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Kidney > Pathology > Flashcards

Pathology Flashcards

1
Q

cysts of the kidney can be

A

solitary or multiple

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2
Q

complex cyst may contain

A

septations, thick walls, calcifications, internal echoes, and mural nodularity

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3
Q

complex cyst are considered

A

malignant until proven benign

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4
Q

with complex cysts internal echoes are often the result of

A

protein content, hemorrhage, and/or infection

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5
Q

any irregularity at the base of the cyst should be considered

A

a malignant growth

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6
Q

if septa is thicker than 1mm with vascularity on color or power Doppler, the lesion is

A

presumed malignant

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7
Q

parapelvic cyst are

A

small cysts

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8
Q

parapelvic cysts originate from

A

the renal sinus

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9
Q

parapelvic cysts do not communicate with

A

the collecting systems

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10
Q

what are the polycystic kidney disease

A
  • autosomal-recessive polycystic disease (ARPKD)
  • autosomal-dominant polycystic kidney disease (ADPKD)
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11
Q

infantile polycystic disease

A

autosomal-recessive polycystic disease (ARPKD)

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12
Q

rare polycystic kidney disease

A

autosomal-recessive polycystic disease (ARPKD)

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13
Q

common polycystic kidney disease

A

autosomal-dominant polycystic kidney disease

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14
Q

adult polycystic kidney disease

A

autosomal-dominant polycystic kidney disease

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15
Q

four kinds of autosomal-recessive polycystic disease (ARPKD)

A
  • perinatal
  • neonatal
  • infantile
  • juvenile
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16
Q

the type of diagnose of autosomal-recessive polycystic disease (ARPKD) depends on

A

patients age at the onset of clinical signs

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17
Q

perinatal form of autosomal-recessive polycystic disease (ARPKD) is found in

A

utero

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18
Q

autosomal-recessive polycystic disease (ARPKD) usually progresses to

A

renal failure, causing pulmonary hypoplasia and intrauterine demise

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19
Q

with autosomal-recessive polycystic disease (ARPKD) dilation of the renal collecting tubules causes

A

renal failure

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20
Q

what is the most common form of polycystic kidney disease

A

autosomal-dominant polycystic kidney disease (ADPKD)

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21
Q

when does autosomal-dominant polycystic kidney disease (ADPKD) usually clinically manifest

A

does not clinically manifest until the fourth or fifth decade when hypertension or hematuria develops

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22
Q

by age 60 years, patient with autosomal-dominant polycystic kidney disease (ADPKD) approximately

A

50% of patients have end-stage renal disease

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23
Q

sonographic findings of autosomal-dominant polycystic kidney disease (ADPKD)

A
  • bilateral disease
  • enlarged kidneys with multiple asymmetrical cyst vary in size and location in the renal cortex and medulla
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24
Q

clinical symptoms of autosomal-dominant polycystic kidney disease (ADPKD)

A
  • pain
  • hypertension
  • palpable mass
  • hematuria
  • headache
  • UTI
  • renal insufficiency
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25
Q

common non hereditary renal dysplasia (abnormal cells)

A

multicystic dysplasia kidney

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26
Q

most common form of cystic disease in neonates

A

multicystic dysplastic kidney

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27
Q

multicystic dysplastic kidney is thought to be caused by

A

early in-utero urinary tract obstruction

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28
Q

multicystic dysplastic kidney usually occurs

A

unilaterally, with poor function

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29
Q

when multicystic dysplastic kidney is bilateral involvement it is

A

incompatible with life

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30
Q

sonographic findings of multicystic dysplastic kidney disease in neonates and children

A

kidneys are multicystic, with the absence of the renal parenchyma and renal sinus

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31
Q

sonographic findings of multicystic dysplastic kidney disease in adults

A

kidneys may be small (atrophic and calcified) and echogenic

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32
Q

medullary sponge kidney occurs in

A

the medullary pyramids

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33
Q

medullary sponge kidney consists of

A

cystic or fusiform dilation of the distal collecting ducts (ducts of Bellini)

