"nephron isn't a word" Flashcards
(258 cards)
1
Q
medical renal disease typically __ the echogenicity of the kidneys bilaterally
A
increases
- brightness of cortex corresponds to severity but does not correlate to cause
+/- prominent pyramids
2
Q
CHRONIC medical renal disease will typically cause size of kidneys to __
A
SHRINK
- end stage kds are small in size echogenic and often diff to find
3
Q
function of kidney to remove waste products, excessive fluid, produce hormones, and regulate body’s __
A
salt, potassium and acid content
4
Q
renal function to produce hormones ie -
A
stimulate RBC production
regulate blood sugar
control calcium metabolism
5
Q
lab tests for renal function
A
serum creatinine
BUN
eGFR
6
Q
serum creatinine __ when kidneys are not funcitoning properly
A
rises
**a waste product of muscle metabolism normally excreted in urine
7
Q
BUN aka
A
blood urea nitrogen
urea waste product from protein metabolism formed in liver
nitrogenous wastes products of protein metabolism
8
Q
BUN __ when kidneys are not functioning properly
A
rises
9
Q
eGFR aka
A
estimated glomerular function
- calculation to assess how well renal glomeruli are filtering blood
- based on serum creatinine and age, sex, race
10
Q
GFR <60 indicates
A
renal disease
11
Q
GFR >60 indicates
A
normal funciton
12
Q
GFR <15
A
renal failure
13
Q
normal amount of urine output per day
A
1-2 L
14
Q
AFR aka
A
acute renal failure
- develops over hours -weeks
15
Q
CKD aka
A
chronic kidney disease
- develops over weeks - months
16
Q
rapid decrease in renal function in previously stable chronic renal failure
A
acute on chronic renal failure
17
Q
broad categories of renal failure
A
pre renal
*hypoperfusion
renal
* medical renal disease
post renal
* bilat obstruction
18
Q
most common cause of acute renal failure
A
pre renal causes (not enough blood)
hypoperfusion
* shock
* dehydration
* hemorrhage
* heart failure
19
Q
second most common cause for acute renal failure
A
medical renal disease
- something wrong with parenchyma of kidney
20
Q
excessive nitrogenous products in blood
A
azotemia
increased BUN and serum creatinine
21
Q
urine in your blood showing clinical symptoms
A
uremia
22
Q
muscle weakness, cramping, cardiac arrhythmia, nausea/vomiting, shortness of breath
A
symptoms of azotemia
23
Q
broad term referring to renal disorders that are tx with medical rather than sx therapy
A
medical renal disease
primarily involves parenchyma of kidney
“nephropathy”
24
Q
common causes for nephropathy
A
acute tubular necrosis (ATN)
acute glomerulonephritis
**less common causes
acute cortical necrosis
amyloidosis
25
ATN aka
acute tubular necrosis
reversible if caught early because the tubules constantly regenerate
** common causes are toxic exposures or ischemic (hypotensive)
26
what is the most common cause for acute renal failure
ATN
27
agents for toxic ATN
drugs
- antibiotics
- antineoplastics
- anesthetics
chemicals
- carbon tetrachloride
-antifreeze (ethylene glycol)
pigments
- myoglobn (rhabdomyolysis)
- hemoglobin
xray contrast media
- "contrast nephropathy"
28
ESRD aka
end stage renal disease
29
unilateral small kidney; ddx??
