Renals Flashcards
(220 cards)
1
Q
The paired kidneys are ________, lying against the deep muscles of the back. The right is slightly ______ in location compred to the left.
A
retroperitoneal
inferior
2
Q
In relation to the right kidney: the adrenal gland is \_\_\_\_\_\_, liver is \_\_\_\_\_\_, right colic flexure is \_\_\_\_\_\_, and the 2nd portion of the duodenum is \_\_\_\_\_.
A
the adrenal gland is superomedial,
liver is superolateral,
right colic flexure is inferior, and the
2nd portion of the duodenum is medial
3
Q
In relation to the left kidney:
the adrenal gland is _____,
the spleen is _____,
pancreatic tail is _______ to the upper pole, and the left colic flexure is _____
A
the adrenal gland is superior,
the spleen is superior,
pancreatic tail is anterior to the upper pole, and the left colic flexure is inferior
4
Q
The diaphragm, psoas muscle ad QL muscle are on the ______ aspect of the kidneys.
A
posterior
Psoas - post/med to kidney
QL - immediately post to kidney
5
Q
At the hilum of the kidney the vein exits ______, the _____ enters between the vein and ureter, and the ureter exits _______.
A
anteriorly
artery enters between vein and ureter
posteriorly
6
Q
Describe the echogenicity of the renal cortex, medullary pyramids, renal sinus
A
renal cortex - isoechoic or hypoechoic
pyramids - anechoic
renal sinus - hyperechoic
7
Q
Outer renal parenchyma from base of medullary pyramids to renal capsule.
A
Renal cortex
8
Q
Normal thickeness of the renal cortex is > ____cm.
A
1cm
9
Q
Inner portion of the kidney from the base of pyramids to center of kidney.
A
renal sinus
10
Q
anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus.
A
Medullary pyramids
11
Q
Structures commonly seen in enonatal and pediatric kidneys.
A
medullary pyramids
12
Q
Funnel-shaped transition from the major calyces to the ureter
A
renal pelvis
13
Q
Medial opeining for entry/exit of artery, vein, ureter
A
renal hilum
14
Q
3 extension for the renal pelvis
A
Major calyces
15
Q
Extensions of the major calyces that collects urine from the medullary pyramids.
A
Minor calyces
16
Q
Apex of medullary pyramid.
A
renal papilla
17
Q
Fibrous sheath enclosing kidney and adrenal glands. Also referred to as the perirenal space.
A
Gerota’s fascia
18
Q
Functional unit of kidney consisting of the renal corpsucle, proximal convuluted tubule, descending and ascending limbs of Henle’s loop, distal convuluted tubule, and collecting tubles.
A
Nephron
19
Q
What structures are contained within the nephron?
A
renal corpuscle prox. convulted tubule desced/ascend limbs of Henle's loop distal convoluted tubule collecting tubules
20
Q
Consists of glomerulus and glomerular capsule (Bowman’s capsule)
A
renal corpuscle (malpighian body)
21
Q
Renal corpuscle is aka?
A
malpighian body
22
Q
Describe the arterial blood supply to the kidney
A
- MRA branches off the Ao and divides into 5 segmental arteries at the hilum,
- the segmentals divide into interlobar arteries between the medullary pyramids and travel perpendicular to the renal capsule
- At the base of the medullary pyramids, arcuate arteries branch from the interlobar in a manner that is parallel to the the renal capsule (difficult to obtain spectral bc perepndicular to beam)
- the interlobular arteries branch from the arcuate, running perpendicular to the renal capsule
23
Q
Lists the renal arterial supply in order
A
MRA Segmental Interlobar Arcuate Interlobular
24
Q
T/F - congenital anomalies of the genitourinary tract are more ocmmon than any other organ systems.
