Renal/Urinary tract Flashcards
(145 cards)
1
Q
What is acute pyelonephritis?
A
Acute inflammation of the parenchyma typically involving the pyelocaliceal lining
2
Q
Acute pyelonephritis affects _________ more frequently than ________.
A
Females
Male
3
Q
What age range is acute pyelonephritis typically identified in?
A
15-30 years
4
Q
Lab results with acute pyelonephritis
A
Elevated WBC
Pyuria
Bacteremia
Microscopic hematuria
5
Q
What is emphysematous pyelonephritis?
A
Life threatening infection of renal parenchyma with gas formation in tissue or collecting system
6
Q
Emphysematous pyelonephritis affects males more frequently than females (2:1)
T/F
A
False
7
Q
Clinical presentation of Emphysematous pyelonephritis
A
Fever/chills Flank pain Lethargy Confusion Dehydration Acidosis Electrolyte imbalance
8
Q
Gas within parenchyma or collecting system will produce what kind of artifact?
A
Ring down reverberations
9
Q
It is uncommon for Emphysematous pyelonephritis to extend into perirenal space.
T/F
A
False, 80% do
10
Q
What is the mortality rate for Emphysematous pyelonephritis?
A
High, 30-75% depending on treatment
11
Q
Ultrasound is the most reliable and sensitive imaging modality for Emphysematous pyelonephritis.
T/F
A
False, CT
12
Q
What is chronic pyelonephritis?
A
Interstitial nephritis from ongoing/recurring UTIs
13
Q
What is acute tubular necrosis?
A
Temporary reversible renal failure due to significant reduction in tubular blood flow rate as a result of drugs or ischemia producing processes that increase arteriole resistance
14
Q
Exposure to mercury, uranium, antifreeze or arsenic can increase the risk of:
A
Acute tubular necrosis
15
Q
ATN will present with:
A
Oliguria
Uremia
Electrolyte imbalance
16
Q
With ATN, the kidneys will measure larger in the ______ dimension.
A
AP
17
Q
Pyonephrosis is the presence of pus in the urinalysis collecting system secondary to:
A
Ureteral obstruction
18
Q
What are some Sonographic traits of pyonephrosis?
A
Hydro
Low level echo particles in dilated calyces
19
Q
Acute glomerulonephritis occurs where?
A
In the corticomedullary junction
20
Q
Acute glomerulonephritis is:
A
Inflammation and necrosis of the glomeruli
21
Q
Acute glomerulonephritis is usually associated with:
A
Autoimmune and other systemic disease processes
22
Q
Clinical presentation of acute glomerulonephritis
A
Oliguria
N/V
Fever
Hypertension
23
Q
Lab values with acute glomerulonephritis
A
Hematuria
Elevated BUN, creatinine and potassium
Azotemia
24
Q
With acute glomerulonephritis there is focal increase in the cortical echogenicity that makes the normal medulla appear prominent.
T/F
A
False, diffuse
25
Schistosomiasis is endemic in:
Puerto Rico, South Africa, Egypt, Nigeria, Tanzania and Zimbabwe
26
A 30 year old patient presents with flank pain, dysuria and has blood and albumin in their urine. The kidneys appear normal but the bladder wall is thickened with some calcifications. What is the likely diagnosis?
Schistosomiasis
27
Urinary tuberculosis is an infestation to the kidney of mycobacterium tuberculosis from:
An extraurinary source
28
Urinary tuberculosis affects female more frequently.
| T/F
False, females
29
Urinary tuberculosis affects people that are usually less than:
50 years age
30
Urinary tuberculosis is usually bilateral or unilateral?
Unilateral
31
Acute urinary tuberculosis appears as:
Enlarged kidney
Multiple focal lesions (tuberculomas)
Possible UVJ edema/obstruction and hydroureter
32
Chronic urinary tuberculosis appears as:
Decreased renal size
Varying scarring and obstruction from fibrotic changes
Eventually shrunken, no functioning, and calcified
33
What is it called when a kidney is shrunken and calcified and no longer functions?
