Radiology and Kidney Disease

Question 1

Using the labels below label all the aspects of the glomerulus:

• efferent arteriole
• afferent arteriole
• podocyte
• endothelial cell
• bowmans capsule
• mesangial cell
• glomerular basement membrane
• glomerular capillary
• bowmans space

Answer 1

1 - afferent arteriole (A for add to glomerulus)
2 - podocyte
3 - bowmans capsule
4 - bowmans space (urine)
5 - efferent arteriole (E for empty glomerulus)
6 - mesangial cell
7 - glomerular capillary
8 - endothelial cell
9 - glomerular basement membrane

Question 2

Label the key parts of the nephron tubules using the labels below:

• look of henle
• distal convoluted tubules
• proximal convoluted tubules
• collecting duct

Answer 2

1 - look of henle
2 - proximal convoluted tubules
3 - distal convoluted tubules
4 - collecting duct

Question 3

What is nephrotic syndrome?

1 - damage to tubules of kidneys
2 - immune complex formation in capillaries of glomerulus (type III hypersensitivity) causing immune and inflammatory response
3 - damage to filtration of glomerulus, leading to loss of glomerulus content
4 - inflammation of the of arterioles

Answer 3

3 - damage to filtration of glomerulus, leading to loss of glomerulus content

• can be podocytes, basement membrane affected
• primarily leads to high proteins leaking out

Question 4

Nephrotic syndrome is when there is damage to the filtration of the glomerulus (podocytes, basement membrane), meaning things that shouldn’t be able to enter the urine do, such as proteins. Which of the following is NOT a symptom/measure associated with Nephrotic syndrome?

1 - high protein content in urine >3.5g/day (albumin drops)
2 - hematuria (blood in the urine)
3 - frothy urine
3 - systemic oedema
5 - hyperlipidaemia
6 - low anti-thrombin III (increased risk of DVT)

Answer 4

2 - hematuria (blood in the urine)

Question 5

What is nephritic syndrome?

1 - damage to tubules of kidneys
2 - immune complex formation in capillaries of glomerulus (type III hypersensitivity) causing immune and inflammatory response
3 - damage to filtration of glomerulus, leading to loss of glomerulus content
4 - inflammation of the of arterioles

Answer 5

2 - immune complex formation in capillaries of glomerulus (type III hypersensitivity) causing immune and inflammatory response

Question 6

Nephritic syndrome is when there is an immune response and inflammation of capillaries and endothelium of the glomerulus, which can be due to immune complex formation in capillaries of glomerulus (type III hypersensitivity) that affects filtration. Which of the following is NOT a symptom/clinical marker of Nephritic syndrome?

1 - haematuria
2 - pyuria (WBC in urine)
3 - granular casts (RBCs)
4 - systemic oedema
5 - sediment in the urine
6 - oliguria (low urine output)
7 - high blood pressure

Answer 6

4 - systemic oedema

• can see high protein, but not to same levels as nephrotic

Question 7

Which of the following is NOT typically causes of renal disease?

1 - diabetes
2 - hypertension
3 - drug toxicity (NSAIDs, heroin)
4 - malignancy
5 - osteoarthritis
6 - recent infections (streptococcal)

Answer 7

5 - osteoarthritis

Question 8

What is the normal filtration rate of protein per day in the kidneys?

1 - 1.5mg
2 - 15mg
3 - 150mg
4 - 1500mg

Answer 8

3 - 150mg

Question 9

A primary cause of nephrotic syndrome is Minimal Change Glomerulonephritis (also called minimal change disease). What does this mean?

1 - very little damage to glomerulus
2 - damage to whole of glomerulus with no symptoms
3 - damaged glomeruli can only be seen under a very powerful microscope
4 - damaged glomeruli at capillary/endothelium level.

Answer 9

3 - damaged glomeruli can only be seen under a very powerful microscope

• can be due to podocyte damage from T cells and cytokine release

Question 10

A primary cause of nephrotic syndrome is Minimal Change Glomerulonephritis (also called minimal change disease). This is when there is damage to the glomeruli that can only be seen under a very powerful microscope. Is this more common in adults of children?

Answer 10

• children
• generally idiopathic in nature, but has been linked to Hodgkins lymphoma

Question 11

A primary cause of nephrotic syndrome is Membranous Glomerulonephritis. What does this mean?

