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Flashcards in Kidney Pathology Deck (68):
0

What is confused with the right renal artery?

the diaphragmatic crura

1

Where do the arcuate vessels lie?

at the base of the renal pyramids

2

What are Bertin's columns?

normal variant

columns are prominent invaginations of the cortex located at the varying depths within the medullary substance of the kidneys

with have the same echogenicity as the normal kidney...cortex comes way down through the pyramids

3

The dromedary hump is....

a cortical bulge that occurs on the lateral border of the kidney, typically more on the left. (like a camel hump)

in some patients it may be so prominent that it looks like a neoplasm

4

What is a junctional parenchymal defect?

a triangular echogenic area in the upper pole of the renal parenchyma that can be seen during normal sonographic scanning

remnant of fusion site

small chunk taken out of the kidney

5

What are lobulated appearances of the kidney?

norma variant

surface of the kidney is indented between the calyces giving the kidney a lobulated appearance

6

Is an extrarenal pelvis a normal variant?

yes

tends to be larger with long major calyces

7

What is the duplex collecting system?

normal variant

central renal sinus appears as two echogenic regions separated by a cleft of moderately echogenic tissue similar in appearance to the normal renal parenchyma

8

What is a horseshoe kidney?

most common fusion anomaly

(renal ectopia is another fusion anomaly)

fusion of the polar regions of the kidneys

rule out masses and prove its a horseshoe kidney

9

What is sinus lipomatosis?

a condition that is characterized by the deposition of a moderate amount of fat in the renal sinus

10

What is ageneis, dysgenesis and supernumerary?

Agenesis: absence or failure of formation

dysgenesis: defective embryonic development

supernumerary: exceeding the normal number

11

What is a solitary kidney?

rate and results from unilateral renal agenesis

look for a small nonfunctioning kidney before making a diagnosis of solitary kidney

renal enlargement occurs with solitary kidney

12

Where do you scan if you don't find the kidney in its normal position?

scan the retroperitoneum and pelvis

most true ectopic kidneys are located in the bony pelvis and may be malrotated

a pelvic kidney may simulate a solid adnexal mass

13

What is BUN related to?

renal failure

parenchymal disease

renal obstruction

dehydration

diabetes

14

What causes creatinine to rise?

renal failure

chronic nephritis

renal obstruction

diabetes

15

What are some reasons for renal imaging?

ABN lab values

abn urinalysis

pain

difficulty with uriation

repeat UTI

16

What is a simple renal cyst?

most common renal mass

typical cyst criteria

occurring in 50% of adults over 50

not significant unless they distort the calyces or produce pain or hydronephrosis

asymptomatic

17

What other kinds of renal cysts are they?

peripelvic

parapelvic

cortical

exophytic

milk of calcium

18

What is a peripelvic cyst?

small, multiple, bilateral

develop from lymphatic system

originate in renal sinus/pelvis

does not communicate with collecting system

19

What is a parapelvic cysty?

finish slide 12

in the renal hilum (may mimic hydronephrosis)

originate

20

What is a cortical cyst?

small cortical cysts may be difficult to differentiate with pyramid....but out in the cortex

21

What is an Exophtic cyst?

projected out away from the kidney

22

What is a milk of calcium cyst?

very rare

fluid level within the cyst

23

What diseases and syndromes presenting with cystic areas in the kidneys?

slide 19

24

What is Von Hipple-Linau?

finish slide 20

autosomal-dominant genetic presents in the second and third decade of life

tumors of the central nervous system and orbits

***retinal angioma

25

What is Tuberous sclerosis?

Genetic

multiple renal cysts

multiple angiomyolipomas

mental retardation

seizures/epilepsy

cutaneous/skin lesions

26

What is aquired cystic disease of dialysis?

increased incidence of cysts, adenoma, RENAL CARCINOMA

bleeding can cause flank pain

dialysis causes the cysts in the kidneys

27

What is polycystic disease?

infantile polycystic kidney disease (IPKD) or

autosomal *recessive* polycystic kidney disease (ARPKD) or Potter Type 1

Adult polycystic kidney disease (APKD) or Autosomal *Dominant* Plycystic kidney disease or Potter type III

28

What is congenital cystic disease?