A
T
25
Complications associated with congenital abnormalities:
obtsruction/stasis leading to impaired renal function, infection, calculus formation
26
Emrbyologically, the kidneys originate in the _____ and _____ into the abdomen so that the upper pole of each kidney is more ____ than the lower pole.
plevis
ascend
medial
27
Ectopic kidney aka
pelvic kidney
28
Ectopic kidneys have an increased incidence for (3)
UPJ obstruction
ureteral reflux
multicystic renal dysplasia
29
Horseshoe kidneys are typically fused by the ______ poles across the ML and ______ to the Ao.
lower poles
| anterior
30
The large U-shaped horseshoe kdiney lies lower in the abdomen because ascent is prevented by the _____ _______ _____.
inferior mesenteric artery
31
Where are the ureters on a horseshoe kidney typically located?
anterior to the isthmus, could be mistaken for lymphadenopathy
32
Horseshoe kidney is associated with (5)
```
kidney stones
Infections
Turner Syndrome
Trisomy 13, 18, 21
Wilm's Tumor
```
33
Two kidneys are visualized on one side of the abdomen with absence of a contralateral kidney
Crossed fused renal ectopia
34
The developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carying the other one with it across ML.
Crossed fused renal ectopia
35
How are the ureters arranged in fused renal ectopic kidneys?
ureters connect on both sides of the bladder and one ureter crosses the ML
36
What are kidneys that fuse to form a round mass in the pelvis known as a discoid or pancake kidney?
fused pelvic kidney
37
Dromedary hump
common variant of cortical thickening on the lateral aspect of the left kidney
38
column of bertin (septal cortex)
Normal variation of prominent renal cortical parenchyma located between two medullary pyramids
-can give the appearance of a mass effect although the echogenicity is the same as the peripheral cortical tissue
39
junctional parenchyman defect
triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney
40
Junctional parenchymal defect is aka
fetal lobulation, which is partial fusion of the renunculi (embryonic kidney)
41
Duplex kidney
Complete or incomplete duplication of the collecting system
42
Complete duplex kidney
two ureters
43
incomplete duplex kidney
one ureter
44
Sonographic appearance of duplex kidney
typically longer
| complete central coritical break within the hyperechoic sinus
45
A frequent complication of ectopic ureter is a ______.
ureterocele
46
Uretertocele
prolapse of the distal ureter into the bladder
47
Complications of a prolapsed ureterocele that resulted from an ectopic ureter
hydroureter and hydronephrosis of the upper collecting system of the kidney (Weigert-Meyer rule)
48
With complete duplex kidney, double ureters, where does the ureter draining the upper pole typically insert?
Typically inserts in an ectopic location on the bladder, and is susceptible to developing ureteroceles
49
What is associated with oligohydramnios and pulmonary hypoplasia and is it compatible with life?
Bilateral renal agenesis
| No
50
what happens to the solitary kidney in unilateral renal agenisis?
compensatory hypertrophy in order to maintain normal renal function
51
Unilateral renal agenesis may be isolated congenital malformation or may be associated with chromosomal abnormalities or a variety of syndromes including ________ and _______.
VACTERL
| MURCS
52
VACTERL Syndrome (6)
```
V - vertebral defects
A - anal atresia
C - cardiovascular anomalies
TE - trachesophageal fistual
R - renal anomalies
L - limb defects
```
53
MURCS Syndrome (3)
MU - Mullerian agenesis
R - renal agenesis
CS - Cervicothoracic somite abnormalities
54
Unilateral renal agenesis is associated with genital anomalies related to what embryological origin in females and males?
Mullerian Duct derivative for females
-Uterus or Vagina could be abnormal or atretic
-bicornuate/unicornuate, ipsilateral blind vaginas and mullerian duplications
Wolffian Duct derivative in males
-abscence of the seminal vesicles and vas deferens and seminal vesicle cyst
55
Where is the renal pelvis normaly located?
within the renal sinus
56
Where is an extrarenal pelvis found?
lies outside the renal sinus
| appears as a cystic collection medial to the renal hilum
57
POsterior uretheral valve is a common cause of ______ _______ in the male neonatal patient.
urinary obstruction
58
What causes the obstrcution in posterior uretheral valve?
due to a flap of mucosa that has a slit-like opening in the area of the prostatic urethra
59
What findings indicate posterior uretheral valve (4)?
large bladder
hydroureter
hydronephrosis
urinoma
60
SImple renal cysts occur in _____% of the people over the age of 50.
50%
61
Sonographic criteria for simple renal cysts
acoustic enhancement
absence of internal echoes
sharply defined wall
round or oval shape
62
Most renal cysts are simple ____ cysts that originate from obstructed _____ _______.
cortical cysts
| uriniferous tubules
63
What are threee types of renal cysts?
pylogenic
parapelvic
peripelvic
64
pylogenic cysts
calyceal diverticula that sonographicaly appear as a simple cyst
65
parapelvic cysts
cortical cysts that bulge into the central sinus of the kidney
parenchymal cysts
66
peripelvic cysts
lymphatic cysts in the central sinus
67
T/F - sonographically the different types of renal cysts can be distinguished.
