Flashcards in Urinary Deck (293):
1
What is the path of blood to and from the kidneys?
RA
Segmental A.
Interlobar A.
Arcuate A.
Interlobular A.
Afferent Arterioles
Efferent Arterioles
Peritubular Capillaries/Vasa Recta
Venules
Interlobular V.
Arcuate V.
Interlobar V.
Segmental V.
RV
2
What is the structure called in which the glomerulus is located?
Bowman's Capsule
3
What is the path in the nephron?
Glomerulus
Bowman's Capsule
Proximal Convoluted Tubule
Descending limb
Loop of Henle
Ascending limb
Distal Convoluted Tubule
Collecting Duct
Calyx
4
What do the kidneys do? (5)
- Get rid of waste products from blood
- Balance volume of fluid in body
- Change BP
- Produce active Vitamin D
- They help make RBCs
5
What is the standard size of a kidney?
9-12cm
6
Every day our kidneys perform an essential job of filtering _____ of blood, to remove about _____ of waste products and unneeded water.
200 liters
2 liters
7
As early as the _____ week of embryonic development, the kidneys begin to form. The _____, or the functional units of a kidney, begin to function approximately at _____ weeks.
3rd
nephrons
8
8
The kidneys migrate from their pelvic location to the _____. This migration is not complete until _____ years of life, therefore the kidneys in infants and young children are located more _____.
abdomen
6
caudal
9
In the adult, each kidney is about the size of a tightly clenched _____ and each one measures between _____-_____ and weighs between _____-_____.
fist
9-12 cm
120-170 grams
10
The paired kidneys are retroperitoneal and lie against the _____ of the back. The right is slightly _____ in location as compared to the left.
deep muscles
inferior
11
The reddish-brown organs are _____ (convex/concave) laterally and _____ (convex/concave) medially.
convex
concave
12
On the medial border is an indentation called the renal _____ that leads into a space called the renal _____. _____, _____, _____, and _____ enter or exit the hilum and occupy the sinus.
renal hilum
renal sinus
renal blood vessels
lymphatics
nerves
ureter
13
If you want to test if what you see is hydro, have the patient _____ and check again. If the cortex has shrunk down, it was normal back up. If the cortex stays the same, it probably is hydro.
void
14
The parenchymal volume of the right kidney is _____ (more/less) than the left.
less
15
What are possible explanations for the parenchymal volume being less on the right kidney? (2)
1) the spleen is smaller than the liver, which allows for more left kidney growth.
2) the LRA is shorter than the RRA, therefore increased blood flow in the LRA results in increased renal volume.
16
The left kidney usually lies _____ (measurement) _____ (higher/lower) than the right.
1-2cm
higher
17
The kidneys are mobile and will move depending on _____. In the supine position, the superior pole of the left kidney is at the level of the _____ thoracic vertebrae and the inferior pole is at the level of the _____ lumbar vertebrae.
body position
12th
3rd
18
Within the renal sinus are major branches of the RV, which exits _____, the ureter which exits _____ and the RA which _____ (exits/enters) between the vein and the ureter.
anteriorly
posteriorly
enters
19
Also within the renal sinus is the collecting system. The collecting system (renal pelvis) lies _____ to the renal vessels in the renal hilum. The remainder of the renal sinus is packed with _____.
posterior
fat
20
To the RT kidney:
The adrenal gland is _____.
The liver is _____.
The RT colic flexure is _____.
The 2nd portion of the duodenum is _____.
superomedial
superolateral
inferior
medial
21
To the LT kidney:
The adrenal gland and spleen are _____.
The pancreatic tail is _____ to the superior pole.
The left colic flexure is _____.
superior
anterior
inferior
22
The diaphragm, psoas muscle, and the _____ muscle are on the _____ aspect of the kidneys.
quadratus lumborum
posterior
23
The renal parenchyma is composed of _____ and _____.
cortex
medullary pyramids
24
Echogenicities (compared to liver):
The renal cortex is _____ or _____.
Medullary pyramids are _____.
The renal sinus is _____.
isoechoic or hypoechoic
anechoic
hyperechoic
25
The 13 major structures that the kidneys are composed of are:
cortex
medulla
columns
sinus
pyramids
pelvis
hilum
major calyces
minor calyces
papilla
Gerota's Fascia
nephron
corpuscle
26
The renal cortex is the outer renal _____. It extends from the _____ to the _____.
parenchyma
sinus
capsule
27
The renal medulla is the _____ portion of the kidney. It extends from the _____ of the _____ to the _____ of the kidney.
inner
base of the pyramids
center
28
The renal column is between the renal _____.
renal pyramids
29
The renal sinus is the cavity within the kidney which houses the renal _____. _____ and blood vessels pass into the renal sinus through the _____.
pyramid
nerves
hilum
30
The renal pyramids are _____ (echo), _____-spaced triangles of collecting tubules, between the _____ and the renal _____.