Finish slide 24-25

ARPKD (infantile)

infants often die with complications of renal failure and hepatic disease

rare

problem with chro

29

What is ADPKD?

slides 28-29

finish

30

When you see poly cystic kidney what else do you look at?

liver and spleen

31

What is multicystic dysplastic kidney?

non hereditary

renal dysplasia - the tubules aren't working correctly (not really cysts)

unilaterally

**most common palpable mass and cystic disease in neonates***

may lead to infection, hypertension, hematuria, flank pain

more common than IPKD

32

What are the issues with multicystic dysplastic kidney

slide 40

33

What are medullary cystic disease and nephronophyhisis (NPH)

qutosomal recessive/dominant forms

salt wasting nephropahty

bilateral

34

What is medullary cystic disease?

finish slide 41

tubular atrophy

glomerular sclerosis

multiple small cysts

35

what are renal calcifications?

urolithiasis

nephrolithiasis

finish slide 42

36

What is urolithiasis?

combinations of chemicals in urine

kidney stones anywhere in the urinary tract

common

cause obstruction

severe back pain

37

What is nephrolithiasis?

Kidney stones WITHIN the kidney

harmonic imaging may enhance shadowing

compound imaging my hide shadowing

38

What is sonographic techniques of urolithiasis and nephrolithiasis?

color doppler - *twinkling artifact***

renal stones are echogenic with shadowing

may see ureter because of blockage...follow it to find the stone

39

What is a staghorn calculus?

large stones in the central portion of the kidney

Nephrolithiasis more common in men

40

How do you treat urolithiasis and nephrolithiasis?

extracoporeal shockwave lithotripsy

percutaneous nephrolithotomy

ureteroscopic stone removal

41

What is nephrocalcinosis?

accumulation of calcium within the rnal parenchyma

medullary or cortical

NOT A STONE, a calcium deposit

42

What is the sonographic findings of slide 51

finish

43

What is cortical

slide 52

finihs

44

What is medullary sponge kidney?

RARE

birth defect

benign

calcium stones

dysplastic dilatation of tubules

abnormal function because calcium in the tubules

be able to recognize from the picture

45

What are the malignant renal tumors?

renal cell carcinoma

transitional cell carcinoma

squamous cell carcinoma

lymphoma

metastases

Wilm's tumor

46

WHat is your first choice when you see a solid mass on a kidney?

malignant cancer

47

WHat is the most common renal tumor?

Renal Cell Carcinoma

48

What is renal cell carcinoma

most common renal tumor

twice as common in females as in males

sixth to seventh decade of life

clincal:

hematuria

flank pain

palpable mass

unexplained weight loss

better prognosis - can be removed

49

What is the staging system for RCC? (renal cell carcinoma)

Robson System

1. confined to kidney

2. spread to perinphric fat but within gerota

3. perinephric involvement with spread to RENAL VEIN and/or IVC

4. lymph node enlargement

5. venous and lymph

6. invasion of adjacent structures

50

If you see RCC where else do you check automatically?

IVC

51

What is the sonographic findings of renal cell carcinoma?

AKA: hypernephroma/adenocarcinoma

solid parenchymal mass

areas of hemorrhage and necrosis

erythrocytosis

leukocytoisis

"basket sign" with color doppler - demonstrates peripheral vascularity of the tumor

52

What is transitional cell carcinoma?

most common tumor of the COLLECTING SYSTEM

often multiple

higher in males

hypoechoic mass in the renal pelvis

***invasive***

***OBSTRUCTIVE****

53

What tumor causes pain secondary to obstruction?

transitional cell carcinoma

hematuria

54

What is renal lymphoma?

secondary to Non-hodgkins

finish slide 68

55

Where do kidney metastases come from?

most common lung and breast

56

What is Wilm's Tumor?

nephroblastomas

most common solid renal mass of childhood

associated with Bechwith-wiedemann

sporadic aniridia (no color in the eye)

omphalocele

57

Sonographic findings of Wilm's tumor

palpable abd mass

nausea vomiting

finish slide 71-72

58

What are the benign solid tumors?

angiomyolipoma

adenoma

lipoma

oncocytoma

nephroma

fibroma

59

Angiomyolipoma slide 77-78

finish

60

What is an Adenoma?

finish

benign renal tumor

tubular epithelial

incidental finding

well defined

calcifications

renal cortex


61

What is a lipoma?

fat cells

more often in females

asymptomatic

hematuria

well defined echogenic mass

connective tissue tumor

62

What is oncocytoma?

finish slide 81-82

63

What happens when you have a diffuse renal disease?

examine the renal parenchyma because the entire look of the kidney will change when there is disease.

inspect the edges - disease begins here...inferior, superior pole

64

What is inflammatory kidney diseases?

acute pyelonephritis

acute tubular necrosis

pyonephrosis

glomerulonphitis

fungal-candidiasis

abscesses

65

If you have an acute disease, how does the kidney appear?

typically acute disease will have a normal looking kidney

66

What is inflammatory cystic disease?

finish slide 87

inflammatory or necrotic

pain

hematruia

proteinuria

pyuria

white blood cells in urine

internal echoes

67

When you have a renal infection what do you lose?

loss of ability to distinguish the cortex from the medulla

(the corticomedullary junction)