Direct Method--Renal Aorta Ratio compares the peak systolic velocity (PSV) of the AO to the PSV of the main renal artery If the renal artery PSV of the main artry is 3.5 times > than the AO, a diagnosis of 60% or greater stenosis is made

Renal Vasculature Review Flashcards by Mandy Wright

What do most kidneys have?

A single main renal artery

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Accessory renal arteries occur in about _____% of individuals.

30%

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The main renal arteries branch off the:

aorta laterally just inferior to the SMA

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The right renal artery is ________ and passes ________ to the IVC

longer; posterior

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The main renal artery ________ into segmental branches just before entering the _____________. What are these 4 or 5 branches responsible for?

bifurcates; renal hilum

*supplying blood to a specific segment of the kidney

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What do the segmental branches become?

The interlobar arteries as they pass through the junction b/n the cortex and the medulla

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What do the interlobar arteries divide into?

Arcuate arteries farther into the cortex

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What do the small veins in the renal cortex combine and drain into?

the interlobular veins

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The interlobular veins join to form:

the main renal vein

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The main renal vein leaves the renal hilum to travel ________ to join the ________.

cephaled; IVC

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Is the right or left renal vein longer?

Left renal vein is longer

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Where is the left renal vein located?

Anterior to the AO and posterior to the celiac

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The angle of insonance should be adjusted to:

30-60 degrees as the exam progresses

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The Doppler angle should be:

parallel with the walls of the vessel

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You should examine the proximal segment of the main renal artery: (3 things to look for)

Examine w/ color looking for areas of increased velocity or turbulence
Spectal Doppler is recorded in the area of the highest peak systolic velocity
The main renal artery has a quick upstroke w/ a sharp systolic waveform and low impedance flow pattern

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The segmental, interlobar and arcuate arteries all exhibit:

quick upstrokes in systole and a continuous low impedance flow pattern

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The smaller vessels have a :

lower peak systolic velocities

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The renal vein is examined with:

color and spectral Doppler for flow and direction of flow

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The renal vein waveform is a low velocity monophasic flow that responds to:

respiratory variations and flows away from the renal hilum

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What is the major cause of renal artery stenosis?

arteriosclerosis

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2 methods are used to determine renal artery stenosis:

Directly by evaluating the main renal artery

* Indirectly by evaluating the arcuate and interlobar arteries

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Direct method of renal artery stenosis: (3 characteristics)

Diagnosis relies on identifying a focal area of increased velocity by pulsed Doppler
color Doppler can facilitate locating areas of turbulent flow
> than 150-190 cm/s

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What is RAR?

Direct Method–Renal Aorta Ratio
compares the peak systolic velocity (PSV) of the AO to the PSV of the main renal artery
If the renal artery PSV of the main artry is 3.5 times > than the AO, a diagnosis of 60% or greater stenosis is made

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what is RI?

Resistive index:

peak systole-end diastole/peak systole

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What is a normal RI?

0.70 is the upper limits of normal (except in pts under the age of 6 and older pts)

What does the indirect method for determining renal artery stenosis do?

* evaluates for intrarenal arteries | * look at the wave form and evaluate the acceleration time and acceleratioin index

Indirect method--shows RAS when:

*the absence of ESP and prolonged systolic upstroke or acceleration time together with decreased peak systole and a dampening of the waveform

What is "tardus parus"?

Indirect method--describes the decreased acceleration time and the decreased peak

Renal Varients: (6 of these)

* Dromedary hump * junctional parenchyma defect * fetal lobulation * duplex collecting system * extrarenal pelvis

Renal abnormalities are abnormalities in:

number, size, position, structure or form

What is renal agenesis?

Failure of one or both kidneys to form - -bilateral renal agenesis: neither kidney formed - -unilateral renal agenesis: results in a solitary kidney which may be larger than normal kidneys to compensate

What is renal dysgenesis?

defective embryonic formation

What is renal pseudotumor?

overgrowth of cortical tissue that indents the echogenic renal sinus. May be mistaken for a renal tumor

What is supernumenary tumor?

complete duplication of the renal system

When should you look for a pelvic kidney?