1 - very little damage to glomerulus
2 - damage to whole of glomerulus with no symptoms
3 - damaged glomeruli can only be seen under a very powerful microscope
4 - damaged to basement membrane of glomeruli

Answer 11

4 - damaged to basement membrane of glomeruli

• has been linked with hypersensitivity type III and activation of the complement pathway
• leads to leaking of glomeruli and thickening of the basement membrane

Question 12

Nephritic syndrome is when there is an immune response and inflammation of capillaries and endothelium of the glomerulus, which can be due to immune complex formation in capillaries of glomerulus (type III hypersensitivity) that affects filtration. What is the leading primary cause of this?

1 - drugs (NSAIDs, heroin)
2 - hypertension
3 - diabetes
4 - IgA nephropathy

Answer 12

4 - IgA nephropathy

Question 13

Is nephritic syndrome more commonly associated with acute or chronic kidney injury?

Answer 13

• acute kidney injury

Question 14

Acute kidney injury or AKI can be defined as what?

1 - decline in eGFR over weeks
2 - damage to kidneys caused by trauma or drug overdose
3 - decline in eGFR over days
4 - infection lead to chronic kidney injury

Answer 14

3 - decline in eGFR over days

Question 15

Acute kidney injury or AKI is a decline in eGFR over days. Which of the following is not a common cause of AKI?

1 - pre-renal (dehydration/sepsis)
2 - post-renal (renal calculi)
3 - following IV contrast imaging
4 - renal (glomerular disease)
5 - hypertension

Answer 15

5 - hypertension

Question 16

What does pyonephrosis mean?

1 - pus formation in the ureters
2 - pus formation in the bladder
3 - pus formation in the renal collecting system
4 - pus formation in the glomerulus

Answer 16

3 - pus formation in the renal collecting system

• essentially this causes a blockage and renal distension

Question 17

Pyonephrosis is pus formation in the renal collecting system that essentially causes a blockage and renal distension. According to NICE guidelines if pyonephrosis, infected and/or obstructed kidneys is suspected what image modality should be used within 6 hours?

1 - X-ray
2 - contrast CT scan
3 - ultrasound
4 - MRI with contrast

Answer 17

3 - ultrasound

Question 18

According to NICE guidelines, if adult, children and young people have no identified cause of their acute kidney injury or are at risk of urinary tract obstruction, they should be offered urgent ultrasound of the urinary tract that should be performed in what time frame?

1 - 1 hour
2 - 6 hour
3 - 12 hours
4 - 24 hours

Answer 18

4 - 24 hours

Question 19

According to NICE guidelines if a patient has confirmed acute kidney injury or upper urinary tract obstruction that is causing acute kidney injury, what 2 treatments can they be offered within 12 hours?

1 - nephrostomy or nephrectomy
2 - nephrostomy or stent
3 - stent of nephrectomy
4 - stent or steroids

Answer 19

2 - nephrostomy or stent

Question 20

What does hydronephrosis mean?

1 - fluid formation in the ureters due to an obstruction
2 - fluid formation in the bladder due to an obstruction
3 - fluid formation in the renal collecting system due to an obstruction
4 - fluid formation in the glomerulus due to an obstruction

Answer 20

3 - fluid formation in the renal collecting system due to an obstruction

• can cause dilation of the kidneys

Question 21

The CT scan below shows what in terms of the kidneys?

1 - dilated kidneys
2 - hydronephrosis and renal calculi
3 - renal calculi only
4 - hydronephrosis only

Answer 21

2 - hydronephrosis and renal calculi

Question 22

In chronic kidney disease are kidneys typically larger or smaller?

Answer 22

• smaller due to fibrotic tissue formation

Question 23

If we ultrasound a patient with chronic kidney disease we will see smaller kidneys (generally <8cm). Would we expect to see and increased or decreased echogenicity?

Answer 23

• increased echogenicity
• due to fibrotic tissue that is echogenicitic, often appear brighter than the liver due to this

Question 24

Renal Doppler allows the intrarenal arterial resistive index (RI) to be measured. Why is this important?

