Flashcards in Urinary Deck (293)
What is the path of blood to and from the kidneys?
Peritubular Capillaries/Vasa Recta
What is the structure called in which the glomerulus is located?
What is the path in the nephron?
Proximal Convoluted Tubule
Loop of Henle
Distal Convoluted Tubule
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
What is the standard size of a kidney?
Every day our kidneys perform an essential job of filtering _____ of blood, to remove about _____ of waste products and unneeded water.
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.
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 _____.
In the adult, each kidney is about the size of a tightly clenched _____ and each one measures between _____-_____ and weighs between _____-_____.
The paired kidneys are retroperitoneal and lie against the _____ of the back. The right is slightly _____ in location as compared to the left.
The reddish-brown organs are _____ (convex/concave) laterally and _____ (convex/concave) medially.
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 blood vessels
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.
The parenchymal volume of the right kidney is _____ (more/less) than the left.
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.
The left kidney usually lies _____ (measurement) _____ (higher/lower) than the right.
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.
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.
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 _____.
To the RT kidney:
The adrenal gland is _____.
The liver is _____.
The RT colic flexure is _____.
The 2nd portion of the duodenum is _____.
To the LT kidney:
The adrenal gland and spleen are _____.
The pancreatic tail is _____ to the superior pole.
The left colic flexure is _____.
The diaphragm, psoas muscle, and the _____ muscle are on the _____ aspect of the kidneys.
The renal parenchyma is composed of _____ and _____.
Echogenicities (compared to liver):
The renal cortex is _____ or _____.
Medullary pyramids are _____.
The renal sinus is _____.
isoechoic or hypoechoic
The 13 major structures that the kidneys are composed of are:
The renal cortex is the outer renal _____. It extends from the _____ to the _____.
The renal medulla is the _____ portion of the kidney. It extends from the _____ of the _____ to the _____ of the kidney.
base of the pyramids
The renal column is between the renal _____.
The renal sinus is the cavity within the kidney which houses the renal _____. _____ and blood vessels pass into the renal sinus through the _____.
The renal pyramids are _____ (echo), _____-spaced triangles of collecting tubules, between the _____ and the renal _____.
The renal pelvis (AKA ______) is a _____-shaped transition from the _____ calyces to the _____.
The renal hilum is the _____ opening for the entry/exit of the _____, _____, and _____.
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.
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 _____.
These are used to subdivide the sections of the kidney.
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 _____.
These are extensions of the major calyces that collect urine from the medullary _____.
This is the apex of the medullary pyramids and is _____-shaped.
This fibrous sheath enclosing the kidney and the adrenal glands. It is AKA _____.
This is the functional unit of the kidney.
The nephron consists of (6)
prox convoluted tubules
descending and ascending limbs
dist convoluted tubules
About _____ nephrons are in the _____ of each kidney
This consists of the glomerulus and glomerular capsule (or _____ Capsule). AKA _____.
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 _____.
Basic path of waste is to the _____ of the pyramid, then to the _____, then the _____, then the _____, then the ureter.
The kidneys are supplied with arterial blood via the _____, which branches off the AO.
main renal artery
At the hilum, the main renal artery divides into 5 _____.
At the level of the medullary pyramids, the segmental arteries divide into the _____, which run between the _____.
At the base of the medullary pyramids, the _____ branch in a manner that is _____ (direction) to the renal capsule.
Branching off the arcuate arteries and running perpendicular to the renal capsule are the smallest renal arteries called the _____.
T or F? Congenital anomalies of the genitourinary tract are more common than any other organ system anomalies.
Complications associated with congenital anomalies of the genitourinary tract are associated with these abnormalities (3):
impaired renal function
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 _____.
junctional parenchymal defect
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).
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
This is a common variant of cortical thickening on the lateral aspect of the _____ kidney.
This word means displaced in a location away from the normal position.
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.
With ectopic kidneys, there is an increased risk of _____, _____ reflux, and _____ renal dysplasia.
UPJ (uteropelvic junction)
When there is a single kidney transplanted, the kidney is often placed on the _____ side of the _____.
This is when the developing kidneys fuse together at the lower poles.