F - they cannot be distinguished, U/S determines the location - cortical/ parenchymal cysts in the periphery and periplevic cysts in the center/sinus
68
A renal ________ may mimic a simple cyst and is typically associated with a history of renal Bx or trauma.
pseudoaneurysm
| put color on teh cyst-like structure is you know they've had surgery
69
How can a renal abscess be distinguished from a hemorrhagic renal cyst?
If no air then percutaneous aspiration
70
T/F - Cysts with a single thin septation, minimal wall calcification, internal echoes cuased by artifact or lobulated shaped may all be associated with simple benign cysts.
T - atypical renal cysts
71
When it comes to renal cysts, what characteristics are atypical and suggest malignant cystic lesion?
multiple or thick septation
thick calcifications
mural nodule/soild component
-reuires FNA
72
Bosniak Renal Cyst Classification
defines imaging characteristics that relate to increased chances of malignancy into 4 stages
73
ADPKD
autosomal dominant polycystic kidney disease
74
development of numerous cyst of varying sizes
ADPKD
75
ADPKD is associated with cysts in the _______, _______, and _______.
LIV, PANC, SPL
76
ADPKD results in bilateral renal ________.
enlargement
77
At what age is ADPKD or multiple renal cysts identified?
20-30 years
78
Detsruction of the residual renal tissue ADPKD in advanced stages leads to renal ______ and ______.
renal failure and HTN
79
T/F - ADPKD is associated with arterial aneurysms?
T
80
What type of arterial aneurysms is associated with ADPKD?
cerebral arterial (Berry) aneurysms of the circle of Willis
81
Autosomal Recessive POlycystic Kidney Disease
cystic dilation of the collecting tubules secondary to hyperplasia of the interstitial portions of the ducts resulting in multiple small cysts throughout kidney sonographically
82
Sonographic findings of ARPKD
enlarged kidneys bilaterally
hyperechoic parenchyma
loss of cortical medullary distinction
83
ARPKD is associated with (3)
pulmonary hypoplasia (from oligo)
hepatic periportal fibrosis
portal HTN
84
Can ARPKD be detected in uetero?
Yes, assoc with oligo
85
POtter Syndrome
typical physical appearance of a neonate as a direct result of olig and compression while in utero
86
Causes of Potter Syndrome (6)
ARPKD
| Auotosomal Dominant POlycystic Kidney diesease
87
Most common cause of an abdominal mass in newborns?
MCDK (multicystic dysplastic kidney)
88
A form of renal dysplagia characterized by multiple noncommunicating cysts with the absence of renal parenchyma.
multicystic dysplastic kidney
89
MCDK result from what?
atresia of the uteropelvic junction during fetal development
90
Is MCDK unilateral or bilateral?
can be both but typically unilateral
| -the contralateral kidney is usually normal, but up to 10% may have UPJ obstruction
91
What syndromes is MCDK related to (3)
Beckwith-Wiedemann syndrome
Trisomy 18
VACTERL
92
T/F - many urinary and non-renal malfomations are associated with MCDK
T
93
Describe the progression of MCDK
may persist w/o change
may increase in size
may spontaneously involute and disappear
94
Congenital causes of UPJ obstruction
ureteral hypoplasia
high insertion of the ureter into renal pelvis
compression by segmental artery
95
Anomalies associated with UPJ obstruction
```
MCDK
renal agenesis (contralteral)
duplicated collecting system
horseshoe kidney
ectopoic kidney
```
96
Sonographic evidence of Medullary sponge kidney
hyperechoic medullary pyramids
97
In medullary sponge kidney, what causes the congenital dysplastic cystic dilatation of the medullary pyramids?
tubular ectasia or dysplasia, ectataic collecting tubules
| then urinary stasis and calcium deposits form in the dilated tubules
98
Long-term hemodialysis can affect the kidneys how?
acquired cystic disease, development of multiple cysts in chronically failed kidneys
99
Renal dialysis patients who develop acquired cystic disease are at risk for what?