vascular compromise
chronic infection
?is the other big ?hypertrophic compensation
**not medical renal disease
30
what is the most comon malignancy of the kidney
RCC
31
RCC loves __
to invade the renal vein and the IVC
32
RCC sono features
NO HYDRO
solid hypoechoic mass
+/- invasion of RV and IVC
33
TCC arises from __
urothelium
* kidney, ureter, bladder
frequently causes hydro
34
what is the most common benign tumour of the kidney
angiomyolipoma
35
sono features of angiomyolipoma
small, echogenic solid cortical mass
can be large, can hemorrhage
36
when multiple angiomyolipomata, what may this be associated with
tuberous sclerosis
37
which benign tumour causes excessive renin and can thus cause HTN
juxtaglomerular tumour
38
oncocytoma, adenoma and juxtaglomerular tumours are typically __
benign
**BUT STILL WORK THESE UP AS RRC CZ YOU CAN'T RELALY TELL THE DIFFERENCE SONOGRAPHICALLY
39
types of cystic tumours of the kidney
cystic RCC
multilocular cystic nephroma
40
ANGIOMYOLIPOMA AKA
RENAL HEMARTOMA
41
what is the angiomyolipoma made of
vessels
smooth muscle
fat
42
features of angiomyolipoma
usually solitary and unilateral
echogenic
in cortex, well defined
if small, typically asymptomatic
avascular
usually homogeneous
43
more common demographic for angiomyolipomata
female
44
renal hemartomas will demonstrate radio__ in CT
radioluscency
made up of fat so will come out DARK
45
atypical angiomyolipomas
ie exophytic
work up as possible RRC
46
CT cyst classification system aka
Bosniak rating (1-4)
47
renal adenoma vs. RCC
appear identical with u/s
typically <3cm
iso/hypo echoic solid parenchymal mass
** consider malignant until proven otherwise
48
which renal tumour is known for demonstrating a central stellate scar
oncocytoma
49
juxtaglomerular tumour aka
reninoma
produces renin
uncommon cause of primary HTN
50
sono features of reninoma
cortical lesion
<3cm
strongly echogenic
* ddx AML
51
malignant renal tumours
renal cell carcinoma
transitional cell carcinoma
renal lymphoma
nephroblatoma
52
RCC aka
renal cell carcinoma
hypernephroma
Grawitz tumour
renal cell adneocarcionoma
53
RCC demographic
more common in males
50-70 y
54
associated risks for RCC
smoking
ADPKD
acquired cystic kidney disease in end-stage ('cysts of dialysis')
con HIppel-Lindau disease
tuberous sclerosis
55
the "too late" triad of RCC clinical symptoms
hematuria (gross or micro)
flank pain
palpable mass
56
clinical symptoms for RCC
many asymptomatic; incidental
hematuria
flank pain
palpable mass
low grade fever
HTN
anorexia, fatigue, weight loss
57
sono appearance of RCC
solid, bulky parenchymal mass
variable echogenicity, usually iso/hypo
tend to invade renal vein
*check IVC
+/- punctate calc
+/- mets
HYDRO UNCOMMON
58
what features are indicative for malignancy regarding RCC
size
evidence of venous thrombus
evidence of metastatic adenopathy
evidence of liver mets
high velocity, low resistance Doppler
59
urothelial tumour of the renal pelvis
TCC
60
frequent complication of renal TCC
obstructive uropathy
*increased risk with smoking, exposure to certain chemicals like printing dyes
61
sono features and pitfalls for renal TCC
variable appearance
- hypoechoic solid mass in SINUS
HYDRO is common
pitfalls - clot; fungus ball
** check there is vascularity
62
Wilms tumour aka
nephroblastoma
63
tumour from metanephrogenic blastema cells; most common renal neoplasm in children
nephroblastoma
64
ddx of nephroblastoma
neuroblastoma (adrenal)
65
increased incidence of nephroblastoma in children with __ syndrome
Beckwith-Wiedemann syndrome
66
what type of spread causes metastases to kidneys
hematogenous spread
67
cancer of the lymphocytes
lymphone
Hodgkin and non-Hodgkin
68
what is the preferred technique for dx of lymphoma
CT
69
which type of lymphoma is the most concerning
non Hodgkin
70
Reed-Sternberg cells aka
B cells
* type of WBC
71
malignant mature B cells typically arizing in nodes of the neck, axilla and chest - typically occurring in young adults
Hodgkin lymphoma
72
cancer of B and T cells, can arise in lymph nodes or organs, more common in older people
non Hodgkin
73
