Flashcards in Renal Deck (233)
The right kidney is lower on the right what % of the population?
Kidney ptosis greater than how many cm is considered pathological when going from supine to upright films?
5cm (1.5 vertebral bodies)
The kidney continue to keep on growing until what age?
If the right kidney is greater than the left kidney by _____ OR if the left kidney is more than ______ longer than the right kidney, it is considered pathological.
Embryonically, how do the kidneys originate?
Fused, in the fetal pelvis with the renal pelvis facing anteriorly.
What % of the pop'n have an accessory renal artery? What % is unilateral and what % is bilateral?
Unilateral = 30%; bilateral = 10%
What are the basic features of renal agenesis?
- ipsilateral usually (bilateral rare & incompatible w/ life)
- absence of ipsilateral trigone & ureteral orifice
- absence of renal artery
- contralateral kidney hypertrophied
- adrenal gland absent (8-10%)
How is left renal agenesis identified on plain film?
By medial dislocation of the splenic flexure.
What are the basic features of renal hypoplasia?
- kidney small but still functional
- major calyces absent or fewer
- but renal artery, pelvis & parenchyma all NORMAL
What complications can arise with renal hypoplasia?
a. primary hypertension
b. chronic renal failure
What determines the size of a hypoplastic kidney?
The number of nephrons created during embryological development.
What is the main differential diagnosis of renal hypoplasia?
Acquired renal atrophy (eg. chronic ischemia, long-standing obstruction)
What is renal dysplasia?
- small kidney but no function
On what side is a supernumerary kidney most commonly found and where is it in relation to the dominant kidney?
Left side and more caudally placed, hypoplastic & fused to dominant kidney.
What symptoms are associated with a supernumerary kidney?
What are the two types of collecting systems seen with a supernumerary kidney?
1st type: bifid ureter drains both kidneys
2nd type: a separate ureter drains the supernumerary kidney
Other than CT and US, what are two modalities used to diagnose supernumerary kidney?
1. Angiography -- demonstrates a separate vascular supply
2. IVP -- see separate collecting system
What normal variant represents hypertrophied cortical tissue between medullary pyramids that projects into renal sinus?
Septum of Bertin
What is the M/C fusion anomaly of the GU tract?
Where is the isthmus of a horseshoe kidney in relation to the aorta & IVC?
Crosses anterior to both
What is Rovsing's syndrome?
Pain caused from compression of the aorta & IVC by the horseshoe kidney
There is an increased incidence of which tumor with horseshoe kidney?
Wilm's tumor (2-8x)
Other than Rovsing's syndrome and increased tumor incidence, what are two other complications of horseshoe kidney?
1. Dilation of pelvis/calyces --> Uteropelvic junction obstruction
2. Stasis leads to nephrolithiasis
In crossed ectopic kidney, what % of the ectopic kidney is fused to the normally situated kidney?
How do the ureters fuse in a crossed ectopic kidney?
Normally. They are not ectopic. Normal trigone.
What side is crossed ectopic kidney more common? And which gender is it more predisposed to occur in?
Right 3x M/C
M/C in males
What complications occur with crossed ectopic kidney?
- urinary tract calculi
What is the M/C/C of cystic disease in infants?
multicystic dysplastic kidneys
What is the 2nd M/C/C of abdominal mass in neonate?
multicystic dysplastic kidneys
What are the symptoms of multicystic dysplastic kidney when bilateral?
In infants, causes death from pulmonary hypoplasia.
What is a donut kidney?
upper and lower poles fuse in a ring-like fashion
What is pancake (or lump) kidney? Where is it located and what are the symptoms?
Fusion of upper & lower poles, w/ pelvis facing anteriorly.
Usually midline & presacral.
Name 4 different types of renal positional anomalies.
2. Renal ectopy
4. Intrathoracic kidney
What is the M/C location for renal ectopia?
Presacral (intrapelvic/prevertebral kidney)
What is the blood supply for an ectopic kidney?
What is nephroptosis, who does it happen to and what side is more common?
Excessively mobile kidney with a redundant ureter.
M/C in females on right side.
What complications can arise with nephrotosis?
Deetle's Crisis: renal colic (pain that comes in waves) from kinking of a positionally redundant ureter.
What is intrathoracic kidney?