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34
Q

dilation from medullary sponge kidney causes

A

stasis of urine and stone formation

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35
Q

medullary sponge kidney is a

A

developmental anomaly

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36
Q

sonographic findings medullary sponge kidney

A
  • small echogenic kidneys
  • loss of corticomedullary differentiation
  • multiple medullary small cysts under 2 cm
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37
Q

what occurs with nephrocalcinosis

A

parenchymal calcification occurs

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38
Q

nephrocalcinosis affects

A

both kidneys

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39
Q

nephrocalcinosis

A

diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex

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40
Q

hydronephrosis

A

is distention (dilation) of the kidney with urine caused by backward pressure on the kidney when the flow of urine is obstructed

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41
Q

causes of hydronephrosis

A
  • bladder tumors
  • carcinoma of the cervix
  • calculi
  • neurogenic bladder
  • pelvic mass
  • prostatic enlargement
  • retroperitoneal fibrosis
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42
Q

hydronephrosis grades

A

1-4

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43
Q

hydronephrosis grade 1

A

small, fluid-filled separation of the renal pelvis

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44
Q

hydronephrosis grade 2

A

dilation of some but not all calyces; renal sinus orientation still concave

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45
Q

hydronephrosis grade 3

A

complete pelvocalictasis

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46
Q

hydronephrosis grade 4

A

prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma

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47
Q

hydronephrosis with a dilated ureter indicates obstruction of the UVJ junction is called

A

hydrouteronephrosis

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48
Q

when the renal collecting duct system is dilated what is scanned to located the obstruction

A

the ureters and bladder are scanned to locate the level of obstruction

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49
Q

a mildly distended collecting system can be caused by

A

overhydration, a normal variant of extrarenal pelvis, or by a previous urinary procedure

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50
Q

if hydronephrosis is suspected, the sonographer

A

should examine the bladder

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51
Q

what scanning technique is helpful in preventing the error of hydronephrosis

A

postvoid

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52
Q

at the level of obstruction from hydronephrosis, the sonographer

A

should sweep the transducer back and forth in two planes to see if the mass or stone can be distinguished

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53
Q

conditions that mimic hydronephrosis

A
  • extrarenal pelvis
  • parapelvic cysts
  • reflux
  • persistent diuresis (increased or excessive production of urine)
  • congenital megacalyces
  • papillary necrosis
  • renal artery aneurysm
  • arteriovenous malformation
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54
Q

arteriovenous malformation

A

an abnormal tangle of blood vessels where the arterial blood bypasses capillaries and reaches the veins

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55
Q

what is the most common kidney problem that occurs

A

kidney stones

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56
Q

kidney stones are more common in

A

men

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57
Q

where are majority of stones formed

A

in the kidney and course down the urinary tract

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58
Q

large stones that fill the renal collecting system is called

A

staghorn calculi

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59
Q

sonographic findings of urolithiasis

A
  • very echogenic foci with posterior acoustic shadowing in the renal collecting system
  • stones less than 3 mm may not shadow
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60
Q

clinical findings of urolithiasis

A

is extreme pain followed by cramping on one side. the pain may subside if the stone travels

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61
Q

treatment for urolithiasis

A
  • lithotripsy
  • nephrolithomy
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62
Q

if the stone causes obstruction

A

hydronephrosis will be noted

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63
Q

depending on the location of the stone

A

the ureter may become dilated superior to the level of obstruction

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64
Q

if a renal mass is solid

A

it must be considered malignant unless fat is present

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65
Q

calcifications in a renal mass are always

A

a sign of malignancy

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66
Q

if a cystic renal mass does not meet the sonographic criteria for a simple renal cyst