hemorrhage often occurs in the acquired cysts, resulting in pain and hematuria
also predisposed to RCC
100
Inherited disease which usually presents in the 2nd or 3rd decade of life with serous visual impairement due to the development of cysts throughout the body
Von Hippel-Lindau Disease
101
VHLD is characterizied by retinal and central nervous system ___________.
hemangioblastomas
102
VHLD includes what other related tumors in the abdomen (4)
RCC (clear cell?
pheochromocytomas
iselt cell tumors (neuroendocrine?
renal and pancreatic cysts
103
If suscicion for VHLD, imaging should focus on what 3 organs?
kidneys, adrenal glands, pancreas
104
80% of AMLs involve the _____ kidney
right
105
hyperechoic benign renal mass with echogenicity greater than or equal to the of the renal sinus
angiomyolipoma
106
what kind of artifact is associated with AMLs
propagation speed, reuslting in posterior displacement of structures due to slower acoustic velocity in the fatty mass
107
Multi-system genetic disease that prsents classically with seizures,mental retardation and facial angiofibromas
tuberous sclerosis
108
Patients with tuberous sclerosis have an increased risk for _____ _____ and __________, and _____ _____ _____
renal cysts
angiomylipomas (usually bilateral)
renal cell carcinoma
109
Most common soild renal mass in adults.
renal cell carcinoma
110
What 4 conditions predispose patients to developing RCC?
acquired cystic disease from chronic dialysis
von Hippel-Lindau Disease
tuberous sclerosis
ADPKD
111
RCC is typically a unilateral encapsulated mass that is _____ relative to the normal adjacent parenchyma. Patients commonly presnet with _________.
hypoechoic
hematuria
-males may have varicoceles due to occclusion of the testicular (gonadal vein)
112
Most common site for mets from RCC
lungs
113
T/F - RCC tumor extension into the renal veins and IVC is common
T
114
Renal oncocytoma is difficult to distinguish from _____ ______ _____.
renal cell carcinoma - epidemiology, presentation, imaging and even histology can be similar
115
Renal oncocytomas are relatively benign tumors and patients are usually ______.
asymptomatic, found incidentially
116
Sonographic appearance of renal METS from lung, breast, colon, etc
hypoechoic masses in the renal parenchyma or diffusely enlarged inhomogeneous kidney
117
Malignant cells from _____ and ____ can metastasize to the kidney.
leukemia, lymphoma
118
Most common childhood renal tumor?
Wilm's Tumor (nephroblastoma)
119
When do Wilm's tumors usually present?
3.5 years
120
What do patients with Wilm's Tumor usually present with?
asymptomatic flank mass
HTN
fever
hematuria
121
METS from Wilm's tumor can be seen to the ____, _____, ______, _____ _____, and ____________.
```
lungs
liver
bone
lymph nodes
retroperitoneum
```
122
What important DDx must be rulled out before diagnosis Wilm's tumor?
Wilm's tumor must be differentiated from adrenal neuroblastomas.... Wilm's will destroy the renal contour where as an adrenal neuroblastoma usually doesnt disrupt the renal contour
123
Most common renal tumor in neonates and infants
mesoblastic nephroma3% of PED renal tumors
124
Can mesoblastic nephroma be diagnosed prenatally?
Yes, poly in 71% of cases
125
It is diffiuct to distinguish mesoblastic nephorma from ______ ______.
Wilm's tumor
126
T/F mesoblastic nephroma is benign
F - initially thought to be benign but more of a spectrum exists with the classic type as benign and the cellular variant being aggressive
127
pyelonephritis
bacterial invasion of the renal parenchyma
128
T/F - most renal infections occur as a result of ascending infection from the bladder
T - they are usually caused by gram-negative bacilli from the intestional tract
129
Acute pyelonephritis ultrasound findings include (3)
renla enlargement
hypoechoic parenchyma
absence of sinus echoes, loss of cortical/medullary boundary
130
What acute pyelonephritis appears as a wedge-shaped area or a hypoechoic renal lobe it is referred to as what?
acute focal baterial nephrits or lobar nephronia
| a similar appearance can be seen in focal ischemia ad renal infarction
131
bacterial infection that is associated with renal ischemia and usually requires a nephrectomy.
Emphysematous pyelonephritis
132
What kind of patients are associated with emphysematous pyelonephritis?