Herniation of the LEFT kidney through the foramen of Bochdalek.
M/C in males
What is the blood supply for an intrathoracic kidney?
What is the M/C/C for a palpable abdominal mass in a neonate?
Hydronephrosis d/t ureteropelvic junction obstruction.
What % ureteropelvic junction obstruction are unilateral and what side is it M/C on?
What are some causes for ureteropelvic junction obstruction?
a. ureteral hypoplasia
b. abnormal insertion of ureter into renal pelvis
c. secondary scarring from stones, infection, instrumentation or neoplasm
What is Gensinger's rule?
A separate blood supply, ureter & insertion is needed to define a duplex kidney.
What % of duplex kidneys are unilateral and what gender are they common in?
What is the M/C type of ureter insertion in a duplex kidney?
Incomplete -- ureters join along their course and insert normally on bladder.
What is the Weigert-Meyer Law in reference to complete duplex kidney/ureter?
The ectopic ureter inserts INFERIORLY & MEDIALLY in relation to the ureter draining the lower moiety.
What complications occur with duplex kidneys?
a. Reflux (M/C)
What is the imaging of choice for visualizing primary vesicoureteral reflux?
What is a megaureter and what is the M/C gender and location?
- the distal ureter diameter >7mm
- usually bilateral
- absence of obstruction or reflux
- left sided
Ectopic ureteral insertions M/C occur in whom?
Where in reference to the external urethral sphincter does an ectopic ureter insert in females? In males?
Females --> after the urethral sphincter; continual dribbling
Males --> before the urethral sphincter; no dribbling
The presence of a ureteral jet phenomenon excludes the possibility of which condition?
Significant vesicoureteral reflux
What is a retrocaval ureter and what side is it predominately found on?
Right sided ureter runs behind the inferior vena cava
What's the M/C complication of a retrocaval ureter?
What is a ureterocele? What are the two types?
Focal dilation submucosal portion of distal ureter d/t absence of outer muscular layer causing inherent weakness in that area.
Simple (orthotopic) and Ectopic
What is the difference between simple and ectopic ureterocele?
Simple = congenital prolapse; normal insertional site
M/C in males & unilateral
Ectopic = does not terminate in the normal position on the trigone.
M/C in females (7x)
What is the ratio of simple to ectopic ureterocele?
4-5x ectopic M/C
What are two radiographic signs associated with simple ureteroceles?
Spring onion --> small ureterocele
Cobra head --> large ureterocele
What is ectopic ureteroceles associated with?
50% have vesicoureteral reflux
50% have stenotic orifices that do not reflux (cuases hydronephrosis)
What is a pseudoureterocele and what is it associated with?
Stone impacted in distal ureter producing a zone of edema.
Most often caused by transitional cell carcinoma of bladder or carcinoma of cervix.
If the median umbilical ligament doesn't form, the connection between the bladder and umbilicus is called?
What is the M/C ureteral anomaly?
Congenital obstruction of the ureter (M/C at urteropelvic junction)
What is the classic triad of Prune-Belly Syndrome?
1. Deficient/absent abdominal muscles
3. Urinary tract abnormalities (eg. vesicoureteral reflex, urachus, bladder diverticula etc.)
What plain film finding may you see with Prune-Belly Syndrome?
Widening/absence of pubic symphysis & bulging of flanks
What is an aka for Prune-Belly Syndrome?
What is the M/C nephrolithiasis forming material?
Calcium oxalate 75-80% (calcium phosphate & calcium urate next most common)
What is the M/C location for stone lodging? What are two other common locations?
1. Ureterovesicular junction
Other: ureteropelvic junction & pelvic brim as ureter crosses into pelvis
What is the M/C complaint of a renal stone?
What is the M/C/C for stone formation by calcium oxalate?
Idiopathic hypercalciuria (85%)
Which stone forms in the presence of a UTI (most particularly Proteus)?
Magnesium ammonium hexahydrate (struvite)
2nd M/C type of stone (15-20%)
Which type of stone is involved in a staghorn calculi?
Calcium magnesium ammonium phosphate (triple phosphate).
The M/C component of a staghorn calculus is Struvite apatite.
Which stones are lucent radiographically?
Uric acid & xanthines
Which type of stone is associated with AIDS patients?