A

it must be considered malignant

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67
Q

sonographic evaluation of a malignant mass

A
  • wall thickness greater than 1mm
  • irregularity at the base of the cyst
  • septations evident
  • calcifications evident
  • vascularity present in the septa and/or cystic wall
68
Q

what is another name for renal cell carcinoma

A
  • hypernephroma
  • Grawitz tumor
69
Q

what is the most common of all malignant renal neoplasms

A

renal cell carcinoma

70
Q

renal cell carcinoma is twice as common

A

in men

71
Q

when does renal cell carcinoma develop

A

in the sixth or seventh decade of life

72
Q

clinical presentation of renal cell carcinoma is often

A

nonspecific

73
Q

patients with renal cell carcinoma may report

A

hematuria, flank pain, and palpable mass

74
Q

sonographic appearance of renal cell carcinoma

A

most RBCs are solid with no predilection for either right or left kidney or its location in the organ

75
Q

sonographic findings of renal cell carcinoma

A
  • most RBCs are isoechoic; they may appear hyperechoic
  • the larger the tumor, usually the more heterogenous its echotexture, which is caused by intertumoral hemorrhage and necrosis
  • tumors less then 3cm are usually hyperechoic; distinguishing them from echogenic fat-containing tumors similar to angiomyolipoma is difficult
76
Q

Transitional cell carcinoma accounts for

A

90% of malignancies that involve the renal pelvis, ureter, and bladder

77
Q

small transitional cell carcinomas ten to be

A

flat high-grade malignancy tumors

78
Q

transitional cell carcinoma spread

A

easily to the other tissues and organs

79
Q

patients with transitional cell carcinoma may have

A

gross or microscopic hematuria and flank pain

80
Q

sonographic findings of transitional cell carcinoma

A

hypoechoic mass in the collecting system, with low vascularity on color Doppler

81
Q

what is the most malignant bladder tumor in adults

A

transitional cell carcinoma in the bladder

82
Q

bladder tumors are not detected sonographically until they

A

become advanced

83
Q

clinical findings of transitional cell carcinoma in the bladder

A

gross or microscopic hematuria

84
Q

sonography transitional cell carcinoma in the bladder can not distinguish between

A

benign and malignant tumors

85
Q

what is recommended to detect small tumors in the bladder

A

cystoscopy and to obtain biopsy of the tissue

86
Q

tumors that are less than

A

3-4mm can not be seen sonographically

87
Q

sonographic findings of transitional cell carcinoma in the bladder

A
  • echogenic irregular mass in the bladder
  • may be along the bladder wall
  • most commonly located in the posterior wall of the bladder
  • may also be flat in appearance
  • single or multiple
88
Q

metastases of the kidneys is relatively

A

common

89
Q

what are the most common primary malignancies that metastasize to the kidneys

A
  • carcinoma of the lung
  • breast
  • renal cell carcinoma of the contralateral kidney
90
Q

sonographic findings of metastases to the kidneys

A
  • multiple
  • poorly marginated
  • hypoechoic masses are evident
91
Q

what is the most common abdominal malignancy

A

nephroblastoma

92
Q

what is the most common solid renal tumor in pediatric patients

A

nephroblastoma

93
Q

what is also know as

A

nephroblastoma

94
Q

nephroblastoma peak incidence is

A

2.5 to 3 years of age

95
Q

nephroblastoma is

A

2 to 8 times more common in patients with horseshoe kidneys

96
Q

clinical signs of nephroblastoma

A
  • abdominal flank mass
  • hematuria
  • fever
  • anorexia
97
Q

sonographic findings of nephroblastoma

A
  • determine whether the mass is cystic or solid and confirm that it is renal in origin
  • mass varies from hypoechoic to moderately echogenic
  • increased vascularity
98
Q