87-97% diabetics
immunosuppressed
those with UTIs
133
Emphysematous pyelonephritis results from _____ bacteria that produce intrarenal gas, which casues ______ and ______ artifacts.
anerobic
| reverberation and comet-tail
134
Recurrent renal infection that casues renal injury and end-stage renal disease is known as
chronic pyelonephritis
135
Chronic pyelonephritis infection reuslts from _3)
anatomic anomalies
obstructive lesions
ureteral reflux
136
sonographic appearance of chronic pyelonephritis
small hyperechoic kidney with cortical thinning (parenchyma)
137
Staghorn calculus is associated with what type of chronic pyelonephritis resulting from chronic infections from long-term obstruction?
XGPN - xanthogranulomatous pyelonephritis
138
associated fidnings with XGPN (8)
```
renal enlargement
parenchymal abscesses
staghorn calc
papillary necrosis
hydronephrosis
pyonephrosis
loss of cortical-medullary boundary
cortical thinning
```
139
Infection secondary to renal obstruction that presents with dilated renal collecting systems, hyperechoic purulent debris material in the collection system of the kidney
pyonephrosis
140
T/F - percutaneous or surgical drainage is required for treatment of pyonephrosis
T
141
Common fungal infections of the urinary trcat that appear as hyperechoic nonshadowing masses
mycetoma (fungal ball)
142
Where do fungal infections tend to occur in the kidney?
In the drainage structures vs the parenchyma
ex: PT with systemic candidiasis are vulnerbale to the formation of cortical abscesses or obstructive intrarenal masses (fungal balls) usually at the renal pelvis
143
Hyperechoic masses
```
mycetoma
AML
blood clots
pyogenic debris
sloughed papilla
renal stones
```
144
Rapid decrease in renal function characterized by low urine output or increased serum BUN or creatinine
acute kidney injury or acute renal failure
145
What are the 3 main mechanisims for AKI?
Prerenal failure - inadequat perfusion
Intrinsic Renal failure - pathology within kidney
Postrenal failur - obstructive nephropathy
146
Prerenal failure is charcterized by inadequate perfusion due to (3)
hypotension (low BP)
volume depletion
decreased cardiac output
147
Intrinsic renal failure results from pathology within the kidney from things such as (3)
acute tubular necrosis
acute glomerulonephritis
nephrotoxins
148
Postrenal failure result from obstructive nephropathy from (3)
obstructive tubules with precipitates
bilat ureteral obstrcution
bladder outlet obstruction
149
In tha case of AKI, ultrasound is used to identify _______ and abnormal _____ ______.
hydronephrosis = postrenal failure
| abnormal RI = suggests intrinsic
150
Common causes of renal vein thrombosis (6)
```
nephrotic syndrome
hypercoagulabilty disorders
malignant renal tumors
extrinisc compression
trauma
transplant rejection
```
151
Sonographic fidnings suggestive of renal vein thrombosis (4)
dilated thrombosed RV
absent intrarenal venous flow
enlarged hypoechoic kdiney
high-RI RA
152
Renal arery thrombosis is a sudden cause of _______ failure that presnts with (3)
prerenal
acute flank pain
hematuria
sudden rise in BP
153
Sonoraphic fidninsg associated with renal artery thrombosis (3)
focal hypoechoic areas of infarct
absence of intrarenal arterial flow
renal enlargement
154
Songraphic fidnings associated with ATN
renal enlargement
| increased RI
155
_____ ______ ______ is the most common casue of AKI (medical renal disease/intrinsic renal failure)
acute tubular necrosis
156
ATN likely occurs in patients with history of recent _____, _____, or ______.
surgery
sepsis
hypovolemia (dec blood volume circulating)
157
What does ATN result from?
prolonged ischemia or nephrotixins (drugs and contrast agents), which casues damage to the tubular epithelium of the nephron and acute renal failure
158
T/F - the renal insufficiency that occurs in ATN can be reversible.
T
159
______ _____ is an inflammatpry response resulting in glomerular damage caused by infectious and noninfectious casues.
Acute glomerulonephritis (GN)
160
Clinical presentation of acute GN
sudden onset of hematuria, proteinuria, RBC casts in the urine
-often accmpanied by HTN, edema, azotemia (dec GFR), renal salt/water retention
161
MOst common infectious casue of acute GN?
infection by stretococcus species due to upper respiratory and skin infections
162
Sonographic fidninsg associated with acute GN?
renal enlargement
| increased RI
163
Adult hydronephrosis
dilatation of the renal pelvis and calyces from an anechoic urine collection
164
Hydro secondary to obstruction can lead to what if left untreated?