anechoic
equally
cortex
sinus
31
The renal pelvis (AKA ______) is a _____-shaped transition from the _____ calyces to the _____.
collecting system
funnel
major
ureter
32
The renal hilum is the _____ opening for the entry/exit of the _____, _____, and _____.
medial
Artery
Vein
Ureter
33
The hilus is the slit-like opening in the middle of the _____ concave/convex) _____ (lateral/medial) border of the kidney. Nerves and blood vessels pass through the hilum into the renal _____ within.
concave
medial
sinus
34
These are the recesses in the internal medulla of the kidney which enclose the pyramids. They are used to subdivide the sections of the kidney anatomically, with distinction being made between major _____ and minor _____.
calyces
calyces
calyces
35
These are used to subdivide the sections of the kidney.
calyces
36
The portion of the urinary collecting system within the kidney that drains several minor calyces. The major calyx collects urine from several renal _____; all major calyces unite to form the renal _____.
major calyces
papillae
pelvis
37
These are extensions of the major calyces that collect urine from the medullary _____.
minor calyces
pyramids
38
This is the apex of the medullary pyramids and is _____-shaped.
papilla
U-shaped
39
This fibrous sheath enclosing the kidney and the adrenal glands. It is AKA _____.
Gerota's Fascia
perirenal space
40
This is the functional unit of the kidney.
nephron
41
The nephron consists of (6)
renal corpuscle
prox convoluted tubules
descending and ascending limbs
Henle's Loop
dist convoluted tubules
collecting tubules
42
About _____ nephrons are in the _____ of each kidney
1 million
cortex
43
This consists of the glomerulus and glomerular capsule (or _____ Capsule). AKA _____.
renal corpuscle
Bowman's Capsule
Malpighian Body
44
The central region of the kidney has structures for urine collection and transport. Renal _____ project and drain into cuplike _____ calyx. The calyces unite to form the _____ calyx. These calyces unite to form funnel-like renal _____. This renal _____ tapers to the muscular tube _____. This transports urine to the _____.
papilla
minor
major
major
pelvis
ureter
urinary bladder
45
Basic path of waste is to the _____ of the pyramid, then to the _____, then the _____, then the _____, then the ureter.
apex
minor calyx
major calyx
collecting system
46
The kidneys are supplied with arterial blood via the _____, which branches off the AO.
main renal artery
47
At the hilum, the main renal artery divides into 5 _____.
segmental arteries
48
At the level of the medullary pyramids, the segmental arteries divide into the _____, which run between the _____.
interlobar arteries
pyramids
49
At the base of the medullary pyramids, the _____ branch in a manner that is _____ (direction) to the renal capsule.
arcuate arteries
parallel
50
Branching off the arcuate arteries and running perpendicular to the renal capsule are the smallest renal arteries called the _____.
interlobular arteries
51
T or F? Congenital anomalies of the genitourinary tract are more common than any other organ system anomalies.
True
52
Complications associated with congenital anomalies of the genitourinary tract are associated with these abnormalities (3):
impaired renal function
infection
calculus formation
53
During normal development, there is partial fusion of the 2 parenchymal masses called _____. If defects occur at this site, they must not be confused with pathalogic processes such as renal _____ and _____. This is referred to as a _____.
renunculi
scars
angiomyolipomas
junctional parenchymal defect
54
Typically, a junctional parenchymal defect is located _____ (relationship) and _____ (relationship) as a triangular _____ (echo) area and is seen more often on the _____ kidney.
Also known as _____, which is partial fusion of the _____ (embryonic kidney).
anteriorly
superiorly
hyperechoic
right
fetal lobulation
renunculi
55
This is a normal variant located between 2 medullary pyramids that gives the appears of a mass. The echogenicity is EQUAL to the peripheral cortical tissue.
Hypertrophied Column of Bertin
56
This is a common variant of cortical thickening on the lateral aspect of the _____ kidney.
Dromedary hump
left
57
This word means displaced in a location away from the normal position.
ectopic
58
This variant of kidney formation results from a failure of the kidneys to ascend into the abdomen. Often this kidney is also referred to as a _____ kidney.
ectopic
pelvic
59
With ectopic kidneys, there is an increased risk of _____, _____ reflux, and _____ renal dysplasia.
UPJ (uteropelvic junction)
uretral
multi-cystic
60
When there is a single kidney transplanted, the kidney is often placed on the _____ side of the _____.
right
pelvis
61
This is when the developing kidneys fuse together at the lower poles.
Horseshoe kidney
62
Horseshoe kidneys are AKA
cake or lump kidney
63
This is a defect in which the upper and lower poles of the two kidneys are fused and form a round mass in the pelvis. AKA _____ or _____ kidney. What is the state of the ureters? The total kidney appearance is _____ and _____.
fused pelvic kidney
discoid or pancake kidney
each kidney has a distinct ureter that opens normally into the bladder
irregular
lobulated
64
What poles are involved with a horseshoe kidney? What poles are involved with a fused pelvic kidney?
lower poles
upper and lower poles
65
This is the 2nd most common renal fusion anomaly.
crossed fused ectopic kidney
66
What is crossed fused ectopic kidneys?