patients with benign renal tumors are usually

A

asymptomatic

99
Q

patients with benign renal tumors have flank pain if the mass is

A

large or if hemorrhaging from the mass has occurred

100
Q

types of benign renal tumors

A
  • angiomyolipoma
  • oncocytoma
  • lipoma
101
Q

what is the most common benign renal tumor

A

angiomyolipoma

102
Q

angiomyolipoma are composed of

A

fat, muscle, and blood vessels

103
Q

angiomyolipoma tumor size varies between

A

1 to 20cm

104
Q

sonographic findings of angiomyolipoma

A

hyperechoic lesion

105
Q

angiomyolipoma complications

A

intramural hemorrhage

106
Q

angiomyolipoma appears

A

as echogenic focal mass in the renal parenchyma

107
Q

what is a uncommon benign renal tumor

A

oncocytoma

108
Q

oncocytoma tumor size

A

varies but average size 6 cm

109
Q

patients with oncocytoma typically

A

asymptomatic

110
Q

oncocytoma may cause

A

pain and hematuria

111
Q

sonographic findings of oncocytoma

A
  • hypoechoic in more than 50% of cases
  • may have increase vascularity
  • “spoke-wheel” patterns of enhancement evident with a central scar
  • extremely difficult to differentiate from RCC
112
Q

oncocytoma has increased incidence in

A

middle-aged and older patients

113
Q

lipoma tumors consists of

A

fat cells

114
Q

lipoma are found more often

A

in women than in men

115
Q

patients with lipoma are typically

A

asymptomatic

116
Q

sonographic findings of lipoma is

A

well-defined echogenic mass within the kidney

117
Q

what 3 things do sonographers evaluate when scanning the kidneys

A
  • is the cortical thickness WNL?
  • can you see a difference between the cortex and the central renal sinus?
  • is the cortical echogenicity less echogenic (or more hypoechoic) than the liver
118
Q

4 processes that happen to the kidney with medical renal disease

A
  • increase in cortical echogenicity
  • cortical thinning
  • atrophy of the kidney
  • increase in size
119
Q

increase in cortical echogenicity

A

produces a generalized increase in cortical echoes, which are believed to be result of a deposition of collagen and fibrous tissue

120
Q

cortical thinning

A

causes a loss of normal anatomic detail, resulting in the inability to distinguish the cortex and medullary regions

121
Q

atrophy of the kidney

A

decrease in the size of the kidney

122
Q

acute renal failure

A

is a common medical condition caused by a variety of diseases or pathophysiologic mechanisms

123
Q

acute renal failure may occur

A
  • prerenal
  • renal
  • postrenal
124
Q

prerenal stage of acute renal failure is

A

secondary to the hypoperfusion of the kidney

125
Q

renal stages of acute renal failure may be caused by

A

parenchymal disease
(acute glomerulonephritis, acute interstitial nephritis, or acute tubular necrosis

126
Q

acute renal failure may also be caused by

A

renal vein thrombosis or renal artery occlusion

127
Q

postrenal failure usually result of

A

outflow obstruction

128
Q

postrenal failure usually

A

increased in patients with a malignancy of bladder, prostate, uterus, ovaries, or rectum

129
Q

causes of acute renal failure

A
  • prerenal
  • renal
  • postrenal
130
Q

prerenal acute renal failure

A
  • hypoperfusion
  • hypotension
  • congenital heart failure
131
Q

renal acute renal failure

A
  • infection
  • nephrotoxicity
  • renal artery occlusion
  • renal mass or cyst
132
Q

postrenal acute renal failure

A
  • lower urinary tract obstruction
  • retroperitoneal fibrosis
133
Q

sonographic findings of acute renal failure

A
  • enlarged
  • hypoechoic
134
Q

loss of renal function as a result of chronic renal disease such as

A
  • glomerulonephritis (infection of the kidneys)
  • chronic pyelonephritis (infection of the kidneys)
  • renal vascular disease
  • diabetes
135
Q

sonographic findings of chronic renal disease

A
  • small and echogenic
  • diffusely echogenic kidney with a loss of normal anatomy; is a nonspecific sonographic findings
  • if chronic renal disease is bilateral, small kidneys are identified
  • may be the result of hypertension, chronic inflammation (infection), or chronic ischemia
136
Q

what is the most common renal disease to produce acute renal failure

A

acute tubular necrosis

137
Q

acute tubular necrosis can be

A

reversible

138
Q

sonographic findings of acute tubular necrosis

A

bilaterally enlarged kidneys evident with hyperechoic pyramids, can revert to a normal appearance
- if it reverses, it is probably acute tubular necrosis