Horseshoe kidneys are AKA
cake or lump kidney
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
What poles are involved with a horseshoe kidney? What poles are involved with a fused pelvic kidney?
upper and lower poles
This is the 2nd most common renal fusion anomaly.
crossed fused ectopic kidney
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.
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.
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.
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.
Describe an incomplete duplex kidney.
it has two ureters at the kidney that fuse together along the path to the bladder.
With complete double ureters, the ureter draining the _____ pole typically inserts in an _____ location in the bladder.
A frequent complication of ectopic ureter is a _____.
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.
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 _____.
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.
Bilateral renal agenesis is associated with _____ and _____, and is incompatible with life.
Can compensatory hypertrophy of a solitary kidney maintain normal renal function?
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...
seminal vesicle agenesis
it is bigger so it can do the work of 2 kidneys
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.
in front of
This is a common cause of urinary obstruction in the male neonate patient.
posterior urethral valve
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.
A posterior urethral valve can increased _____ pressures and may alter normal development of the fetal _____ and _____.
An exterior symptom of a posterior urethral valve is
a hard pelvis
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
_____ 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
Simple renal cysts occur in 50% of people over the age of 50. Most renal cysts are _____ cysts.
simple cortical cysts
The 3 types of renal cysts are
Parapelvic or Peripelvic cysts
Cortical or Parenchymal cysts
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 _____.
_____ in the pyelogenic cysts predisposes one for stone formation and most likely _____.
The initial symptom for a pyelogenic cyst may be _____, which is believed to be related to poor drainage due to pressure on the _____.
Pyelogenic Renal Cyst = cyst with a
_____ 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)
bulge into the sinus
Peripelvic cysts =
originate in the sinus
Parapelvic and Peripelvic cysts are generally located in what region of the kidney?
center of kidney/renal sinus
Cortical or parenchymal cysts are located in what region of the kidney?
in the periphery
Can the different types of renal cysts be distinguished with U/S?
Although the different types of renal cysts cannot be distinguished with U/S, U/S can _____.
determine the location
What are the 4 criteria for a cyst?
absence of internal echoes
sharply defined thin walls
round or oval shape
This is a clearly delineated echolucent mass with through transmission, but also with internal echoes.
Will a hemorrhagic cyst light up with color flow? Why or why not?
No, because dried blood won't show color flow.
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
Cysts that are atypical may suggest a malignant lesion if the septation is _____, the walls are _____ and there are _____ components within.
APKD - ADULT is
Autosomal Dominant Polycystic Kidney Disease
APKD - ADULT is _____ (inherited/non-inherited).
This is bilateral renal enlargement caused by numerous cysts of varying sizes.
APKD - ADULT
APKD - ADULT is associated with cysts in the _____, _____, and the _____.
With APKD - ADULT, destruction of the residual renal tissue in advanced stages leads to _____ and _____.
APKD - ADULT is associated with this kind of brain condition, specifically _____.
APKD - INFANTILE (ARPKD) is
Autosomal Recessive Polycystic Kidney Disease
Is APKD - INFANTILE inherited?
This is the most common genetically determined childhood cystic disease of the kidneys.
APKD - INFANTILE
APKD - INFANTILE may be detected in utero with _____.
oligohydramnios (low amniotic fluid)
The sonographic findings of APKD - INFANTILE are (4)...
Bilaterally enlarged kidneys
Loss of cortical medullary distinction
Almost no cysts visible because the cysts are VERY tiny
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
4) poorly distended urinary bladder
APKD - INFANTILE
With adult and infantile versions of PKD, what size are the kidneys?
This is the MOST COMMON cause of an abdominal mass in the newborn.
Multicystic Dysplastic Kidney Disease (MCKD)
Is MCKD unilateral or bilateral? It is usually the result of _____ during fetal development.
atresia of the UPJ
With common kidney issues in newborns, ARPKD has _____ (large/small) kidneys _____ (with/without) cysts. MCKD has _____ (large/small) kidneys _____ (with/without) cysts and no _____.
Can a child survive with bilateral MCKD (Multicystic Dysplastic Kidney Disease)?
Development of cortical and medullary cysts in patients with end stage kidney disease and who are on dialysis from noncystic causes.