HTN
loss of renal function
sepsis
165
Common casues of adult hydro (6)
```
calculi
benign prostatic hypertrophy
prostate ca
pelvic malignancies
pregnancy
UPJ obstruction
```
166
What are three common areas of obstruction by a stone causing adult hydro
UVJ*
UPJ
Pelvic brim
167
How else can can obstrcutive nephropathy be diagnosed?
By evalulating intrarenal vascularity]RI > 0.7 = suggests obstructive hydro
168
Newborn/Prenatal hydro can occur for a variety of reasons, the most common include: (3)
vesicoureteral reflux
non-obstructive hydro
UPJ obstruction
169
T/F - renal pelvic dilatation in PEDS can be transient, most pateints with moderate hydro will resolve by 18 months of age.
T
170
An increased risk of congenital anomalies of the kidney and urinary tract are assoicated with the presence of ____ ___ abnormalities and ____ ____ _____.
outer ear
| single umbilical artery
171
spinal and/or LE abnormalities may be assoicated with a _______ _____, which is assocaited with ______ and _____ ______.
neurgenic bladder
hydro
dilated ureters
172
What does billateral hydro suggest in a PEDS pateint?
an obstructive process at the level or diatls to the bladder (ureterocele or posterior uretheral valves in male infants)
173
What is the graded severity for hydro postnatally, performed after 48hrs of life in a full-term infant.
NML <7mm
Mild 7-8mm
Mod 9-15mm
Severe >15mm (at greastes risk for renal diz and surgery)
174
What is the most common casue of pediatric hydro?
UPJ obstruction
| occurring more in males on the left kidney
175
What qualifies as a megaureter?
Diameter >7mm
176
How is megaurter classified?
according to the presence or absence of reflux and obstruction
177
What is obstrcutive primay megaureter?
- distal adynamic segment with proximal dilatation, -ureter tapers to a short segment of narrowed distal ureter, usally just above the VUJ (vesicoureteric junction)
- assoicated hydro and active peristaltic waves seen
- bilateral involvement in 20% of patients
- male:female 4:1, left side more than right
178
What casues secondary megaureter?
abormalities that involve the bladder or urethra such as: neurgenic bladder, prune belly syndrome, posteriro urethral valves
179
Nephrocalcinosis related to hyperparathyroidism is aka
Albright's calcinosis
| Anderson-Carr Kidneys
180
Nephrocalcinosis
deposition of microscopic crystaline calcium precipitates
181
renal stones in the collecting system
Nephrolithiasis
- presents with acute flank.back pain radiating down ipsilateral groin
- if severe, fever, chills, dysuria (discomfort with urination), cloudy urine,hematuria
182
What is the single most common cause of nephrocalcinosis in adults?
primary hyperparathyroidism
183
caclium deposits in the renal pyramis (papillae)
Anderson-Carr-Randall
184
Sonographic presentation of papillary nephrocalcinosis
- echogenic material in collecting system (sloughed papillae)
- triangular cystsic collection representing the absence of medullary pyramids
- bright echoes produced by arcuate arteries at the base of pyramids
185
What is papillary necrosis?
necrosis of the meduallary pyramids and papillae brought on by several conditions and toxins leading to ischemia of the pyramids
186
How is the clincial diagnoses of paillary necrosis achieved?
identifying sloughed papillae in the urine
| -passage can casue pain and urinary tract obstrcution
187
What conditions are associated with papillary necrosis?
DM
analgesic abuse
sickle-cell disease
188
______ _____ was orginally described with the overuse of analegesics containing phenacetin, but also NSAID.
analgesic nephropathy
189
Increase renal sinus fat that replaces normal renal parenchyma, causes compression of teh calyces and renal pelvis.
renal sinus lipomatosis
190
Sono findings of renal sinus lipomatosis
increase in central sinus echo complex with cortical thinning
191
Bladder is located behind the ____ ____. The apex points ________ and is connected to the umbilicus by the ______ ______ ________ (urachus).
pubic bone
anteriorly
median umbilical ligament
192
The ureters enter the bladder at the _______ angle of the trigone and ext the bladder via the _____.
supeolateral
| urethra
193
What is the normal wall thickness in a distended and nondistended bladder?