enlarged PAINLESS nodes, fever/chills, unexplained weight loss, NIGHT SWEATS, lack of energy, pruritus
lymphoma symptoms
74
renal lymphoma usually associated with systemic __ lymphoma
non Hodgkin
*occasionally localized to kidneys
75
what are the sono appearances of renal lymphoma
focal pattern
* hypo, anechoic solid masses
diffuse pattern
* disruption of architecture, reniform shape
perirenal involvement
* hypo perirenal mass; perirenal "rind"
76
which renal condition can create a "rind" around the kidney
renal lymphoma with perirenal involvement
77
multilocular cystic nephroma aka
cystic RCC
encapsulared, multilocular cystic lesion
benign neoplasm
78
common demographic for cystic RCC
young males
older females
79
sono features of cystic RCC
complex cystic mass
unable to differentiate from malignant RCC
80
common pitfall for renal tumours
junctional parenchyma/ hypertrophied column of Bertin
** won't alter contour
81
demographic for MCDK
obstetrics and pediatrics
non genetic congenital cystic kidney disease
little to no parenchyma
82
bilat enlarged kidneys with multiple cysts; with cysts in other organs
ADPKD
'adult' PKD
83
bilat enlarged echogenic kidneys in utero and pediatrics
ARPKD
84
cysts of dialysis aka
ACKD
acquired cystic kidney disease
**look for RCC
85
hydatic cysts aka
cysts within cysts
daughter cysts
water lily sign
86
multilocular cystic nephroma aka
cystic tumour
** younger males, older females
87
calyceal diverticula aka
milk of calcium cysts
88
cystic dilatation of the renal tubules within the pyramids; congenital disorder
medullary spone kidney
89
medullary sponge kidneys are prone to __
nephrocalcinosis and stones
90
cystic lesion with hx of trauma or intervention
think vascular complications
ie pseudoaneurysm
91
where do parapelvic cysts originate
renal sinus
92
what type of fluid is in a parapelvic cyst
lymphatic
93
sanguinous
bloody
94
t/f parapelvic cysts are usually bilateral
true
95
which plane of section may best help differentiate multiple marapelvic cysts from hydronephrosis
coronal
**want to demonstrate no communication
96
parapelvic cysts are __ cysts
lymphatic
97
parapelvic cysts have potential to cause __
HTN
hematuria
hydro
98
ACKD aka
acquired cystic kidney disease
'cysts of dialysis'
uremic renal cystic disease
99
what kidney disease is seen in end stage kidneys; 90% of patients on dialysis for 5+ years
ACKD
100
ACKD increases risk for __
RCC 35x
101
associated with cerebral 'berry' aneurysms
ADPKD
102
renal hydatid cyst aka
Echinococcus granulosus
(tiny tape worm)
103
dominant inheritance = what percentage of occurrance in offspring
50%
104
recessive inheritance = what percentage of occurrance in offspring
25%
105
congenital disease causing microscopic cysts in renal tubules
ARPKD
106
all genetic renal disorders are demonstrated __
bilaterally
107
t/f MCDK is a genetic disorder
f
often unilateral
108
t/f MCDK is often identified incidentally in a >OBS exam
t
109
small, malformed kidney with multiple cysts and little to no parenchyma demonstrated
MCDK
110
MCDK often associated with contralateral __
UPJ obstruction
111
etiology of MCDK
embryonic urinary tract obstruction
112
which renal cystic disease is most likely to cause oligohydramnios
ARPKD
113
which renal cystic diseases are genetic
ADPKD
ARPKD
**MCDK is non genetic, congenital
114
which renal cystic disease are you least likely to see cysts
ARPKD (microscopic)
115
which renal cystic disease is patient likely to be the oldest
ACKD (cysts of dialysis)
116
what maneuver can you perform to differentiate a MOC from other renal cystic lesions
changing pt position
117
MOC are frequently the site of __
recurrent infection
(static outpouching in collecting system)
118
congenital defect in formation of medullary tubules (not thought to be genetic) - causing dilatation of distal collecting ducts hear the papillae resulting in cysts
medullary sponce kidney
** cysts often contain calcium
119
sono features of medullary sponge kidney
calcium in medulla
***medullary nephrocalcinosis
calculi
medullary cysts often too small to be seen w/ u/s
rarely symptomatic until adulthood (infection, calculi, hematuria)