1 - assesses venous drainage from kidneys
2 - assess for risk of renal artery stenosis
3 - assess for capillary function in glomerulus

Answer 24

2 - assess for risk of renal artery stenosis

• a higher RI indicates stenosis which is bad

Question 25

What would be the most common cause for the use of renal angiogram? 1 - stenosis of renal arteries 2 - obstruction 3 - hydronephrosis 4 - scarring due to CKD

Answer 25

1 - stenosis of renal arteries - can be identified and often repaired using angioplasty - enter through the femoral artery

Question 26

A nuclear medicine scan using dimercaptosuccinic acid (DMSA) scan can be useful. What do they typically identify? 1 - malignancy 2 - obstruction 3 - hydronephrosis 4 - scarring due to CKD

Answer 26

4 - scarring due to CKD - DMSA is absorbed by healthy parenchyme, but scarred tissue will not - can be caused by reflux nephropathy, where urine moves backwards into the kidneys

Question 27

Intravenous contrast media are generally water soluble and contain iodine (except MRI). To enhance the radiopacity of the image what atomic number does iodine have? 1 - 3 2 - 5 3 - 35 4 - 53

Answer 27

4 - 53

Question 28

Intravenous contrast media are generally water soluble and contain iodine (except MRI). Iodine contrast can be ionic or non ionic, meaning they are or are not able to dissolve into positively charged solutions. Which is safer?

Answer 28

- non-ionic

Question 29

Which contrast media is typically used in MRIs? 1 - iodine 2 - barium 3 - gadolinium 4 - barium air

Answer 29

3 - gadolinium - reaction are rare, but can be seen in CKD patients - can cause Nephrogenic Systemic Fibrosis

Question 30

Which of the following is NOT a side effect of iodinated contrast? 1 - Warmth / hot flushing 2 - Headache 3 - Nausea 4 - Itching 5 - Metallic taste 6 - Anaphylactic shock

Answer 30

6 - Anaphylactic shock

Question 31

Which of the following is NOT a sign of an allergic reaction to iodinated contrast? 1 - Urticaria (hives) 2 - Bronchospasm 3 - Laryngeal oedema 4 - Hypotension 5 - Systemic oedmea 6 - Anaphylactic shock 7 - Cardiac or respiratory arrest

Answer 31

5 - Systemic oedmea

Question 32

Gadolinium can be used as a contrast in MRI. However, in patients with CKD can develop Nephrogenic Systemic Fibrosis. Which of the following is not a common presentation of Nephrogenic Systemic Fibrosis? 1 - eyes 2 - skins lesions 3 - heart failure 4 - muscle weakness

Answer 32

3 - heart failure - MUST CHECK eGFR

Question 33

How does contrast media help with ultrasound scans? 1 - contrast is absorbed by cells increasing echogenicity 2 - contrast is able to identify dead/scar tissue better 3 - contrast contains bubbles oscillate and reflect ultrasound waves

Answer 33

3 - contrast contains bubbles oscillate and reflect ultrasound waves

Question 34

Prior to administering a contrast a radiographer must ensure it is safe to do so. Which of the following is NOT a contraindication that the radiographer must check? 1 - Previous contrast reaction 2 - Asthma 3 - Claustrophobia 4 - Severe allergy 5 - Renal impairment

Answer 34

3 - Claustrophobia

Question 35

When injecting a contrast who has the final say over whether to inject a contrast into a patient? 1 - nurse 2 - SHO 3 - consultant 4 - radiographer

Answer 35

4 - radiographer

Question 36

What is post contrast AKI? 1 - AKI present prior to contrast 2 - AKI caused directly by the contrast 3 - AKI linked with diet and dehydration 4 - AKI caused by analgesia

Answer 36

2 - AKI caused directly by the contrast - sudden deterioration following injection - 25% increase in creatinine - muddy brown urine - image shows contrast media trapped in necrotic tubules

Question 37

In an attempt to minimise side effects of contrast a number of things are done. Which of the following is NOT commonly a part of this? 1 - ensuring patient is hydrated 2 - use of low osmolar contrast media 3 - consideration of alternative imaging 4 - eat prior to scan 5 - withhold metformin

Answer 37

4 - eat prior to scan

Question 38

If a patient has hydronephrosis due to a blockage in the ureter and/or malignancy, how is this commonly treated? 1 - open surgery 2 - nephrectomy 3 - fluroscopy 4 - nephrostomy

Answer 38

4 - nephrostomy - ultrasound guided - temporary normally