The developing kidneys fuse while in the pelvis and one ascends to its normal position, dragging the other behind across the midline. Two kidneys are visualized on one side of the abdomen with the absence of a contralateral kidney.
67
What is the state of the ureters with a cross fused ectopic kidney?
They connect on both sides of the bladder, which means one ureter has to cross the midline.
68
This is a duplication of the collecting systems that occurs in about 15% of the population. It may be complete with 2 ureters or incomplete with 1 ureter.
Duplex kidney
69
How differently does a kidney appear when there is a duplex kidney malformation?
It has a separation of sinus/medullary areas, divided by a central cortical break that reaches to both sides of the kidney. It is usually longer than a regular kidney.
70
Describe an incomplete duplex kidney.
it has two ureters at the kidney that fuse together along the path to the bladder.
71
With complete double ureters, the ureter draining the _____ pole typically inserts in an _____ location in the bladder.
superior
ectopic
72
A frequent complication of ectopic ureter is a _____.
ureterocele
73
This is a prolapse of the distal ureter into the bladder. It will result in a _____ and _____ of the upper collecting system of the kidney.
ureterocele
hydroureter
hydronephrosis
74
If not corrected, the blockage in a ureterocele can cause the kidney to lose its ability to _____ and _____, and it can also give rise to dangerous _____.
purify blood
produce urine
infections
75
This is normally located in the renal sinus. It is a variation in which the renal pelvis lies outside the renal sinus, sonographically appearing as a cystic collection _____ to the renal hilum.
extrarenal pelvis
medial
76
Bilateral renal agenesis is associated with _____ and _____, and is incompatible with life.
oligohydramnios
pulmonary hypoplasia
77
Can compensatory hypertrophy of a solitary kidney maintain normal renal function?
yes
78
Unilateral renal agenesis is frequently associated with _____. AKA _____ in females and _____ in males. Typically, this kidney is _____ (bigger/smaller) than usual, about _____. This is because...
uterine duplication
bicornuate uterus
seminal vesicle agenesis
bigger
14-16cm
it is bigger so it can do the work of 2 kidneys
79
This is the term for more than 1 kidney on one side. It is a rare anomaly and is usually _____ (bigger/smaller) than normal and can be found _____, _____, _____, or _____ the normal kidney.
supranumerary kidney
smaller
above
below
in front of
behind
80
This is a common cause of urinary obstruction in the male neonate patient.
posterior urethral valve
81
What is a posterior urethral valve?
It is an abnormal congenital membrane located within the posterior male urethra and obstructs it from normal bladder emptying.
82
A posterior urethral valve can increased _____ pressures and may alter normal development of the fetal _____ and _____.
voiding
bladder
kidneys
83
An exterior symptom of a posterior urethral valve is
a hard pelvis
84
The preferred examination for a posterior urethral valve is a renal ultrasound in the male newborn. The findings can show (3)...
very large, thick-walled bladder
dilated ureters (hydroureter) with bilateral hydronephrosis
dilated posterior urethra – “Keyhole” appearance
85
_____ continues to be a very, very important part of end-stage renal failure in children and accounts for about _____ of all boys with end-stage renal failure.
Posterior urethral valve
1/4
86
Simple renal cysts occur in 50% of people over the age of 50. Most renal cysts are _____ cysts.
50%
simple cortical cysts
87
The 3 types of renal cysts are
Pyelogenic cysts
Parapelvic or Peripelvic cysts
Cortical or Parenchymal cysts
88
This type of renal cyst is usually discovered as an incidental finding on intravenous urography. Since the cyst communicates with the collecting system of the kidney, it may become infected and act as a reservoir for bacteria in chronic urinary tract infections. AKA _____.
pyelogenic cyst
calyceal diverticulum
89
_____ in the pyelogenic cysts predisposes one for stone formation and most likely _____.
Stasis
hematuria
90
The initial symptom for a pyelogenic cyst may be _____, which is believed to be related to poor drainage due to pressure on the _____.
loin pain
calyx
91
Pyelogenic Renal Cyst = cyst with a
stone
92
_____ in a small renal cyst or a _____ is quite common. The main sonographic features are echogenic material layering in the _____ portion of a cyst, associated with reverberation echoes _____ (with/without) shadowing. Shadowing was seen when MOC was present in larger amounts. Because MOC is usually _____ and requires no treatment, differentiation from other lesions, such as calculi or _____, is important for proper patient management.
Milk of Calcium (MOC)
calyceal diverticulum
dependent
without
asymptomatic
angiomyolipomas
93
Parapelvic =
bulge into the sinus
94
Peripelvic cysts =
originate in the sinus
95
Parapelvic and Peripelvic cysts are generally located in what region of the kidney?
center of kidney/renal sinus
96
Cortical or parenchymal cysts are located in what region of the kidney?
in the periphery
97
Can the different types of renal cysts be distinguished with U/S?