When the kidney isn't seen in the normal position in the renal fossa.

Where are most ectopic kidneys located?

In the bony pelvis

Pelvic kidneys may be:

malrotated

Pelvic kidneys may stimulate:

an adnexal mass and may be associated with other abnormalities

Complications of pelvic kidneys: (3 things)

* chronic pyelonephritis * hydronephrosis * stones

What is a horseshoe kidney?

A fusion anomaly--fusion of the polar regions of the kidneys during fetal development--almost always the lower poles

Horseshoe kidney is commonly associated with:

improper ascent and malrotation of the kidneys

Horseshoe kidneys generally lie close to:

the spine

What is a crossed-fuse kidney?

Both kidneys are located on the same side of the body

With a crossed-fuse kidney, commonly the upper pole of the ectopic kidney is fused to the:

lower pole of the other kidney

How may duplication of the ureters be complete?

with separate ureters draining the upper and lower collecting systems of the kidneys

How do duplication of the ureters enter the bladder?

separately

Duplication of the ureters may be:

unilateral or bilateral

Duplication of the ureters are more common in:

females

Incomplete duplication of the ureters occurs when:

the ureters join together and enter the bladder as one

What is a utreterocele?

Cyst-like enlargement of the lower end of the ureter

Ureterocele is caused by:

congenital or acquired stenosis of the distal end of the ureter

Ureterocele may cause infection of the:

upper urinary system

If a ureterocele is large they may cause:

bladder outlet obstruction

Ureteroceles are found more often in:

adults than in children

US can be used to evaluate residual bladder volume in pts with:

outflow obstruction

How many planes is a post void bladder scanned in?

two

Bladder formula:

(Length x width x height) x .523

A residue of less than ________ cc of urine is considered normal in an adult

20 cc

What is the bladder and where is it located?

thin walled reservoir, behind the pubic bone

Normal bladder wall size:

<3mm distended

The bladder can hold:

600-800 ml of fluid

What is the top, bottom and middle of the bladder called?

apex=top neck=bottom trigone=middle

What is acute cystitis?

inflammation of the urinary bladder

Acute cystitis can be caused by: (7 things)

``` catheterization obstruction bladder calculi pregnancy getting pregnant sexual intercourse poor hygiene ```

Sonographic findings of acute cystitis:

thick urinary bladder, mucosa wall, smooth, continuous redundant and polypoid looking

Sonographic findings of a ureterocele:

Obstructed ureter, wall of ureter will balloon into the urinary bladder cyst-like enlargement lower end of ureter

What is a papiloma?

Pre-malignant tumor to transitional cell carcinoma

How big are papilomas?

.5-2cm

Papilomas have the same appearance as

TCC

Papilomas are located

lateral to bladder wall

Transitional Cell Carcinoma--TCC is the:

most common bladder tumor

Findings of TCC:

mass or focal thickening of wall | squamous cell--associated with infections, stones or strictures

Patent uracus occurs:

early in life continuous with allantois

Allantois progresses into urachus if:

lumen persists while urachus forms and a fistula develops

Patent urachus causes:

urine to drain from bladder to umbilicus

Urachal cysts develop if:

lumen persists

Posterior urethral valve syndrome occurs in:

male fetuses only; presence of valve in posterior urethra

Posterior urethral valve syndrome presents with: (3 things)

thickened urinary bladder wall (key hole sign) * hydronephrosis * hydroureter

What is prune belly syndrome? What is it 2ndary to?

* Dilation of the fetal abdomone | * 2ndary to severe bilateral hydronephrosis and fetal ascites, oligohydramnios

What is a urinary bladder extrophy?

fetal anomaly in utero; defect in abdominal wall of the urinary bladder *everted bladder becomes exposed on abdominal wall

Renal Vasculature Review Flashcards

(80 cards)