renal function and increased protein catabolism result in BUN _______________ that is relative to the degree of renal impairment and rate of urea nitrogen excreted by the kidneys.
elevation
The renal parenchyma surrounds the fatty central renal sinus, which contains these five structures:
calyces, infundibula, pelvis, vessles, and lymphatics
Dilation of the collection system has also been noted in ______________ patients, especially the right kidney.
pregnant
The _______________ is the area from the renal sinus to the outer renal surface.
parenchyma
The _______________ and _______________ arteries are best demonstrated as intense specular echoes in cross section or oblique section at the corticomedullary junction.
Interlober vessels, arcuate
The _______________ generally is echo producing, whereas the medullary pyramids are _______________.
cortex, hypoechoic
The cortex and medullary pyramids are separated from each other by bands of cortical tissue, called _______________, that extend inward to the renal sinus.
columns of Bertin
The _______________ lie posterior to the renal arteries and should be identified by their lack of pulsations and absence of Doppler flow.
crura
The _______________ of the pyramid points toward the sinus, and the _______________ lies adjacent to the renal cortex.
apex, base
The _______________ is a cortical bulge that occurs on the lateral border of the kidney, typically more on the left side.
dromedary hump
A(n) _______________ is a triangular, echogenic area in the upper pole of the renal parenchyma that can by seen during normal scanning.
junctional parenchymal defect
In a patient with a(n) _______________, there is fusion of the kidneys during fetal development that almost invariably involves the _______________ poles.
horseshoe kidney, lower
A cystic mass presents sonographically with several characteristic features:
smooth, thin, well-defined border, round or oval shape, sharp interface between the cyst and renal parenchyma, anechoic, increased posterior acoustic enhancement
A cystlike enlargement of the lower end of the ureter is called a(n) _______________.
ureterocele
Sonographically, it is difficult to differentiate between a(n) _______________ cyst and a small adjacent cortical cyst.
septated
The parapelvic cyst is found in the _______________ but does not communicate with renal collecting system.
renal hilum
Name the four forms of autosomal recessive polycystic kidney disease:
perinatal, neonatal, infantile, juvenile
Discuss the characteristics of autosomal dominant polycystic kidney disease.
It is a bilateral disease, multiple cysts located in renal cortex and medulla. Cysts vary in size and may be asymmetrical. Doesn’t usually manifest until 4th or 5th decade (progressive). Approximately 50% of patients by age 60 will have end stage renal disease. Clinical symptoms: pain, hypertension, palpable mass, hematuria, headache, urinary tract infection, and renal insufficiency.
Usually a(n) _______________ renal contour is the first finding that a mass may be present and require further investigation.
abnormal
Define the characteristics of renal cell carcinoma.
The classic clinical presentation is nonspecific; however, patient may report hematuria, flank pain, and palpable mass. The tumor appears bilaterally, 0.1%-1.5% of patients. The incidence is increased in patients with von Hippel-Lindau and patients on long term dialysis. It is twice as common in females, usually in the 6th or 7th decade.
One of the most common benign renal tumors is called _______________.
adenoma
An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is _______________.
angiomyolipoma
A(n) _______________ appears as a well-defined echogenic mass, found more often in females.
lipoma
Sonographic findings include one or more fluid spaces at the _______________ junction that corresponds to the distribution of the renal pyramids.
corticomedullary
Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with unifrom loss of renal tissue in patients with _______________.
renal atrophy
The most common medical renal disease that produces acute renal failure is _______________.
acute tubular necrosis
Chronic renal disease is loss of renal _______________ as a result of disease, most commonly parenchymal disease.
function
There are three primary types of chronic renal failure: _______________, _______________, and _______________.
nephron, vascular, and interstital abnormalities
_______________ 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.
hydronephrosis
A localized hydronephrosis occurs as a result of _______________, calculi, _______________, or the _______________.
strictures, focal masses, duplex collecting system
Hydronephrosis with a dilated ureter and bladder indicates obstruction of the _______________ junction or of the _______________.
ureterovesical, posterior urethra
If hydronephrosis is suspected, the sonographer should evaluate the _______________.
bladder
Name two conditions that might mimic hydronephrosis.
peripelvic cysts, renal vessels in the peripelvic area, extrarenal pelvis
Describe the sonographic findings in acute obstruction.