Which stones have soft tissue density on both plain films and CT?
What % of urinary tract calculi are radiopaque?
What is the method of choice for evaluation of acute flank pain?
Bladder stones are M/C which type of stone?
Uric acid stones
Fluid-fluid level seen in the parenchyma of the kidney is most likely what?
renal milk of calcium
What are the 2 types of nephrocalcinosis and which is more common?
1. Medullary nephrocalcinosis (95%)
2. Cortical nephrocalcinosis (5%)
What is the radiographic sign seen with cortical nephrocalcinosis?
Tram lines -- parallel calcific tracks
What are the M/C etiologies of cortical nephrocalcinosis? List 4.
1. Chronic glomerulonephritits
2. Renal chronic necrosis
3. Alport's syndrome (hereditary nephritis & nerve deafness)
4. Transplanted kidney: chronic rejection
What is the radiographic features of medullary nephrocalcinosis?
- Renal pyramids involved
- Diffuse, fan-shaped clusters (stippled or punctate calcification)
What are the causes of medullary nephrocalcinosis?
1. Primary hyperparathyroidism (40%)
2. Tubular acidosis (20%)
3. Medullary sponge kidney (20%)
4. Milk-alkali syndrome
5. Hypervitaminosis D
6. Hypercalcemic/hypercalciuric states
What is the M/C bacterial infection in humans (of all ages)?
What is the M/C group of bacteria to causes UTI?
Coliform bacteria (eg. E.coli)
What is the M/C type of renal disease?
What is the M/C/C of acute pyelonephritis?
Gas found in the collecting system is indicative of which condition?
What 2 organisms are M/C associated with emphysematous pyelonephritis?
E.coli & proteus
Emphysematous pyelonephritis is M/C seen in what pop'n?
What is the etiology of chronic pyelonephritis?
Previous inflammatory process (eg. sarcoidosis, Wegener's etc.)
What is the M/C/C of chronic pyelonephritis in children?
Vesicoureteral reflex of infected urine
What is the 1st radiographic sign of pyelonephritis?
loss of renal parenchyma
What is the modality of choice for a renal abscess?
What pop'n of individuals more commonly have renal abscesses?
Immunocompromised or diabetics
What is the M/C organism involved in a xanthogranulomatous pyelonephritis?
What is the classic triad associated with xanthogranulomatous pyelonephritis?
1. Staghorn calculus
2. Absent/diminished excretion of contrast
3. Poorly defined renal mass
What is renal papillary necrosis?
Infarction of the papilla BILATERALLY in FEMALES d/t an underlying cause.
What is the M/C/C of renal papillary necrosis?
Other than diabetes, what are some other causes for renal papillary necrosis?
ADIPOSE (Chapman) or POSTCARDS (ExpertConsult)
I infants in shock
S sickle cell anemia
S sickle cell anemia
R renal vein thrombosis
S systemic vasculitis
What are the named radiographic signs associated with renal papillary necrosis?
1. Lobster claw sign --> streaking of contrast on both sides of fornix along long axis of papilla
2. Ring sign --> contrast making a moat around necrotic papilla
3. Signet ring --> ring sign with pooling of contrast also in papilla
What is the cause for bilateral hemorrhagic necrosis?
Hemorrhagic complication of pregnancy
What condition does galloping consumption refer to?
What is end-stage of TB called and what does it look like?
Putty kidney --> extensive parenchymal calcification
Kidney is autonephrectomized.
What is the 1st, 2nd and 3rd M/C location for an echinococcal cyst?
1st = liver
2nd = lungs
3rd = muscles
What % of echinococcal cysts calcify?
Fungus balls "mycetomas" M/C occur in which condition?
What is the classical triad of Goodpasture's Syndrome?
2. Pulmonary hemorrhage
3. Iron deficiency anemia
What is the M/C form of renal trauma?
Blunt trauma (80%)
What is the imaging modality of choice for renal trauma?
CT w/ contrast
Ureteral injuries are rare, but when they occur, what is the most likely mechanism?
Benign vs. malignant tumors is not a diagnosis for IVP. What is better modality?
Angiogram -- benign tumors are avascular (except hemangioma)
What is the M/C grade of kidney injury and by what %?
Grade 1 (80%) -- simple renal contusion
What are the two tissue types for benign renal tumors?