Autonephrectomy or putty kidney
34
Diabetics are affected twice as often with:
Renal abscesses
35
ATN accounts for 75% of
Acute renal failure
36
Chronic renal failure may be a result of:
```
Chronic infection/inflammation
Long standing vascular disease
Diseases affecting blood protein levels
Diabetes, gout, hypercalcemia
Congenital renal diseases
Hepatorenal syndrome and radiation
```
37
Four classifications of renal failure causes
Prerenal
Renal
Postrenal
Congenital
38
Prerenal causes of renal failure
```
When the kidney isn’t getting enough blood
Hemorrhage
Cardiac failure
Fluid and electrolyte depletion
Liver failure
```
39
These are the most common causes of renal failure
```
Renal classification:
ATN
Glomerulonephritis
Tubointerstitial nephritis
Arterial/venous obstruction
Cortical necrosis
```
40
Postrenal causes of renal failure
```
The least common
Outflow obstruction processes like:
Enlarged prostate
Urinary calculi
Neoplasms
```
41
Congenital causes of renal failure
Polycystic kidney disease
Multicystic kidney disease
Medullary cystic disease
42
Lab values associated with renal failure
Elevated BUN and creatinine
Proteinuria
Anemia
Uremia
43
cortical diseases that only affect the CORTEX include:
```
Renal transplant rejection
Acute/chronic glomerulonephritis
Acute lupus nephritis (and other forms)
Diabetic/hypertensive nephrosclerosis
Methemoglobinuric renal failure
```
44
Cortical disease has lab values of:
```
Increased BUN and creatinine
Decreased serum calcium
Low urinary specific gravity
Proteinuria, RBC/WBC in urine
Anemia
```
45
Parapelvic cysts are:
Fluid filled mass of lymphatic origin in renal sinus
46
Sono traits of parapelvic cysts
```
Usually multiple
Usually bilateral
May be complex
Easy to mistake for hydronephrosis
Do not communicate with each other or the calices
```
47
MDKD stands for:
Multicystic dysplastic kidney disease
48
What is MDKD?
Developmental anomaly resulting in multiple renal cysts and fibrosis of kidney
49
What is the most common renal cystic disease in infants?
Multicystic dysplastic kidney disease
50
MDKD is more often bilateral.
| T/F
False, unilateral occurs more often
51
Unilateral MDKD affects:
Males more often
| Left kidney more often
52
Bilateral MDKD is more common in infants with:
Diabetic mothers
53
Bilateral MDKD is uniformly fatal.
| T/F
True
54
IPKD is:
Infantile polycystic kidney disease
55
IPKD is AKA ARPKD which stands for:
Autosomal recessive polycystic kidney disease
56
IPKD is an:
Autosomal recessive inherited disorder characterized by abnormal proliferation and dilatation of renal tubules resulting in multiple tiny cysts bilaterally
57
IPKD is more frequent in:
Females (1:70)
58
ARPKD occurs more frequently than ADPKD.
| T/F
False, less frequent
59
IPKD sonographically appears as:
Bilateral enlarged hyperechoic kidneys
60
Why is IPKD typically fatal?
Due to fetal pulmonary hypoplasia and renal failure
61
Adult polycystic kidney disease is AKA:
Autosomal dominant polycystic kidney disease (ADPKD)
62
ADPKD is an inherited disorder with bilateral development of:
Parenchymal MACROcysts
63
What is the third most common cause of chronic renal failure?
Adult polycystic kidney disease
64
Symptoms for ADPKD typically present around what age?
35
65
What are some associated findings with ADPKD?