The resistive index of the intrarenal vessles may be greater than 0.70 for 48-72 hours after obstruction. The RI returns to normal. No ureteral jet will be present on the affected side, or flow will be decreased if the obstruction is partial.
Ureteral jets are best visualized by _______________ imaging.
color Doppler
When pus is found within the obstructed renal system, the condition is called _______________.
pyonephrosis
_______________ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently can also be seen in the renal cortex.
nephrocalcinosis
A renal _______________ occurs when part of the tissue undergoes necrosis after the cessation of the blood supply, usually as a result of artery occlusion.
infarction
The major problem encountered with renal transplantation is _______________.
graft rejection
Early after surgery, a baseline sonographic examination is performed to determine _______________, _______________, and _______________.
renal size, calyceal pattern, external fluid collections
Perirenal fluid collections, such as _______________, _______________, _______________, or _______________ can be diagnosed reliably and differentiated from acute rejection.
hematoma, abscess, lymphocele, urinoma
_______________ rejection occurs within hours of transplantation and is caused by vasculitis leading to thrombosis and usually the loss of the graft.
hyperacute
_______________ rejection occurs within days to months after transplant.
acute
_______________ rejection causes include preformed antibodies, immune complexes, and cell-mediated responses.
immunologic
_______________ rejection can occur months after transplantation with gradual onset.
chronic
When using ultrasound to help diagnose rejection, care must be taken to visualize these five things:
the size/shape of kidneys; the appearance of the pyramids, cortex, and parenchma; and the presence of any surrounding fluid collections
The incidence of acute tubular necrosis is usually higher in _______________ transplants than in _______________ transplants.
cadaveric, doner-relative
Early signs of obstruction are _______________ or severe _______________ in a patient with satisfactory renal volumes.
anuria, oliguria
Renal artery stenosis exhibits a(n) _______________ jet with distal turbulence.
high-velocity
_______________ Doppler is not angle dependent and has a greater sensitivity to detect blood flow.
power
The initial clinical sign of a kidney stone is extreme _______________, typically followed by cramping on the side where the stone is locatd; nausea and vomiting may also occur.
pain
Renal stones have very ________________ foci with posterior acoustic shadowing.
echogenic
If the stone causes obstruction, there will be _______________ and, depending on the location of the stone, the ureter may be dilated _______________ to the level of obstruction.
hydronephrosis, superior
_______________ entails herniation of all layers of the bladder wall and is located in the posterior angle of the trigone.
Congenital diverticulum
_______________ diverticula are herniations of only the two inner layers through the muscle layer.
Acquired
_______________ is usually secondary to another condition that causes stasis of urine in the bladder.
cystitis
The majority of bladder tumors in adults are _______________ carcinoma.
transitional cell
A 75-year old male was experiencing right upper quadrant pain. An incidental finding was seen on the right kidney. What is this incidental finding?
It is most likely a right upper pole renal cyst.
What pathology is demonstrated on these longitudinal scans of both kidneys of a young adult male? Explain how the sonographer can be certain that the lesion is not hydronephrosis.
It is polycystic renal disease. Both images show enlarged kidneys, with cysts of various sizes. All cysts are distinct lesions and do not connect with the central renal sinus to indicate hydronephrosis.
A 6-year-old male presents with multiple urinary tract infections. What pathology do the images demonstrate?
medullary sponge kidneys
A 14-month-old child presents with a palpable right-sided mass, decreased appetite, and lethargy. What is the sonographic finding?
Wilms’ tumor
A 43-year-old female presented for an abdominal ultrasound examination. Name the abnormality that these images demonstrate.
angiomyolipoma
Does this patient have hydronephrosis? Explain why or why not.
No. The hyperechoic pyramids are consistent with nephrocalcinosis.
A young adult male presents with flank pain after renal transplant surgery. What are the sonographic findings?
Two fluid collections: one adjacent to the lower pole of the renal transplants and another within the anterior abdominal wall at the incision site.
A 54-year-old female presents with right flank pain. What does the sonogram demonstrate?
small stone in the renal sinus
Outer parenchyma of the kidney that contains the renal corpuscle and proximal and distal convoluted tubules of the nephron
Cortex
Outer parenchyma of the kidney that contains the renal corpuscle and proximal and distal convoluted tubules of the nephron
Cortex
