Flashcards in Kidney Pathology Deck (68):
What is confused with the right renal artery?
the diaphragmatic crura
Where do the arcuate vessels lie?
at the base of the renal pyramids
What are Bertin's columns?
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
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
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
What are lobulated appearances of the kidney?
surface of the kidney is indented between the calyces giving the kidney a lobulated appearance
Is an extrarenal pelvis a normal variant?
tends to be larger with long major calyces
What is the duplex collecting system?
central renal sinus appears as two echogenic regions separated by a cleft of moderately echogenic tissue similar in appearance to the normal renal parenchyma
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
What is sinus lipomatosis?
a condition that is characterized by the deposition of a moderate amount of fat in the renal sinus
What is ageneis, dysgenesis and supernumerary?
Agenesis: absence or failure of formation
dysgenesis: defective embryonic development
supernumerary: exceeding the normal number
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
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
What is BUN related to?
What causes creatinine to rise?
What are some reasons for renal imaging?
ABN lab values
difficulty with uriation
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
What other kinds of renal cysts are they?
milk of calcium
What is a peripelvic cyst?
small, multiple, bilateral
develop from lymphatic system
originate in renal sinus/pelvis
does not communicate with collecting system
What is a parapelvic cysty?
finish slide 12
in the renal hilum (may mimic hydronephrosis)
What is a cortical cyst?
small cortical cysts may be difficult to differentiate with pyramid....but out in the cortex
What is an Exophtic cyst?
projected out away from the kidney
What is a milk of calcium cyst?
fluid level within the cyst
What diseases and syndromes presenting with cystic areas in the kidneys?
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
What is Tuberous sclerosis?
multiple renal cysts
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
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
What is congenital cystic disease?
Finish slide 24-25
infants often die with complications of renal failure and hepatic disease
problem with chro
What is ADPKD?
When you see poly cystic kidney what else do you look at?
liver and spleen
What is multicystic dysplastic kidney?
renal dysplasia - the tubules aren't working correctly (not really cysts)
**most common palpable mass and cystic disease in neonates***
may lead to infection, hypertension, hematuria, flank pain
more common than IPKD
What are the issues with multicystic dysplastic kidney
What are medullary cystic disease and nephronophyhisis (NPH)
qutosomal recessive/dominant forms
salt wasting nephropahty
What is medullary cystic disease?
finish slide 41
multiple small cysts
what are renal calcifications?
finish slide 42
What is urolithiasis?
combinations of chemicals in urine
kidney stones anywhere in the urinary tract
severe back pain
What is nephrolithiasis?
Kidney stones WITHIN the kidney
harmonic imaging may enhance shadowing
compound imaging my hide shadowing
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
What is a staghorn calculus?
large stones in the central portion of the kidney
Nephrolithiasis more common in men
How do you treat urolithiasis and nephrolithiasis?
extracoporeal shockwave lithotripsy
ureteroscopic stone removal
What is nephrocalcinosis?
accumulation of calcium within the rnal parenchyma
medullary or cortical
NOT A STONE, a calcium deposit
What is the sonographic findings of slide 51
What is cortical
What is medullary sponge kidney?
dysplastic dilatation of tubules
abnormal function because calcium in the tubules
be able to recognize from the picture
What are the malignant renal tumors?
renal cell carcinoma
transitional cell carcinoma
squamous cell carcinoma
WHat is your first choice when you see a solid mass on a kidney?
WHat is the most common renal tumor?
Renal Cell Carcinoma
What is renal cell carcinoma
most common renal tumor
twice as common in females as in males
sixth to seventh decade of life
unexplained weight loss
better prognosis - can be removed
What is the staging system for RCC? (renal cell carcinoma)
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
If you see RCC where else do you check automatically?
What is the sonographic findings of renal cell carcinoma?
solid parenchymal mass
areas of hemorrhage and necrosis
"basket sign" with color doppler - demonstrates peripheral vascularity of the tumor
What is transitional cell carcinoma?
most common tumor of the COLLECTING SYSTEM
higher in males
hypoechoic mass in the renal pelvis
What tumor causes pain secondary to obstruction?
transitional cell carcinoma
What is renal lymphoma?
secondary to Non-hodgkins
finish slide 68
Where do kidney metastases come from?
most common lung and breast
What is Wilm's Tumor?
most common solid renal mass of childhood
associated with Bechwith-wiedemann
sporadic aniridia (no color in the eye)
Sonographic findings of Wilm's tumor
palpable abd mass
finish slide 71-72
What are the benign solid tumors?
Angiomyolipoma slide 77-78
What is an Adenoma?
benign renal tumor
What is a lipoma?
more often in females
well defined echogenic mass
connective tissue tumor
What is oncocytoma?
finish slide 81-82
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
What is inflammatory kidney diseases?
acute tubular necrosis
If you have an acute disease, how does the kidney appear?
typically acute disease will have a normal looking kidney
What is inflammatory cystic disease?
finish slide 87
inflammatory or necrotic
white blood cells in urine