120
echogenic pyramids dx
medullary nephrocalcinosis
** could be medullary sponge kidney but cannot tell what the etiology was so move on with your life
121
hydatid cysts in the kidney look similar to __
hydatid cysts in the liver
122
uncommon types of acute pyelonephritis
xanthogranulomatous
emphysematous
focal
abscessed/ cabuncle
123
__ is associated with staghorn calculi
xanthogranulomatous pyelonephritis
124
which form of acute pyelonephritis is often seen with diabetics
emphysematous pyelonephritis
125
infected collecting system **hx is key
pyonephrosis
126
chronic granulomatous calcification
renal tuberculosis
127
candida or pneumocystitis affects which demographic
fungal infection in kidney
immunocompromised pt
128
clinical picture of renal infection
**broad spectrum depending on cause, chronicity etc.
lower back and abd pain
chills, fever
dysuria, frequency, urgency
hematuria
129
inflammation of the kidney and renal pelvis - most commonly an ascending bacterial infection from GI tract organism
pyelonephritis
130
high risk groups for renal infection
pregnant
congenital anomaly
calculus disease
hydronephrosis
neurogenic bladder
diabetics
immuno-suppressed
131
acute pyelonephritis most frequently __lateral
unilateral
132
sono features of acute pyelonephritis
diffuse nephromegaly
increased or decreased parenchymal echogenicity
+/- evidence of stones/hydro
+/- urothelial thickening
+/- perinephric fluid
*******assess for tenderness
133
focal pyelonephritis aka
focal lobar nephronia
134
focal, acute inflammatory mas in the renal parenchyma without drainable puss (essentially a phlegmon) - may regress with antibiotics or become an abscess
focal pyelonephritis
*depending on degree of liquification, may have enhancement
135
typically occurs in patients with hydronephrosis secondary to staghorn calculi
xanthogranulomatous pyelonephritis
**may be diffuse or segmental
136
typicaly pt is middle aged, obese diabetic female is staghorn calc, recurrent fever and flank pain unresponsive to antibiotics
xanthogranulomatous pyelonephritis
137
commonly occurs in chronic diabetes patients, usually VERY ill, F>M but no specific clinical features
emphysematous pyelonephritis
**gas-forming infection
138
chronic pyelonephritis aka
chronic atrophic pyelonephritis
**mostly in children with reflux (VUR)
139
if bilateral, chronic pyelonephritis may cause __
renal failure
++ cortical scarring
140
sono features of chronic pyelonephritis
increased echogenicity
irregularity of contour
141
tx for pyonephrosis
percutaneous nephrostomy
needs to be drained
* purulent exudate becomes walled off and protected from body's natural immune system (and antibiotics)
142
obstructive uropathy (hydro) with superimposed infection
pyonephrosis
143
sono features of pyonephrosis
hydro +/- internal echoes or fluid-filled levels
** check history and pain; could be fungal
144
kidney upper pole is located __
medial and posterior
145
RK is slightly __ than LK due to the liver
lower
psoas pulls it lower down
2-4cm displacement
146
lower pole of kidneys __ and slightly __ due to proximity to psoas muscle
anterior and slightly lateral
147
__ space contains pancreas, parts of colon, part of duodenum, pararenal fat and crosses ML
anterior pararenal space
148
__ space contains kidney, ureter, renal vessels, adrenals, and perinephric fat. does not cross midline
perirenal space
aka perinephric
149
__ space posterior to the kidneys. contains +/- fat
posterior pararenal space
150
kidney is surrounded by __
renal fascia; surrounds perirenal fat
aka Gerota's fascia
** not the renal capsule
151
what is contained within the renal sinus
collapsed collecting system (minor, major calyces and renal pelvis)
segmental vessels
sinus fat
lymphatics and nerves
152
renal pelvis vs. sinus
pelvis is part of the collecting system
sinus is the cavity
pelvis is INSIDE the sinus
153
kidney formed from __ renal lobes called __
12
renunculi
154
each renunculus consists of __
one pyramid surrounding cortical substance
155
what is the functional unit of the kd
nephron
156
list the units of the nephron in order of beginning to end
glomerulus
Bowman's capsule
proximal convoluted tubule
loop of Henle
distal convoluted tubule
collecting duct
157
__ vessels rest within the corticomedullary junction
arcuate vessels
158
pyramids contain the loops of __, collecting tubules, and __
loops of Henle
Papillae
159
renal columns aka
columns of Berlin
medullary extensions of renal cortex
160
renal columns contain __ vessels