Concomitant cysts in liver (80%)
Berry aneurysms if cerebral arteries
Aortic aneurysm
66
Medullary cystic disease is a developmental disorder.
| T/F
False, autosomal inherited disorder
67
Dominant medullary cystic disease is:
Adult onset with rapid progression, uremia, and death within 2 years
68
Recessive medullary cystic disease is:
Juvenile onset with uremia and death within 10 years
69
Lab findings with medullary cystic disease
Sodium loss
Anemia
Azotemia
Increased BUN and creatinine in late stages
70
Sono findings will medullary cystic disease
Bilateral
Increased echogenicity of pyramids
Thin cortex
71
What is medullary sponge kidney?
Dysplastic microcystic dilation of medullary and papillary portions of collecting tubules
72
Sono findings with medullary sponge kidney
```
Unilateral in 25%
May affect single pyramid in 25%
Increased echogenicity of pyramids
Renal calculi
80% have medullary nephrocalcinosis
```
73
Acquired cystic kidney disease is:
Development of multiple renal macrocysts in native kidneys of patients with chronic renal failure undergoing dialysis.
May affect transplant kidneys
74
Acquired cystic kidney disease is usually unilateral.
| T/F
False, bilateral
75
Angiomyolipoma is AKA
Renal hamartoma
76
What is angiomyolipoma composed of ?
Fat, blood vessel, and smooth muscle tissue
77
Angiomyolipomas are benign.
| T/F
True
78
Lesions greater than ________ can cause flank pain, hematuria, and be prone to hemorrhage.
4 cm
79
Angiomyolipomas appear:
Hyperechoic, solid, round
| Parenchymal or exophytic
80
What is the most common cortical mass?
Adenoma
81
Renal adenomas occur more frequently in:
Males (3:1)
| Older than 30 (incidence increases with age)
82
Sono findings of renal adenomas
75% solitary
Small, well defined, solid subcapsular cortical mass (3 cm or smaller)
Isoechoic/hypoechoic
83
It is easy to differentiate renal adenomas from RCCs.
| T/F
False, impossible
84
What is the second most common benign solid tumor of the kidneys?
Oncocytoma
85
What is an oncocytoma?
A well encapsulated epithelial cell tumor of proximal tubular cells
86
Oncocytomas are more frequent in:
Males
87
Describe the Sono traits of an oncocytoma
```
Homogeneous
Hypoechoic
Well defined
Solid
Size range .1 cm - 26 cm
```
88
If oncocytoma is larger how will it appear?
```
Has a central stellate scar
Central necrosis and hemorrhage
Calcification
Loss of border distinction
Invasion of renal capsule and renal vein
```
89
Mesoblastic nephromas are the benign counterpart to:
Wilms tumor
90
What’s another name for a mesoblastic nephroma?
Fetal renal hamartoma
91
A benign tumor of mesoderm tissue found in children is:
Mesoblastic nephroma
92
What is the most common renal tumor of infants?
Fetal renal hamartoma
93
Mesoblastic nephromas are more frequent in males and 90% occur in second year of life.
T/F
False, in first year of life
| Peak incidence is 1-3 months
94
Sono findings of fetal renal hamartomas
```
Homogeneous
Hypoechoic
Solid
Parenchymal mass that Replaces 60-90% of kidney
Involves sinus
Grows through capsule
DOES NOT invade renal vein
```
95
RCC is also referred to as:
Hypernephroma
96
RCC consists of :
Tubular cells
97
RCC accounts for 90% of primary malignancies in adults, has a peak incidence of 50-70 years of age, and more frequent in females.
T/F
False, more frequent in males
98
What is the classic triad of clinical presentation for RCC?
Gross hematuria
Flank pain
Palpable renal mass
99
Clear cell RCC occurs in:
7/10 cases
| Most common
100
Papillary RCC has the best prognosis of RCCs.
| T/F
True
101
Clear cell RCC arises from __________ tubules, where as papillary RCC arises from _________ tubules.