No
98
Although the different types of renal cysts cannot be distinguished with U/S, U/S can _____.
determine the location
99
What are the 4 criteria for a cyst?
acoustic enhancement
absence of internal echoes
sharply defined thin walls
round or oval shape
100
This is a clearly delineated echolucent mass with through transmission, but also with internal echoes.
hemorrhagic cyst
101
Will a hemorrhagic cyst light up with color flow? Why or why not?
No, because dried blood won't show color flow.
102
This is a cyst with a single thin septation, minimal wall calcification, and internal echoes that are caused by artifact or lobulated shapes; may be associated with simple benign cysts.
Atypical Renal Cyst
103
Cysts that are atypical may suggest a malignant lesion if the septation is _____, the walls are _____ and there are _____ components within.
thick
irregular
solid
104
APKD - ADULT is
Autosomal Dominant Polycystic Kidney Disease
105
APKD - ADULT is _____ (inherited/non-inherited).
inherited
106
This is bilateral renal enlargement caused by numerous cysts of varying sizes.
APKD - ADULT
107
APKD - ADULT is associated with cysts in the _____, _____, and the _____.
liver
pancreas
spleen
108
With APKD - ADULT, destruction of the residual renal tissue in advanced stages leads to _____ and _____.
Renal failure
HTN
109
APKD - ADULT is associated with this kind of brain condition, specifically _____.
arterial aneurysms
Berry aneurysms
110
APKD - INFANTILE (ARPKD) is
Autosomal Recessive Polycystic Kidney Disease
111
Is APKD - INFANTILE inherited?
Yes
112
This is the most common genetically determined childhood cystic disease of the kidneys.
APKD - INFANTILE
113
APKD - INFANTILE may be detected in utero with _____.
oligohydramnios (low amniotic fluid)
114
The sonographic findings of APKD - INFANTILE are (4)...
Bilaterally enlarged kidneys
Hyperechoic parenchyma
Loss of cortical medullary distinction
Almost no cysts visible because the cysts are VERY tiny
115
These are signs of
1) bilateral grossly enlarged fetal kidneys, almost filling the entire abdomen
2) markedly hyperechoic fetal kidneys with minute anechoic areas within them
3) oligohydramnios
4) poorly distended urinary bladder
APKD - INFANTILE
116
With adult and infantile versions of PKD, what size are the kidneys?
enlarged
117
This is the MOST COMMON cause of an abdominal mass in the newborn.
Multicystic Dysplastic Kidney Disease (MCKD)
118
Is MCKD unilateral or bilateral? It is usually the result of _____ during fetal development.
both
atresia of the UPJ
119
With common kidney issues in newborns, ARPKD has _____ (large/small) kidneys _____ (with/without) cysts. MCKD has _____ (large/small) kidneys _____ (with/without) cysts and no _____.
large
without cysts
large
with cysts
parenchyma
120
Can a child survive with bilateral MCKD (Multicystic Dysplastic Kidney Disease)?
No
121
Development of cortical and medullary cysts in patients with end stage kidney disease and who are on dialysis from noncystic causes.
Acquired Cystic Disease
122
With acquired cystic disease, _____ often occurs in the cysts and results in pain and hematuria. The risk of developing _____ is _____ greater with acquired cystic disease, as compared to the general population.
hemorrhage
RCC
100
123
This is a congenital dysplastic (sloughing off) cystic dilation of the medullary pyramids due to tubular ectasia or dysplasia.
Medullary Sponge Kidney
124
With medullary sponge kidney, _____ deposits form in the dilated tubules, making the medullary pyramids _____ (echo) on U/S.
calcium
hyperechoic
125
The best way to tell the difference between kidney stones and medullary sponge kidneys is that
kidney stones do not line up evenly, as will calcium deposits in medullary sponge kidneys
126
Equally-spaced calcified pyramids =
medullary sponge kidney
127
Kidney stones typically develop in the _____.
renal pelvis
128
In MSK the collecting tubules, which are in the renal _____, are _____ and urine can pool and stagnate in them, which can cause kidney stones to form in the collecting tubules of the pyramids.
pyramids
enlarged
129
An Inherited disease which usually presents in the 2nd -3rd decade of life with serious visual impairment.
Von Hippel-Lindau Disease
130
Von Hippel-Lindau Disease can have related tumors such as (3)...
1) RCC
2) pheochromocytomas
3) islet cell tumors
131
This is a hyperechoic benign renal tumor.
The echogenicity is higher than that of the renal sinus. AKA _____.
angiomyolipoma
renal hamartoma
132
This is a type of tumor that can be found anywhere in the body.
hamartoma
133
Propagation speed artifacts may result in the posterior displacement of structures due to the slower acoustic velocity in this fatty mass.
angiomyolipoma
134
80% of angiomyolipomas involve the _____ kidney.
right
135
Why is there slower acoustic velocity in angiomyolipomas?
because sound moves slowly through fat
136
This is a multi-system genetic disease that causes benign tumors (angiomyolipomas/aka renal hamartomas) to grow on organs such as the brain, kidneys, heart, eyes, lungs and skin. It commonly affects the CNS.