139
Q

renal atrophy

A

is when the kidney has shrunk to an abnormal size with abnormal function

140
Q

renal atrophy is a result of

A

numerous disease processes

141
Q

renal sinus lipomatosis occurs

A

secondary to renal atrophy

142
Q

pyonephrosis

A

occurs when pus is found within the collecting renal system

143
Q

sonographic findings of pyonephrosis include

A

the presence of low-level echoes with a fluid-debris level

144
Q

emphysematous pyelonephritis

A

occurs when air is in the parenchyma

145
Q

emphysematous pyelonephritis may cause

A

for an emergency nephrectomy

146
Q

xanthogranulomatous pyelonephritis

A

uncommon renal disease associated with chronic obstruction and infection

147
Q

emphysematous pyelonephritis and xanthogranulomatous pyelonephritis sonographically show

A

enlarged and hypoechoic kidneys

148
Q

renal artery stenosis results from

A

narrowing of the arteries that carry blood to the kidneys

149
Q

renal artery stenosis causes

A
  • high blood pressure
  • elevated protein levels in urine
  • decreased kidney function and swelling
150
Q

what is the most common correctable of renal artery stenosis

A

hypertension

151
Q

what are the most common caused of renal artery stenosis

A
  • atherosclerosis
  • fibromuscular dysplasia
152
Q

sonographic characteristics of renal artery stenosis

A
  • Absence of early
    systolic peak (ESP)
  • Systolic rise time: ΔT <
    0.1 sec
  • Peak systolic velocity
    (PSV): >160/180 cm/sec
  • Overall waveform
    shape: “tardus” and
    “parvus” waveform
  • Resistive index: RI = (S-
    D) ≥ 0.70 S
153
Q

renal infaraction

A

occurs when part of the tissue undergoes necrosis after the cessation of blood supply (usually arterial occlusion)

154
Q

sonographic findings of renal infarction

A
  • infarctions within the renal parenchyma appear as irregular areas, somewhat triangular, and along the periphery of the renal border
  • irregular area may be slightly more echogenic than renal parenchyma
  • renal contour may be somewhat “lumpy-bumpy”
155
Q

arteriovenous fistula

A

is the connection of a vein and an artery

156
Q

arteriovenous fistula and pseudoaneurysms are most often

A

acquired

157
Q

pseudoaneurysms may develop after

A

graft anastomosis, renal biopsy, or intratumoral hemorrhage

158
Q

cystitis

A

inflammation of the bladder has several infectious and noninfectious causes

159
Q

cystitis is usually

A

secondary to another condition that causes stasis of urine in the bladder

160
Q

sonographic findings of cystitis

A

the bladder wall may appear normal in the early stages of inflammatory. as duration of inflammation increases, the smooth bladder wall will become diffuse or focal with hypoechoic thickening

161
Q

as the inflammatory process progresses

A

the bladder will become fibrotic and scarred

162
Q

what is the majority of bladder tumors in adults

A

TCCs

163
Q

bladder tumors are usually not detected until

A

they have become advanced

164
Q

patients with bladder tumors typically have

A

gross hematuria, dysuria, urinary frequency, or urinary urgency

165
Q

sonographic findings of bladder tumors

A
  • appearance of bladder masses vary
  • usually an echogenic mass
166
Q

all primary bladder tumors have the same sonographic appearance

A

irregular echogenic mass that projects into the lumen (wall) of the bladder

Kidney (2 decks)

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