<3mm distended
| <5mm nondistended
194
What are bladder diverticula?
herniations of the bladder mucosa through the bladder wall musculatur
195
Most acquired bladder diverticula are associated with longstanding bladder ____ ______ due to benign _____ _______.
outlet obstruction
| prostatic hypertrophyr
196
______ _____ is a cystic dilatation of the fetal urachus. Seen sonographically as a cystic structure superior and anterior to the bladder
Urachal cyst
197
The ureters exit the kidney _____ to the RA and RV. Descending inferiorly, the ureters lie on the _____ surface of the psoas. In the pelvis, the ureters cross ______ to the common iliac vessels to insert upon the ______ of the bladder.
posterior
anterior
anterior
trigone
198
Cyst-liek enlargement of the lower end of the ureter which projects into teh bladder lumen at the UVJ.
ureteroceles
199
Ureteroceles are most commonly found in association with what?
compelete ureteral duplication from duplex kidney, ectopic insertion into the bladder
200
Most common bladder neoplasm
TCC (trasnitional Cell Carcinoma)
-urinary tract is lined with trasitional cells, so can occur in the ureters or renal pelvis but more commonly the bladder
201
Sonographc finding of TCC
solid mass or focal thickening of bladder wall
| -hydro may be caused by TCC originating in the ureter
202
Most common clinical finding of TCC
hematuria
203
In addition to TCC, what other bladder masses are there (6)
```
cystitis
prostate ca
squamous cell ca
blood clots
pyogenic debris
bladder papilloma
```
204
Renal dysfunction, caused by a variety of reasons, results in loss of diastolic flow and increased renal arterial resistance. RA normally demosntrated continuous forward flow during diastole (low resistance). What is the equation for RI?
RI = peak systolic freq - end diastolic freq/peak systolic freq
205
Normal RI
<0.7
0. 5 = diastole is 50% of systole
0. 7 = diastole is 30% of systole
1. 0 = diastole is absent
206
Symtoms of renal artery stenosis
sudden onset of HTN
| uncontrollable HTN
207
A hemodynamically significant renal artery stenosis may produce decreased renal size ____
<9cm in length
208
Direct eval for RA stenosis
renal artery velocities
| RA/Ao ration (RAR) >3.5 = suggests at least a 65% stenosis
209
Indirect eval for RA stenosis
```
intrarenal waveforms
parvus tardus (small slow pulse) mole hill appearance
absent early systolic peak
```
210
Most common casue of renal disease (ESRD) leading to kideny trasnplantation.
diabetes
211
Why is the left kidney preferred for harvesting?
because the renal vein is longer
212
In the immediate posttransplant period, poor function may be the result of _____ _____ ____.
acute tubular necrosis
213
Post-tx complications
```
fluid collections
-hematomas, 24 hrs
-urinomas, 24 hrs
-lymphoceles
-abscesses
RA kinking or thrombosis
RV thrombosis
```
214
The Tx ureter is attache dto the ____. The arterial anastomoses may be with the ______ or _______ ____ ____.
bladder
| EIA or IIA
215
Sonographic findings of acute Tx rejection:
renal enlargement
dec echogenicity
loss of cortical medullary boundary
inc flow resistance index
216
Describe the breakdow ofRIs to evaluate the arterial flow resistance in the renal vascualr bed of a Tx
<0.7 = NML
0.7 - 0.8 = quetsionnable Tx dysfunction
>0.8 = Tx dysfunction
217
Urinalysis
```
microscopic examination of sediment and qualitative evaluation of the following in urine:
specific gravity
acidity
protein
glucose
ketones
blood
nitrates
WBCs
bilirubin
```
218
waste/break-down product of skeletal muscle that is filtered out of the blood by the kidneys
serum creatinine - thresholdsmay vary 1.2 to 2.0 depending on the amount of skeletal muscle
219
determines stages of kideny disease, calculated by determing creatinine clearance
glomerular filtration rate
220
_____ is produced by the liver and is a waste product of protein metabolism.
Urea/blood urea nitrogen
| BUN is unsuitable as a single measure of renal function because it varies with urine flow rates and production of urea