Tuberous sclerosis
137
Tuberous sclerosis causes tumors to grow on organs like the _____, _____, _____, _____, _____, and _____. It commonly affects the _____.
brain
kidneys
heart
eyes
lungs
skin
CNS
138
If you see multiple angiomyolipomas, you may be dealing with _____.
tuberous sclerosis
139
The _____ is/are the main focus of an abdominal evaluation in a patient with tuberous sclerosis.
kidneys
140
This is the MOST COMMON solid renal mass in the adult. AKA _____.
RCC
hypernephroma
141
With RCC, it is usually _____ (unilateral/bilateral) and a nephrectomy is recommended.
unilateral
142
With RCC, tumor extension into the _____ and _____ are common (check all the way into the right _____).
RVs
IVC
atrium
143
These are the presenting symptoms for _____:
Hematuria
Flank pain
Palpable mass
RCC
144
Sonographically, RCC is _____ (echo) in comparison to the adjacent renal tissue.
hypoechoic
145
Increased incidence of RCC occurs with
Acquired Cystic Disease
Von Hippel-Lindau Syndrome
Tuberous Sclerosis
APKD-ADULT
146
A well-defined, hyperechoic small renal mass with a hypoechoic rim and intratumural cystic area may represent
RCC
147
Renal parenchyma can be the site where tumors have metastasized from other primary organs like _____, _____, _____, etc.
Malignant cells from _____ and _____ can also metastasize to the kidney.
lung
breast
colon
leukemia
lymphoma
148
A hypoechoic mass with a diffusely enlarged inhomogeneous kidney could represent
RCC
149
This is the MOST COMMON childhood renal tumor. AKA _____. Average age is _____ years for diagnosis. There is a _____% survival rate.
Wilm's Tumor
nephroblastoma
3.5
90%
150
A young patient presents with a large asymptomatic flank mass, HTN, fever, hematuria and anemia. What is this likely to be?
Wilm's Tumor (nephroblastoma)
151
Symptoms for a Wilm's Tumor include (5)
flank mass
HTN
fever
hematuria
anemia
152
Wilm's tumors (nephroblastomas) MUST be differentiated from _____.
adrenal neuroblastomas
153
How can you tell the difference between a Wilm's tumor (nephroblastoma) and an adrenal neuroblastoma?
Wilm's tumors (nephroblastomas) destroy the renal contour. If the renal contour is normal bilaterally, the abdominal mass is MOST likely an adrenal neuroblastoma.
154
A solid heterogeneous mass in the left renal fossa is seen in a young patient, without abnormal renal contour. What is this likely?
adrenal neuroblastoma
155
Renal enlargement, hypoechoic parenchyma, and absence of sinus echoes is seen in a young child. What could be the cause?
Acute Pyelonephritis
156
Acute Pyelonephritis =
"the kidney infection"
157
"The kidney infection" =
acute pyelonephritis
158
This word means inflammation of the kidney, due to infection
pyelonephritis
159
Most kidney infections occur via a(n) _____ (ascending/descending) route and are usually caused by gram negative bacilli from the _____.
ascending
intestinal tract
160
Can acute pyelonephritis be diagnosed clinically?
yes
161
This condition appears as a focal wedge-shaped area or a hypoechoic renal lobe.
Focal Acute Pyelonephritis
162
Focal Acute Pyelonephritis is AKA
lobar nephronia
163
This mimics RCC but (basically) only the WBCs will be high, as opposed to with RCC the WBCs and other lab counts are high too.
Focal Acute Pyelonephritis
164
"Mass formed from infection"
nephronia
165
This is a bacterial infection associated with renal ischemia.
Emphysematous Pylonephritis
166
INFLAMMATION of kidney due to infection =
MASS formed on kidney due to infection =
INFLAMMATION = pyelonephritis
MASS = nephronia
167
This condition is common in diabetics, immunosupressed patients, and patients with urinary tract infections.
Emphysematous pylonephritis
168
What is the usual treatment for emphysematous pylonephritis?
nephrectomy is usually required
169
Describe the sonographic appearance of emphysematous pyelonephritis.
Reverberation and comet tail artifacts, due to anaerobic bacteria producing intrarenal gas.
170
"Echogenic dirty shadowing" =
emphysematous pyelonephritis
171
This is injury to kidney due to recurrent renal infections.
chronic pyelonephritis
172
What eventually happens with chronic pyelonephritis?
it leads to end stage renal disease, which appears as a small, hyperechoic kidney
173
"Pyelo"
inflammation due to an infection
174
Chroinc pyelonephritis resulting from chronic infections due to a long term obstruction.