Epithelial & mesenchymal
What is the M/C benign epithelial renal tumor?
What is the upper size limit of a benign renal adenoma before its suspected to be malignant? What is the malignant tumor that must be ruled out when greater than this size?
3cm; renal cell carcinoma
Which renal tumor has the highest rate of all tumors to induce osteomalacia?
What is the condition associated with hemangiopericytoma and a juxtaglomerular tumor?
Which of the two renal tissue origins is more common for benign tumors? Epithelial or mesenchymal?
What is the M/C benign tumor of the kidney?
What is the most frequent location for a renal hemangioma?
Apex renal pyramids
Renal hemangiomas are M/C unilateral or bilateral?
Tumors of the juxtaglomerular apparatus causes what clinical symptoms and why?
Causes moderate to severe hypertension b/c the tumor secretes renin.
What is the M/C tumor renal medulla?
Renal hamartomas are M/C unilateral or bilateral?
Bilateral hamartomas are M/C associated with which condition?
What % of tuberous sclerosis have angiomyolipomas?
What % of patients with angiomyolipomas have tuberous sclerosis?
What is the M/C benign FETAL renal neoplasm?
Congenital Wilms' tumor (mesoblastic nephroma)
Which benign renal tumor can be indistinguishable from RCC on all imaging modalities?
What is the classic radiographic appearance of this tumor?
Oncocytoma -- should be biopsied
Central stellate scar!
Which phakamatosis is associated with bilateral renal cell carcinoma (50%) or multiple renal adenomas?
Von-Hippel Lindau (retino-cerebellar angiomatosis)
What are the 4 M/C abdominal masses in infancy?
2. Multicystic Dysplastic Kidney (MCDK)
With malignant renal tumors, calcification represents increased risk of malignancy when it is: a) peripheral or b) non-peripheral?
What is the M/C malignant renal tumor?
Renal cell carcinoma
Renal cell carcinoma is M/C unilateral or bilateral?
(Remember, bilateral renal cell carcinomas -- associated with von Hippel Lindau disease)
By which route is renal cell carcinoma most likely to metastasize?
Via venous system
What is the classic clinical triad associated with renal cell carcinoma? What % of patients have this triad?
c. palpable mass
Normally, this tumor is clinically silent until it grows really large & metastasizes.
RCC often metastasizes to what organ?
Lung > lymph node > liver > bone
What is Page kidney?
Phenomenon of developing hypertension following compression of the renal parenchyma from supcapsular renal collections (eg. hematoma, seroma, urinoma).
Compression results in decreased blood flow which then activates the renin-angiotensin system.
What is the M/C renal neoplasm of infancy?
(May be the M/C abdominal neoplasm of infancy too but controversy with neuroblastoma.)
What % of Wilms' tumor calcify?
Rare 10% (compared to neuroblastoma = 90%)
List 3 syndromes often associated with Wilm's tumor.
1. WAGR Syndrome - Wilm's tumor, Aniridia, Genitourinary syndromes & mental retardation
2. Deny-Drash Syndrome - gonadal dysgenesis (male pseudohermaphroditism) & nephropathy
3. Beckwith-Wiedemann Syndrome - enlargement of body organs, bilateral Wilms' tumor (10%)
What's the M/C cell type for renal lymphoma? What's the 2nd M/C cell type?
1st = Non-Hodgkin's lymphoma
2nd = Burkitt's lymphoma
What is the M/C retroperitoneal sarcoma?
90% of all renal pelvis carcinomas are which ones?
transitional cell carcinoma
(remainder 10% is squamous cell)
The M/C location for transitional cell carcinoma is?
What radiographic appearance describes the ureter if transitional cell carcinoma is present?
Champagne glass (or goblet cell)
What % of the pop'n has an accessory renal artery? And where on the kidney is the M/C location?
30% upper pole
What is the M/C cause for a renal arteriovenous fistula?
acquired through percutaneous biopsy
Renal disease is the cause for what % of all hypertension?
What is the M/C/C of splenic hypertension?
Atherosclerosis of the renal artery is M/C on which side and occurs where specifically in the renal artery?
Occurs proximal 1/3rd of renal artery OR within first 2cm of renal arteries.
What is the 2nd M/C/C of renal hypertension?