Acquired Cystic Disease
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.
This is a congenital dysplastic (sloughing off) cystic dilation of the medullary pyramids due to tubular ectasia or dysplasia.
Medullary Sponge Kidney
With medullary sponge kidney, _____ deposits form in the dilated tubules, making the medullary pyramids _____ (echo) on U/S.
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
Equally-spaced calcified pyramids =
medullary sponge kidney
Kidney stones typically develop in the _____.
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.
An Inherited disease which usually presents in the 2nd -3rd decade of life with serious visual impairment.
Von Hippel-Lindau Disease
Von Hippel-Lindau Disease can have related tumors such as (3)...
3) islet cell tumors
This is a hyperechoic benign renal tumor.
The echogenicity is higher than that of the renal sinus. AKA _____.
This is a type of tumor that can be found anywhere in the body.
Propagation speed artifacts may result in the posterior displacement of structures due to the slower acoustic velocity in this fatty mass.
80% of angiomyolipomas involve the _____ kidney.
Why is there slower acoustic velocity in angiomyolipomas?
because sound moves slowly through fat
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 causes tumors to grow on organs like the _____, _____, _____, _____, _____, and _____. It commonly affects the _____.
If you see multiple angiomyolipomas, you may be dealing with _____.
The _____ is/are the main focus of an abdominal evaluation in a patient with tuberous sclerosis.
This is the MOST COMMON solid renal mass in the adult. AKA _____.
With RCC, it is usually _____ (unilateral/bilateral) and a nephrectomy is recommended.
With RCC, tumor extension into the _____ and _____ are common (check all the way into the right _____).
These are the presenting symptoms for _____:
Sonographically, RCC is _____ (echo) in comparison to the adjacent renal tissue.
Increased incidence of RCC occurs with
Acquired Cystic Disease
Von Hippel-Lindau Syndrome
A well-defined, hyperechoic small renal mass with a hypoechoic rim and intratumural cystic area may represent
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.
A hypoechoic mass with a diffusely enlarged inhomogeneous kidney could represent
This is the MOST COMMON childhood renal tumor. AKA _____. Average age is _____ years for diagnosis. There is a _____% survival rate.
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)
Symptoms for a Wilm's Tumor include (5)
Wilm's tumors (nephroblastomas) MUST be differentiated from _____.
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.
A solid heterogeneous mass in the left renal fossa is seen in a young patient, without abnormal renal contour. What is this likely?
Renal enlargement, hypoechoic parenchyma, and absence of sinus echoes is seen in a young child. What could be the cause?
Acute Pyelonephritis =
"the kidney infection"
"The kidney infection" =
This word means inflammation of the kidney, due to infection
Most kidney infections occur via a(n) _____ (ascending/descending) route and are usually caused by gram negative bacilli from the _____.
Can acute pyelonephritis be diagnosed clinically?
This condition appears as a focal wedge-shaped area or a hypoechoic renal lobe.
Focal Acute Pyelonephritis
Focal Acute Pyelonephritis is AKA
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
"Mass formed from infection"
This is a bacterial infection associated with renal ischemia.
INFLAMMATION of kidney due to infection =
MASS formed on kidney due to infection =
INFLAMMATION = pyelonephritis
MASS = nephronia
This condition is common in diabetics, immunosupressed patients, and patients with urinary tract infections.
What is the usual treatment for emphysematous pylonephritis?
nephrectomy is usually required
Describe the sonographic appearance of emphysematous pyelonephritis.
Reverberation and comet tail artifacts, due to anaerobic bacteria producing intrarenal gas.
"Echogenic dirty shadowing" =
This is injury to kidney due to recurrent renal infections.
What eventually happens with chronic pyelonephritis?
it leads to end stage renal disease, which appears as a small, hyperechoic kidney
inflammation due to an infection
Chroinc pyelonephritis resulting from chronic infections due to a long term obstruction.
If a patient comes in and you are unable to visualize the normal kidney, and you see staghorn calculus, this suggests the diagnosis of
What is the biggest indication of xanthogranulomatous pyelonephritis?
This is a calcification area in which CF artifact shows beneath a stone/calcification area.