Xantogranulomatous Pyelonephritis
175
If a patient comes in and you are unable to visualize the normal kidney, and you see staghorn calculus, this suggests the diagnosis of
xanthogranulomatous pyelonephritis
176
Pyo =
pus
177
What is the biggest indication of xanthogranulomatous pyelonephritis?
staghorn calculus
178
This is a calcification area in which CF artifact shows beneath a stone/calcification area.
staghorn calculus
179
Purulent =
pus
180
Purulent material in the collecting system associated with an infection, secondary to renal obstruction.
pyonephrosis
181
An ultrasound shows hyperechoic debris in a dilated renal collecting system (it looks like hydro but with debris), and the patient has a high WBC count. What could this be?
pyonephrosis
182
This is caused by material (pus) being stuck in the kidney due to obstrcution.
pyonephrosis
183
Fungal infections of the kidney usually come from the
bladder
184
This is the most common renal fungal disease
candidiasis
185
This appears as a hyperechoic, non-shadowing mass in the kidney.
myecetoma (fungal ball)
186
Another term for myecetoma is
fungal ball
187
What are the 3 main mechanisms (locations) of Acute Renal Failure (ARF)?
Pre-renal failure
Intrinsic renal failure
Postrenal failure
188
This kind of ARF is when there is decreased perfusion - the heart isn't working right, kidneys fail, and creatinine increases.
Pre-renal failure
189
This kind of ARF occurs with bilateral renal obstruction.
Postrenal failure
190
This kind of ARF is intrarenal
Intrinsic failure
191
What is the most common cause of intrinsic failure?
Acute Tubular Necrosis
192
What 2 roles can U/S play with diagnosing ARF?
1) determining hydro (suggests postrenal failure)
2) abnormal resistive index (suggests intrinsic)
193
With ARF, if the kidney has hydro, it is most likely
postrenal failure
194
With ARF, if the kidney has an abnormal RI, it is mostly likely
intrinsic failure
195
What are the 4 lab studies for ARF?
1) Creatinine***
2) BUN
3) Urinalysis
4) Urine output (24 hours)
196
What is the most accurate method for determining ARF?
testing creatinine levels
197
If creatinine levels reflect a change in _____, this is an indication of ARF.
glomerular filtration rate
198
This is a sudden cause of PRERENAL failure that presents as acute flank pain, hematuria, and a sudden rise in BP.
Renal Artery Thrombosis
199
A patient with high BP often has some kind of _____ problem(s).
kidney
200
If a patient presents with focal hypoechoic areas of infarct, an absence of intrarenal arterial flow, and renal enlargement, this is most likely _____.
Renal Artery Thrombosis
201
What is the first big sign of renal artery thrombosis and how do you check it?
absence of intrarenal arterial flow
put color on it right away
202
This is associated with
-extrinsic compression*** (external mass compression)
-renal transplants****
-renal tumors
-trauma
renal vein thrombosis (RV thrombosis)
203
If a patient presents with
dilated thrombosed RV ****
absent intrarenal venous flow
enlarged hypoechoic kidney****
trauma
renal vein thrombosis (RV thrombosis)
204
How does RV thrombosis appear on arterial doppler?
it goes from low resistance to high resistance and loses its diastolic component
205
The most common cause of renal disease or intrinsic acute renal failure.
acute tubular necrosis
206
What is acute tubular necrosis (ATN) caused by?
the overuse of nephrotoxins (acytelmetaphin, NSAIDs, CT contrast fluids)
and/or prolonged ischemia
these cause damage to the tubular epithelium of the nephron that leads to renal failure
207
This is an inflammatory response that results in glomerular damage, caused by an infection, exposure to toxins, or an autoimmune reaction.
acute glomerulonephritis
208
What are the symptoms of acute glomerulonephritis (clinical/labs (3) and sonographically (2))?
sudden onset hematuria
protenuria
azotemia (too much N in blood)
enlarged kidneys
increased RI
209
With this condition, the renal pelvis and calyces are dilated.
hydronephrosis
210
The 3 common areas of obstruction with hydronephrosis are
1) UPJ (uteropelvic junction)
2) UVJ (uterovessicle junction)
3) pelvic brim
211
The standard RI for a normal kidney is about
.7
212
What are some common causes of hydro (5)?
calculi (blocks urine flow)
BPH (benign prostetic hyperplasia) (blocks flow)
prostate CA
pelvic malignancies
pregnancy
213
If left untreated, hydro can lead to (3)
HTN
loss of renal function
sepsis
214
This is a disorder of calcium metabolism that results in the formation of calcium renal stones and the deposit of calcium salts in the renal parenchyma.
nephrocalcinosis
215
These are causes of what condition?