Fibromuscular dysplasia (30-35%)
What is the M/C/C of renal hypertension in children?
What radiographic sign is associated with renal hypertension?
String of beads
What side and which gender does splenic artery involvement in fibromuscular dysplasia most commonly affect?
Right side (75%) and females
What condition causes necrotizing vasculitis of the smaller & medium sized arteries (M/C renal & hepatic arteries)
What is the M/C/C of renal artery occlusion?
What are the general underlying causes of renal vein thrombosis in both adults and children?
Dehydration, abnormalities in clotting system or kidney itself
What is the M/C/C of renal vein thrombosis in an adult?
What is the M/C/C of renal vein thrombosis in a child?
acute enteritis (acute inflammation of the s. bowel)
Where is the M/C location for a renal artery aneurysm?
2/3rds at bifurcation of renal artery
Calcified aneurysms are _____________ (more or less) likely to rupture.
What % of renal artery aneurysms are bilateral?
What is the 2nd M/C/C of abdominal mass in a neonate?
multicystic dysplastic kidney (MCDK)
What is the relationship between multicystic dysplastic kidney and the collecting system?
The cysts DO NOT communicate with the collecting system.
Infantile Polycystic Kidney Disease is now known by which name?
Autosomal recessive polycystic kidney disease
What is the prognosis/function of the kidneys involved in multicystic dysplastic kidney if it is unilateral? Bilateral?
Unilateral = no renal function; 65% of cases regress in children.
Bilateral = lethal
What are the two types of multicystic dysplastic kidney?
1. Pelvoinfundibular atresia = M/C
- no renal function
- no renal sinus, pelvis, or parenchymal tissue
- atresia of ureter & renal pelvis
- dominant cyst present in the renal pelvis
Is autosomal recessive polycystic kidney disease unilateral or bilateral? What is their relationship to the collecting system?
Communicate with the collecting system
Adult polycystic kidney disease is now known as?
Autosomal dominant polycystic kidney disease
Is autosomal dominant polycystic kidney disease unilateral or bilateral? What is their relationship to the collecting system?
90% bilateral asymmetrical
List 3 co-existing conditions that occur with autosomal dominant polycystic kidney disease.
1. Colon diverticula 80%
2. Liver cysts (60%) & Pancreas cysts (10%)
3. Caroli's disease
List 3 complications of autosomal dominant polycystic kidney disease.
1. Renal failure 35-48%
2. Berry aneurysm 15-20%
4. Increased incidence renal cell carcinoma? (questionable!)
What is one way to help detect the difference between autosomal dominant polycystic kidney disease and multiple simple renal cysts?
Look for extrahepatic cysts! (eg. Liver)
Which is more common: ARPKD or ADPKD?
What does ARPKD have an association with?
What are the features of medullary sponge kidney?
- Medullary cysts caused by dilatation of distal collecting ducts
- No renal function impairment
- Predisposed to calculus formation
What pop'n is medullary sponge kidney seen in?
What % of medullary sponge kidney cases bilateral?
What is the difference between uremic sponge kidney and medullary sponge kidney?
Uremic sponge kidney occurs in a younger pop'n and results in severe normochromic anemia.
What is a parapelvic cyst? What is a peripelvic cyst?
Parapelvic cyst = cyst off parenchyma extending into hilum
Peripelvic cyst = cyst arising in renal hilar itself
What is the M/C/C for hydronephrosis?
List 4 types of hydronephrosis?
1. Congenital, Non-obstructive (Functional eg. congenital megaureter, diabetes insipidus)
2. Congenital, Obstructive (Mechanical eg. positional anomalies of the ureter)
3. Acquired, Non-obstructive (eg. spinal cord trauma)
4. Acquired, Obstructive (eg. stones, tumors)
Where are 3 normal constrictions of the ureter?
1. Ureteropelvic junction
2. Pelvic brim @ point ureter crosses over external iliac crest (L5/S1)
3. Ureterovesicular junction
What is the name of the inflammatory condition where small cysts arise along the ureteral wall?
Ureteritis cystica (or Pyeloureteritis cystica)
What is Potter's syndrome?
Bilateral atresia of ureters. Incompatible with life.
What is the M/C benign tumor of the ureter?