Proximal
| Distal
102
RCC can metastasize to:
Lungs, lymph nodes, liver, bone, adrenals, and contralateral kidney
103
Ultrasound is the best imaging modality for RCC diagnosis.
| T/F
False, MRI
104
TCC is a primary malignant ___________ tumor originating in renal _______, ________, and _________.
Epithelial
Sinus
Ureters
Bladder
105
What is the most common tumor of the collecting system lining?
TCC
106
What is the peak incidence of TCC?
Males
Caucasians
Mean age is 68
In bladder (30-50x)
107
Which modality is the best for staging with bladder presentation of TCC?
MRI
108
Wilm’s tumor is AKA
Nephroblastoma
109
Wilms tumor is a malignant pediatric tumor composed of:
Embryonal elements
110
What is the most common malignant mass of the abdomen for kids 8 years and younger?
Wilms tumor
111
Peak age of wilms tumor incidence
3-4 years
112
33% of people with __________________ will have a wilms tumor.
Sporadic aniridia
113
90% of the time, wilms tumor presents as:
An asymptomatic palpable mass
114
Sono findings of wilms tumor
Large (avg size 12 cm)
Sharply marginated
Solid
Heterogeneous because of cystic, necrosis, hemorrhage, calcifications and fat
115
Wilms tumor may metastasize to:
Lymph nodes
Renal vein, IVC, right atrium
Contralateral kidney
Liver
116
What is a nephroblastoma easily confused with?
A neuroblastoma
117
Common Mets to the kidney
```
Bronchus
Breast
GI tract
Contralateral RCC
Non-Hodgkin lymphoma
Neuroblastoma (in peds)
```
118
Metastatic lesions occur 2-3 times less often than primary renal cancer.
T/F
False, more often
119
Medullary nephrocalcinosis is calcium aggregates in the:
Distal convoluted tubules and loops of Henle
120
95% of all nephrocalcinoses are:
Medullary
121
Hyperparathyroidism, hypercalcemia and hypercalcuria are indications of:
Medullary nephrocalcinosis
122
Blunt force, penetrating trauma or rupture of a neoplasm can result in:
Rupture of kidney/capsule
Subcapsular hematoma
Parenchymal laceration
Urinoma
123
Most bladder trauma is associated with:
A pelvic fracture
124
Most renal traumas are minor injuries with:
No or small perinephric hematoma
125
Minor injuries due to trauma
Renal contusion
Subcapsular hematoma
Intrarenal hematoma
Small subsegmental cortical infarct
126
Major renal injuries
Cortical laceration
Cortical fracture
Shattered kidney
Vascular disruption
127
Infarctions are __________ shaped defects.
Wedge
128
Necrosis of tissue due to occlusion of arterial blood supply is an:
Infarction
129
Acute infarctions appear ___________. Chronic infarctions appear __________.
Hypoechoic
| Hyperechoic
130
Causes of RAS
60% atherosclerosis
| 35% fibromuscular dysplasia
131
RAR greater than ________ indicates RAS
3.5
132
PSV greater than _________ indicates RAS.
150 cm/sec
133
RI of less than ______ is normal for cortical vessels.
0.7
134
How do you find RAR?
PSV of Renal artery/PSV of aorta
135
How do you find RI?
PSV - ED/ PSV
136
Fibromuscular dysplasia strictures of the renal artery gives a _____________ appearance.
String of beads
137
Cystitis is more frequent in:
Females
138
Nondistended bladder wall should measured less than:
5 mm
139
Distended bladder wall should measure less than:
3 mm
140
Majority of bladder stones are caused by:
Urinary stasis
141
Dilation of collecting system above the obstructing mass occurs in the lower one third of ureter how often?
75% of time
142
Which lab value is most sensitive and specific for renal dysfunction?
Serum creatinine
143
Low level debris in dilated calyces is most likely:
Pyonephrosis
144
Uremia may be found in patients with:
Renal insufficiency
145
What artifact may help identify calculi?
Twinkle reverb