Acute cortical necrosis
Chronic glomerulonephritis
Hyperparathyroidism
Vitamin D intoxication
Medullary sponge kidney
Papillary necrosis
Sarcoidoisis
Malignancies
nephrocalcinosis
216
This condition's main symptom is acute back/flank pain that radiates down to the isilateral groin (on the same side).
nephrocalcinosis
217
A patient presents with fever, chills, dysuria, cloudy urine, and hematuria as well as back/flank pain that radiates to the ipsalateral groin. What is the probable cause?
nephrocalcinosis
218
What is the sonographic difference between medullary sponge kidney and nephrocalcinosis?
MSD
evenly lined-up calcium in pyramids
shadows down
Neprhocalcinosis
entire parenchyma filled with calcium
no shadowing
219
What is the term for renal stones?
nephrolithiasis
220
Where does nephrolithiasis usually arise in the kidney?
in the collecting system
221
T or F? With nephrolithiasis, acute renal colic accounts for 1% of all hospital admissions.
True
222
Ischemia of the renal pyramids is
papillary necrosis
223
What is ischemia?
sloughing off of tissue
224
This condition is associated with
Analgesic abuse
DM (diabetes milletus)
Urinary tract infections/obstructions (UTIs)
Renal vein thrombosis (RV thrombosis)
Sickle cell disease
Chronic heart failure (CHF)
cirrhosis
papillary necrosis
225
What is the main symptom of renal stones?
acute back/flank pain often radiating down to the ipsalateral groin
226
The _____ is the location where the medullary pyramids empty urine into the renal pelvis.
renal papilla
227
These are sonographic findings of what?
Echogenic material within the collecting system that represents the sloughed papillae
Triangular cystic collections that represent the absence of the pyramids
Bright echoes produced by the arcuate arteries at the periphery of the cystic space
papillary necrosis
228
What condition appears as bright echoes produced by the arcuate arteries in the periphery of the cystic space?
papillary necrosis
229
With this condition, renal sinus and perirenal fat is increased and replaces the renal parenchyma, resulting in cortex thinning.
renal sinus lipomatosis
230
What are 2 other terms for renal sinus lipomatosis
replacement lipomatosis
fibrolipomatosis
231
The urinary bladder is a hollow _____, and _____ organ that sits on the _____ floor. It is the organ that collects _____ excreted by the kidneys.
Urine enters the bladder via the _____ and exits via the_____.
muscular
distensible (elastic)
pelvic
urine
ureters
urethra
232
The bladder is located _____ (behind/in front of) the pubic bone.
behind
233
The ureters enter the bladder at the _____ angle of the _____ and exit the bladder via the _____.
superiolateral
trigone
urethra
234
Normal bladder wall thickness for a non distended bladder is _____.
less than 5mm
235
Normal bladder wall thickness for a distended bladder is _____.
less than 3mm
236
The apex points _____ (anteriorly/posteriorly) and is connected to the umbilicus by the _____.
anteriorly
urachus
237
Another term for urachus is
median umbilical ligament
238
The urachus is a tube that connects the _____ to the top of the _____. It _____ the bladder.
bellybutton
bladder
suspends
239
During fetal development the _____ is a tube that connects the bladder to the umbilicus. After birth, the urachus normally closes and becomes a _____. If the urachus remains open, _____ is recommended so that _____ or _____ cannot be introduced into the bladder.
urachus
ligament
surgery
bacteria
infection
240
What are the 4 layers of the bladder wall?
serous
muscular
submucous
mucous
241
Bladder Anomalies:
This is herniation of the bladder mucosa through the bladder wall musculature.
bladder diverticula
242
Is bladder diverticula congenital or acquired?
both
243
Most bladder diverticuli are acquired in association with longstanding _____. They are most commonly seen in older _____ (men/women) with benign _____, _____, or _____ of the prostate.
bladder outlet obstruction
men
prostatic enlargement
prostatitis
carcinoma
244
T or F? Bladder diverticula are well demonstrated by intravenous urography or cystography, but may also be seen on ultrasound, CT or MRI.
True
245
Bladder Anomalies:
A cystic dilatation of the fetal urachus.
urachal cyst
246
A urachal cyst is seen as a cystic structure _____ and _____ to the fetal bladder.
superior
anterior
247
The ureters are _____ ducts that propel urine from the kidneys to the urinary bladder.
muscular
248
In the adult, the ureters are usually _____ long.
25-30cm (10-12in)
249
The ureters exit the kidney _____ to the RA and RV.
posterior
250
Descending _____, the ureters lie on the _____ surface of the psoas muscles.
inferiorly
anterior
251
In the pelvis, the ureters cross _____ to the common iliac vessels to insert upon the _____ of the bladder.
anterior
trigone
252
Ureteral Anomalies:
Cyst-like enlargement of the lower end of the ureter which projects into the bladder lumen at the UVJ.
ureteroceles
253
Ureteral Anomalies:
Associated with a duplex kidney and a complete ureteral duplication that results in obstruction of the upper pole collecting system.
ectopic ureteroceles
254
This is the most common bladder neoplasm.
transitional cell carcinoma
255
This makes up 95% of epithelial tumors of the bladder.
transitional cell carcinoma
256
What should be a sign that raises suspicion for transitional cell carcinoma (TCC)?
a mass or focal thickening of the bladder wall
257
What is the primary clinical symptom of transitional cell carcinoma?
hematuria
258
A patient presents with pelvic pain, hematuria, and with U/S a mass or focal thickening of the bladder wall is seen. What is the most likely condition?
transitional cell carcinoma
259
These are examples of what?