Purulent material in the collecting system associated with an infection, secondary to renal obstruction.
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?
This is caused by material (pus) being stuck in the kidney due to obstrcution.
Fungal infections of the kidney usually come from the
This is the most common renal fungal disease
This appears as a hyperechoic, non-shadowing mass in the kidney.
myecetoma (fungal ball)
Another term for myecetoma is
What are the 3 main mechanisms (locations) of Acute Renal Failure (ARF)?
Intrinsic renal failure
This kind of ARF is when there is decreased perfusion - the heart isn't working right, kidneys fail, and creatinine increases.
This kind of ARF occurs with bilateral renal obstruction.
This kind of ARF is intrarenal
What is the most common cause of intrinsic failure?
Acute Tubular Necrosis
What 2 roles can U/S play with diagnosing ARF?
1) determining hydro (suggests postrenal failure)
2) abnormal resistive index (suggests intrinsic)
With ARF, if the kidney has hydro, it is most likely
With ARF, if the kidney has an abnormal RI, it is mostly likely
What are the 4 lab studies for ARF?
4) Urine output (24 hours)
What is the most accurate method for determining ARF?
testing creatinine levels
If creatinine levels reflect a change in _____, this is an indication of ARF.
glomerular filtration rate
This is a sudden cause of PRERENAL failure that presents as acute flank pain, hematuria, and a sudden rise in BP.
Renal Artery Thrombosis
A patient with high BP often has some kind of _____ problem(s).
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
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
This is associated with
-extrinsic compression*** (external mass compression)
renal vein thrombosis (RV thrombosis)
If a patient presents with
dilated thrombosed RV ****
absent intrarenal venous flow
enlarged hypoechoic kidney****
renal vein thrombosis (RV thrombosis)
How does RV thrombosis appear on arterial doppler?
it goes from low resistance to high resistance and loses its diastolic component
The most common cause of renal disease or intrinsic acute renal failure.
acute tubular necrosis
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
This is an inflammatory response that results in glomerular damage, caused by an infection, exposure to toxins, or an autoimmune reaction.
What are the symptoms of acute glomerulonephritis (clinical/labs (3) and sonographically (2))?
sudden onset hematuria
azotemia (too much N in blood)
With this condition, the renal pelvis and calyces are dilated.
The 3 common areas of obstruction with hydronephrosis are
1) UPJ (uteropelvic junction)
2) UVJ (uterovessicle junction)
3) pelvic brim
The standard RI for a normal kidney is about
What are some common causes of hydro (5)?
calculi (blocks urine flow)
BPH (benign prostetic hyperplasia) (blocks flow)
If left untreated, hydro can lead to (3)
loss of renal function
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.
These are causes of what condition?
Acute cortical necrosis
Vitamin D intoxication
Medullary sponge kidney
This condition's main symptom is acute back/flank pain that radiates down to the isilateral groin (on the same side).
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?
What is the sonographic difference between medullary sponge kidney and nephrocalcinosis?
evenly lined-up calcium in pyramids
entire parenchyma filled with calcium
What is the term for renal stones?
Where does nephrolithiasis usually arise in the kidney?
in the collecting system
T or F? With nephrolithiasis, acute renal colic accounts for 1% of all hospital admissions.
Ischemia of the renal pyramids is
What is ischemia?
sloughing off of tissue
This condition is associated with
DM (diabetes milletus)
Urinary tract infections/obstructions (UTIs)
Renal vein thrombosis (RV thrombosis)
Sickle cell disease
Chronic heart failure (CHF)
What is the main symptom of renal stones?
acute back/flank pain often radiating down to the ipsalateral groin
The _____ is the location where the medullary pyramids empty urine into the renal pelvis.
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
What condition appears as bright echoes produced by the arcuate arteries in the periphery of the cystic space?
With this condition, renal sinus and perirenal fat is increased and replaces the renal parenchyma, resulting in cortex thinning.
renal sinus lipomatosis
What are 2 other terms for renal sinus lipomatosis
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_____.
The bladder is located _____ (behind/in front of) the pubic bone.
The ureters enter the bladder at the _____ angle of the _____ and exit the bladder via the _____.