interlobar
161
renal pyramid contains __
papilla (apex)
162
major calyces aka
infundibula
2-3
in collecting system (sinus)
163
how many minor calyces
12
they cup the apex//papilla of the renal pyramids
164
anterior to posterior, that is the order of the RA, RV, and ureter
RV -> RA -> ureter
ov > ureter > IA > IV
165
the point where the renal pelvis becomes the proximal ureter
ureteropelvic junction
UPJ
166
common sites for stone obstruction in GU tract
UPJ
pelvic brim
UVJ
167
muscle that runs directly posterior to kidney
quadratus lumborum
168
the flexure where the transverse and descending colon bend
colic flexure/ splenic flexure
169
muscle that is posterior and medial to the kidney
psoas major
"tenderloin"
170
arterial supply in the kidney
main renal artery
segmental arteries (5)
- in sinus
interlobar arteries
- up columns
arcuate arteries
- over base of pyramids
interlobular arteries
- in cortex
afferent and efferent arterioles
171
venous supply of kidney
main renal vein
- anterior to artery
(lobar) segmental vein
- only lobar veins anastomose
interlobar vein
- up columns
arcuate veins
interlobular veins
172
multiple renal vessels are __
common
173
most common variant of renal artery
antecaval RIGHT renal artery
usually an accessory RRA
associated with anterior malrotation of lower pole
174
most common variant of renal veins
antecaval right renal artery
circumaortic left renal vein
175
most common renal vein variant
circumaortic LEFT renal vein
176
renal arterial blood flow is __ resistance with __ diastolic flow
low resistance
good disatole
177
good renal venous flow is __ velocity and __phasic
low velocity and monophasic
178
where should you sample a pulsed waveform of a kidney and what is a healthy RI
use the segmental or interlobal vessels
RI of arterial vessels should be around 0.7
179
resistive index aka
Pourcelot index
RI = (A-B) / A
180
no diastolic flow will give an RI =
1.0
181
what is the acceptable discrepancy in length between two kidneys
<1.5 cm
182
normal range of kidney volume
100-180 cm^3
(using prolate ellipsoid formula)
183
fetal renunculus (lobule) fusion anomaly leaving fat between
junctional fat defect between pyramids
tiangular, echogenic appearance
peripheral, often communicates with sinus fat
184
junctional fat defect vs. cortical scar
fat defect: between pyramids; may have fat line
* no hx of trauma
cortical scar: more likely at base of pyramid; no fat line
* +/- hx of trauma
185
cortical thinning due to chronic pyelonephritis aka
pyelonephritic scar
186
which vessels. course through hypertrophied columnar variant
interlobar
187
the unresorbed polar parenchyma of 1 or both subkidneys that fuse to form a normal kidney
junctional parenchyma
* due to incomplete fusion of 2 subkidneys
188
what are the types of junctional parenchyma variant
superior JP and inferior JP
** angle of indentation
189
abnormal location of renal lobe, indenting the sinus
lobar dysmorphism
* contains cortex and pyramids
normal vasculature
190
persistent fetal lobulations often mistaken for __
cortical scarring
** persistent fetal lobulations usually bilat
191
additional pelvis vs. extrarenal pelvis
extrarenal is presence of renal pelvis outside the confines of the hilum
additional pelvis suggests two collecting systems (ie duplex, incomplete fusion)
192
which adjective best describes tuberculosis?
- malignant
- auto immune
- genetic
- granulomatous
granulomatous
193
how might we distinguish perirenal fat from a perirenal fluid collection?
hx
check other kidney
194
a form of extra-pulmonary TB more common in immunocompromised patients; hematogeneous spread
renal tuberculosis
likely bilat but only visible macroscopically in one
195
sono features of renal TB
acute -> normal
chronic -> calcs, focal masses, strictures of collecting system, "putty kidney" (calcific autonephrectomy)
will likely see compensatory hypertrophy to less affected kidney
196
renal fungal infection most commonly due to __ in patients with systemic infection
candida
197
demographic for renal fungal infection
immunocompromised
usually in-patients
non specific clinical findings
198
sono features renal fungus balls
echodense, non shadowing mass in dilated collecting sys
ddx tumour, blood clot, pyogenic debris
199
opportunistic infection of the kidneys
renal pneumocystis
**pt with AIDS common
200
sono features of pneumocystic infection
multiple small punctate calcifications
+/- shadows
201
which component of the waveform provides information about downstream resistance?