Benign fibrous polyps
What is the M/C malignant tumor of the ureter?
Transitional cell carcinoma (95%)
Where is the M/C location of a ureteral diverticula?
Proximal or distal third
What is the M/C/C of ureter infection?
What is the 2nd M/C/C of ureter infection?
What tissue cells line the bladder?
What is the M/C congenital anomaly of the bladder?
Exstrophy (or epispadias)
What is exstrophy?
Deficiency in development of lower abdominal wall musculature. Mucosa of the bladder is continuous with the skin.
What is the radiographic findings associated with exstrophy?
Hurley-stick ureter (dilation of distal ureter)
Manta ray sign (widened pubic symphysis)
What is the radiographic appearance of a bladder duplication?
Can have a vertical septum.
Can have a horizontal septum --> "hour-glass bladder"
What causes a pear shaped bladder?
Circumferential compression of the bladder d/t accumulation of fluid (either blood or urine) in the loose tissues surrounding the bladder.
What is the M/C/C of pear-shaped bladder?
A Christmas tree/pine tree bladder can be seen in which condition?
Neurogenic bladder (eg. paraplegia, diabetes, syringomylia)
Which bladder condition has gas in the wall?
What condition will most likely cause calcification along the bladder wall and ureter?
There is an increased incidence of what condition with schistosomiasis?
Squamous cell carcinoma
What is the M/C benign tumor of the bladder?
What is the 2nd M/C malignant tumor of the bladder?
Adenocarcinoma (old theory) or Squamous cell carcinoma (recent books)
What is the M/C/C of external bladder obstruction in males?
Benign prostatic hypertrophy
What is the M/C/C of retroperitoneal fibrosis?
Idiopathic (70%) -- called Ormond's disease
Where is the M/C location for retroperitoneal fibrosis?
Around the aorta and common iliac arteries (the fibrosis encases the aorta and may extend to the IVC and ureters).
What is the M/C retroperitoneal tumor?
What is the M/C primary retroperitoneal tumor?
What is the only retroperitoneal malignant tumor to calcify?
What is the M/C/C of retroperitoneal hematoma/hemorrhage?
Rupture of AAA
What is the 2nd M/C/C of retroperitoneal hemorrhage?
Disease of the adrenal glands/kidneys
What is the imaging of choice for retroperitoneal bleeding?
Corticosteroids and androgens are secreted from which portion of the adrenal glands?
What is secreted from the adrenal medulla?
What is the M/C/C of calcification of the adrenal glands?
Hemorrhage associated with birth trauma
What is Cushing's syndrome?
Excess glucocorticosteroids (either endogenous or exogenous)
What is Addison's disease?
Adrenal hypofunction from primary (eg. tissue destruction of adrenal gland) or secondary (eg. inadequate stimulation by ACTH) causes.
What is the M/C/C of Addison's disease in US?
What is another source of adrenal gland destruction other than idiopathic?
Granulomatous disease (usually TB)
Other than hemorrhage, what are some other causes for adrenal gland calcification?
TB & addison's (infrequently)
What is the M/C location for a neuroblastoma?
adrenal glands (30-50%)
Pheochromocytoma is a vascular tumor of which cells?
Where within the adrenal gland does pheochromocytoma M/C occur?
What is the main clinical sx associated with pheochromocytoma?
What is the rule of 10s with pheochromocytoma?
10% do not have hypertension
10% in children
What is a ganglioneuroma?
Benign, asymptomatic tumor composed of mature ganglion cells & schwann cells.
What this M/C malignant tumor of the urethra?
squamous cell carcinoma (80%)
What's the DDx of a single enlarged kidney without any lesions, normal calyces and pelvis.
1) Acute glomerulonephritis (rarely unilateral)
2) Unilateral renal vein thrombosis
3) Infiltration by lymphoma & leukemia
What's the DDx of a bilateral enlarged kidney without any lesions, normal calyces and pelvis.
1) Acute glomerculonephritis
2) Inferior vena cava thrombosis or bilateral renal vein thrombosis
3) Bilateral infiltration by lymphoma or leukemia
Which conditions are pheochromocytoma associated with?
NF & von Hippel-Lindau & MEN type II
What is the M/C/C of calcification in the bladder?
What is another cause?
2nd cause = tuberculosis