Normal bladder wall thickness for a non distended bladder is _____.
less than 5mm
Normal bladder wall thickness for a distended bladder is _____.
less than 3mm
The apex points _____ (anteriorly/posteriorly) and is connected to the umbilicus by the _____.
Another term for urachus is
median umbilical ligament
The urachus is a tube that connects the _____ to the top of the _____. It _____ the bladder.
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.
What are the 4 layers of the bladder wall?
This is herniation of the bladder mucosa through the bladder wall musculature.
Is bladder diverticula congenital or acquired?
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
T or F? Bladder diverticula are well demonstrated by intravenous urography or cystography, but may also be seen on ultrasound, CT or MRI.
A cystic dilatation of the fetal urachus.
A urachal cyst is seen as a cystic structure _____ and _____ to the fetal bladder.
The ureters are _____ ducts that propel urine from the kidneys to the urinary bladder.
In the adult, the ureters are usually _____ long.
The ureters exit the kidney _____ to the RA and RV.
Descending _____, the ureters lie on the _____ surface of the psoas muscles.
In the pelvis, the ureters cross _____ to the common iliac vessels to insert upon the _____ of the bladder.
Cyst-like enlargement of the lower end of the ureter which projects into the bladder lumen at the UVJ.
Associated with a duplex kidney and a complete ureteral duplication that results in obstruction of the upper pole collecting system.
This is the most common bladder neoplasm.
transitional cell carcinoma
This makes up 95% of epithelial tumors of the bladder.
transitional cell carcinoma
What should be a sign that raises suspicion for transitional cell carcinoma (TCC)?
a mass or focal thickening of the bladder wall
What is the primary clinical symptom of transitional cell carcinoma?
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
These are examples of what?
Squamous cell cancer
The normal renal artery demonstrates continuous forward flow during _____, typical of _____ resistance perfusion.
Renal dysfunction results in the loss of _____ flow, which increases the renal arterial resistance.
The resistive index is commonly used to (3)
evaluate renal transplant rejection
access suspected hydronephrosis
evaluate renal disease
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.
What is the normal RI for kidneys?
This eliminates the need for accurate angle-corrected measurements of blood flow in assessment of vascular resistance.
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.
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
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
A small hard pulse which rises & falls slowly, or an absent early systolic peak is
pulsus parvus et tardus
What is the treatment of choice for end-stage renal disease (ESRD)?
_____ is the MOST COMMON cause of renal disease that leads to transplant.
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
Which kidney is favored for use as a transplant? Why?
left, because it has a longer RV
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 _____.
internal iliac artery
Unless they are causing _____ or _____, native kidneys are left in place.
Poor function of the transplant may be the result of _____ immediately in the post-transplant period.
acute tubular necrosis
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
1) Fluid collections: (4)
2) _____ kinking or thrombosis
3) _____ thrombosis
Sonographically, acute rejection of a transplant appears as (4)
prominent hypoechoic pyramids
loss of cortical-meduallary borders
increased renal length
For a person with no problems or transplant: _____
For a person with transplant: _____
_____ is transplant dysfunction
less than/equal to 0.7
Causes of Elevated Resistive Index (4)
A microscopic exam of the sediment & qualitative evaluation of the protein, glucose, ketones, blood, nitrates and WBC’s.
_____ is inversely related to glomerular filtration rate.
This is a lab value unsuitable as a single measure of renal function because it varies with urine flow rates and production of urea.
What does BUN stand for?
blood, urea, nitrogen
Cyst with a stone in it
Pyelogenic cyst (AKA MOC cyst/calyceal diverticulum)
With RCC the kidney itself is mostly _____. But with renal metastasis, the kidney itself is _____.
Nephroblastoma is also called
To determine if a mass is on the adrenal gland, as opposed to the kidney tissue, have the child _____. This helps because....
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.
With acute pyelonephritis, will it be unilateral or bilateral? Why?
Because the bacteria is traveling the same path and will naturally disperse into both kidneys. Usually starts as a bladder infection or something similar.
Proteinuria and azotemia with enlarged kidneys, sudden onset hematuria, and an increased RI is probably