Cystitis
Prostate cancer
Squamous cell cancer
Blood clots
Pyogenic debris
Bladder papilloma
Bladder stones
bladder masses
260
cys =
bladder
261
The normal renal artery demonstrates continuous forward flow during _____, typical of _____ resistance perfusion.
diastole
low
262
Renal dysfunction results in the loss of _____ flow, which increases the renal arterial resistance.
diastolic
263
The resistive index is commonly used to (3)
evaluate renal transplant rejection
access suspected hydronephrosis
evaluate renal disease
264
This is a widely used measure of resistance to arterial flow within the renal vascular bed and is calculated from the arterial waveform. It is an indicator of resistance of an organ to perfusion.
resistive index
265
What is the normal RI for kidneys?
.7
266
This eliminates the need for accurate angle-corrected measurements of blood flow in assessment of vascular resistance.
RI
267
RI is a value that compares the amount of _____ to that of the _____.
It is a _____ value (no units) that can be measured in frequency or velocity.
diastole
systole
relative
268
Sudden onset of HTN or uncontrollable HTN is a symptom of what?
May produce a decrease in renal size ( < 9 cm in length)
renal artery stenosis
269
The renal arteries may be technically difficult to image. _____, _____, and the _____ may all play role in contribute to this difficulty.
Patients should be kept _____ before the procedure.
large body habits
excessive bowel gas
depth or course of arteries
NPO
270
A small hard pulse which rises & falls slowly, or an absent early systolic peak is
pulsus parvus et tardus
271
What is the treatment of choice for end-stage renal disease (ESRD)?
renal transplants
272
_____ is the MOST COMMON cause of renal disease that leads to transplant.
diabetes
273
A pre-Renal transplant evaluation includes (3)
Evaluation of the living donor
Harvesting the LEFT kidney is favored due to its longer renal vein
Multiple renal arteries need to be identified as this will require additional surgical time
274
Which kidney is favored for use as a transplant? Why?
left, because it has a longer RV
275
The transplanted kidney is generally placed in the _____ _____ portion of the pelvis, typically on the right side.
The _____ is attached to the bladder.
The arterial anastomosis may involve the _____ or the _____.
upper lateral
right
ureter
external artery
internal iliac artery
276
Unless they are causing _____ or _____, native kidneys are left in place.
infection
high BP
277
Poor function of the transplant may be the result of _____ immediately in the post-transplant period.
acute tubular necrosis
278
After transplant, U/S is most commonly used modality to check for what (3)?
immediate surgical complications
location for renal biopsy
vascular status in acute rejection
279
Post-Transplant Complications:
1) Fluid collections: (4)
2) _____ kinking or thrombosis
3) _____ thrombosis
1)
hematomas
urinomas
lymphoceles
abscesses
2) RA
3) RV
280
Sonographically, acute rejection of a transplant appears as (4)
renal enlargement
prominent hypoechoic pyramids
loss of cortical-meduallary borders
increased renal length
281
RI:
For a person with no problems or transplant: _____
For a person with transplant: _____
_____ is transplant dysfunction
less than/equal to 0.7
< 0.7
> 0.8
282
Causes of Elevated Resistive Index (4)
Parenchymal
Vascular
Urological
Technical
283
A microscopic exam of the sediment & qualitative evaluation of the protein, glucose, ketones, blood, nitrates and WBC’s.
urinalysis
284
_____ is inversely related to glomerular filtration rate.
serum creatinine
285
This is a lab value unsuitable as a single measure of renal function because it varies with urine flow rates and production of urea.
BUN
286
What does BUN stand for?
blood, urea, nitrogen
287
Cyst with a stone in it
Pyelogenic cyst (AKA MOC cyst/calyceal diverticulum)
288
With RCC the kidney itself is mostly _____. But with renal metastasis, the kidney itself is _____.
Homogeneous
Heterogeneous
289
Nephroblastoma is also called
Wilm's tumor
290
To determine if a mass is on the adrenal gland, as opposed to the kidney tissue, have the child _____. This helps because....
Breathe in
The glands aren't permanently attached to the kidneys and if there is something wrong you'll be able to see the gland and see it separate when the child breathes in.
291
With acute pyelonephritis, will it be unilateral or bilateral? Why?
Bilateral
Because the bacteria is traveling the same path and will naturally disperse into both kidneys. Usually starts as a bladder infection or something similar.
292
Proteinuria and azotemia with enlarged kidneys, sudden onset hematuria, and an increased RI is probably
Acute glomerulonephritis
293