diastole
*where the flow is going; deeper into organ
202
RI, PI, and S/D ratios __ numerically as downstream resistance increases
increase
203
forumla for RI
(PSV-EDV) / PSV
204
formula for PI
(max-min) / mean
205
formula for S/D ratio
PS / ED
206
lab findings for acute renal failure, pain, hematuria, and fever
acute renal vein thrombosis
207
pulmonary emboli, HTN
chronic renal vein thrombosis
208
acute renal vein thrombosis is usually a complication in ___ patient
an already sick patient
209
nephrotic syndrome aka
collection of symptoms that can damage kidney
- proteinuria
- low levels albumin in blood
- increased platelets
210
sono features of acute renal vein thrombosis
swollen, hypoechoic
distended vein from thrombus
211
what change would be expected in renal arterial waveform when vein has thrombus
very high resistance rather than the usual low
pandiastolic flow reversal
212
chronic renal vein thrombosis usually found in __ patient
incidentally in patient
**find unilateral small, atrophic kidney
213
RAS aka
renal artery stenosis
214
causes for RAS
atherosclerosis (70%)
fibromuscular dysplasia (30%)
215
hyperplasia of vessel media causing 'string of beads' appearance
fibromuscular dysplasia
most common in young adult females
216
high blood pressure due to renal artery stenosis
renovascular hypertension
treatable
140/90 mmHg
217
diagnostic tests for RAS
captopril test
digital subtraction renal angiography
renal ateriography and systemic renin test
magnetic renal angiogrpahy
Doppler ultrasound
218
tx for RAS
percutaneous transluminal balloon angioplasty
sx -> renal endarterectomy; aorto-renal bypass graft
219
RAR aka
renal-aortic ratio
* compare velocity in stenosis to velocity proximal to stenosis (at Ao)
look for "step up" in velocity
(PSV in stenosis / PSV in Ao)
= renal / Ao
>60% stenosis with 3.5:1
220
waveform within kidney with RAS
tardus parvus
221
chronic vascular insult aka
chronic RAS
chronic venous thrombosis
**small echogenic kidney, unilateral with opposing kidney demonstrating compensatory hypertrophy
222
chronic renal insult will cause renal __ and a decrease in renal size
renal infarction
* check perfusion with power Doppler
223
allograft vs isograft
same species used for graft
allo = different DNA
iso = same DNA
224
preferred placement of renal transplant
contralateral iliac fossa; extraperitoneal
ideally RIGHT iliac fossa (no sigmoid to move)
anastomoses attached to external iliac vessels
225
ureter attachment with renal transplant
oblique implantation direct anastomosis to bladder (mucosa to mucosa) to prevent reflux
ureter kept as short as possible to reduce risk of ischemia
stent often inserted at time of sx
226
what happens to the non functioning kidney that a pt is receiving a transplant to replace
unless it is infected, chronic reflux or large polycystic --
non functioning kidney left in situ
227
sono technique for scanning renal transplant
greyscale and doppler
high freq 7MHz transducer ideal
- convex array
+/- standoff pad
+/- EFOV
228
clinical signs of transplant pathology
increased BUN
increased serum creatinine
** azotemia
oligouria
hematuria, proteinuria
HTN
pain
fever
malaise
palpable mass
*** look for any rapid change in size - should look like a normal kidney
229
abnormal sono findings for renal transplant
rapid enlargement (check volume)
hypo or hyperechoic cortex
prominent large pyramids
decrease in sinus echogenicity
+/- urothelial thickening
hydro?? look for level and cause
RI >0.75
fluid collections
** hematoma right away; abscess wouldnt form for 2 w and lymphocele 2-6w
** may cause venous compression
230
complications related to pressure effects of renal transplant fluid collections
leg swelling
*compression of iliac vein
hydronephrosis
* compression of graft ureter
renal ischemia or infarction
* compression of renal vessels
231
"lymphoceles are most __ and the __ "
lymphoceles are the most LIKELY and the LATEST
accumulation of lymphatic fluid
* take several weeks to form (2-6)
usually medial and inferior
often septates
usually asymptomatic but can obstruct ureter if large
232
important question to answer regarding hematomas and renal transplants
is it subcapsular or perinephric
233
how do you tell the difference between urinoma and lymphocele
FNA
234
clinical signs of transplant rejection & types
immune system response
* proliferation of antibodies, WBC, macrophages
types:
hyperacute (immediate, severe(
acute (common) ( days, weeks)
chronic (months, years)
235
sono signs of kidney transplant rejection
enlarged kidney
prominent big pyramids
loss of echogenicity to sinus fat
thickening of lining of collecting sys
increases RI and PI in intrarenal vessels
**** findings non specific and need biopsy to make dx
236
common cause for transplant failure (acute renal failure)
acute tubular necrosis (ATN)
due to post surgical hypotensive state
237
renal ATN is an __ process
ischemic
usually transient
if uncomplicated, is reversible
238
sono findings for transplant ATN
often normal
increased cortical echogenicity
mild nephromegaly
+/- increased RI and PI
** need biopsy for dx
239
4 key assessments for renal transplant doppler
at arterial anastamosis
?stenosis
renal vein
?thrombus
overall perfusion
?infarcts
intrarenal arteries
?tardus parvus ?infarcts
240
normal external iliac artery waveform
very high resistance
flowing to resting leg muscles
compare PSV to RA; should be similar at site of anastamosis in transplant
** ensure correct angle
241
what is the most common site for a renal artery stenosis
site of transplant anastamosis
242
criteria for RAS
PSV > 1.8m/s
>2:1 step up in PSV from RA:EIA
RI >0.75
243
pandiastolic flow reversal in the intrarenal veins suggests __
renal vein thrombosis
OR pseudoaneurysm neck (check with biopsy)
244
tardus parvus flow in the intrarenal arteries suggests __
proximal arterial stenosis
245
what complications do we look for post biopsy of a kidney
hematoma
pseudoaneurysm
AV fistula
246
doppler signs for AVF in kidney
high velocity, very low resistance
RI <0.45
aliasing
247
hematoma as a result of a leaking hole in an artery; forming outside the arterial wall and contained within tissues
pseudoaneurysm
** it must continue to communicate with the artery to be considered a pseudoaneurysm
** yinyang sign (turbulent mess)
248
immunosuppressed patients are at increased risk for both infection and some cancers (lymphoma) - look for enlarged LN and solid masses in or around transplant to r/o ___
post transplant lymphoproliferative disorder
** complication of both solid organ and allogenic bone marrow transplant
249
in most cases of post transplant lymphoproliferative disorder, the associated virus is __ infection of the B cells
Epstein-Barr virus
250
transplant of 2 pediatric kidneys into an adult
En Bloc transplant
also transplant section of aorta and IVC
** kidneys will hypertrophy over time and grow to be normal size
251
bilateral increased deposition of renal sinus fat
renal sinus lipomatosis
more common with age
M>F
* mild cortical thinning; normal sized kidney
252
rounded, triangular cystic spaces in medulla at the edge of pyramids
can be papillary necrosis
pulsating specular echoes from arcuate vessels at the base of the hypoechoic spaces help distinguish from hydronephrosis
can slough off and cause obstruction
253
peeing protein problem
nephrotic syndrome
proteinuria (primary albuminuria)
hypoalbuminuria
generalized edema
hyperlipidemia
lipiduria
**** hx matters
254
renal manifestation of DM
diabetic nephropathy
255
diabetic nephropathy aka
glomerulosclerosis
1. decreased GFR
2. azotemia (increased BUN and creatinine)
u/s findings = medical renal disease
* hx is important
256
atherosclerosis vs. Monckeberg sclerosis vs. diabetic atherosclerosis
atherosclerosis = build up of plaque in intima
Monckeberg = calcification of media (uterus)
diabetic athero = protein buildup in intima
257
accelerated atherosclerosis associated with diabetic nephropathy
diabetic atherosclerosis
protein buildup in the intima because of DM
can calcify, causing narrowing of the lumen
** u/s appears like linear calc but in area of artery
** segmental, interlobar, arcuate
258
common complications of renal biopsy
hematuria
hematoma
* less complications in children
less common: urinoma, infection, acquired AVF, pseudoaneurysm
