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Flashcards in Urinary Deck (156):
1

What are indications for renal u/s?

-UTI
-palpable mass
-elevated creatinine & or BUN
-severe flank pain
-hematuria
-decrease urine output
-assessment for renal mass seen on CT/IVP
-non visualized kidney
-trauma
-post surgical complications
-biopsy/drainage
-hypertension
-diabetes

2

Symptoms of a renal infection or disease process:

-flank pain
-hematuria
-polyuria
-oliguria
-fever
-urgency
-weightloss
-general edema

3

What is urinalysis essential for detecting?

urinary tract disorders in pts. whose renal function is impaired or absent

4

Hematuria is

RBC in the urine

5

Pyuria is

Pus in urine

6

Urine pH is important in managing

diseases such as bacteriauria and renal calculi

7

pH referes to what?

strength of urine as partly acidic or alkaline solution

8

The abundance of hydrogen ions in the urine is called:

pH

9

When is urine acidic?

if it contains an increased concentration of hydrogen ions

10

The formation of renal calculi partly depends on :

pH of urine

11

What are associated with alkaline urine?

Renal tubular acidosis and chronic renal failure

12

What is specific gravity?

measurement of the kidney's ability to concentrate urine (concentration factor depends on the amount of dissolved waste products)

13

Specific gravity is esp. low in cases of:

renal failure
glomerulonephritis
pylonephritis
(these cause renal tubular damage, affecting kidney's ability to concentrate urine)

14

What can hematuria be associated with?

early renal disease

15

An abundance of RBC in the urine may suggest:

-renal trauma
-neoplasm
-calculi
-pyelonephritis
-glomerular inflammatory process
-vascular inflammatory process

16

When may leukocytes present?

with inflammation, infection or tissue necrosis originating from anywhere in the urinary tract

17

What is hematocrit?

relative ratio of plasma to packed cell volume in blood.

18

Decreased hematocrit occurs with

acute hemorrhagic processes secondary to disease or blunt trauma

19

When is hemoglobin present in urine?

When there is extensive damage or destruction of the functioning erythrocytes (injures the kidney and can cause acute renal failure)

20

Albuminuria is commonly found with

benign and malignant neoplasms, calculi, chronic infections, pyelonephritis

21

Measurements of creatinine are an index for determining what?

glomerular filtrations rate

22

T/F: blood serum creatinine levels are said to be more specific and more senstive

T

23

Creatinine is a byproduct of

muscle energy metabolism

24

A decreased creatinine clearance indicates

renal dysfunction because creatinine blood levels are constant and only decreased renal function prevents normal excretion of creatine

25

Creatinine elevated with

-diabetes
-renal function
-acute tubular nephrosis
-pylonephritis

26

Creatinine decreased with

-debilitation
-starvation
-hyperthyroidism

27

What is Blood Urea Nitrogen (BUN)?

the concentration of urea nitrogen in blood and is the end product of cellular metabolism (relative to the degree of renal impairment and rate of urea excreted by kidneys)

28

BUN elevated with:

-renal damage
-renal failure
-dehydration
-chronic or acute renal disease
-urinary obstruction
-GI bleed
-CHF
-shock

29

BUN decreased with:

-overhydration
-pregnancy
-liver failure
-secondary to smoking
-decrease protein intake

30

Types of Renal Cystic Disease

-simple renal cyst
-polycystic renal disease
-multicystic dysplastic kidney
-medullary sponge kidney

31

How often do simple renal cysts occur?

common, 50% of adults over 50 years

32

Where may simple renal cysts be found?

anywhere in the kidney

33

When are simple renal cysts clinically significant?

when they distort the adjacent calyces or produce hydronephrosis or pain

34

Son findings of simple renal cysts:

cystic properties
no septations
cyst may have a cyst or mass within it

35

Polycystic renal disease may present in two forms:

-autosomal-recessive form
-autosomal-dominant form

36

What is autosomal-recessive polycystic kidney disease (ARPKD)?

-fairly rare
-dilation of the renal collecting tubules which causes renal failure and in the later forms there is also liver involvement

37

Four forms of ARPKD?

-perinatal
-neonatal
-infantile
-juvenile
(the earler the symptoms manifest, the less the kidneys are functioning)

38

Son. findings of perinatal form of ARPKD?

-oligohydramnios
-enlarged echogenic kidneys

39

Son. findings of later forms of ARPKD?

-enlarged kidneys
-echogenic cortex and medulla
-lack of coritocmedullary differentiation
-may be macroscopic cysts (1-2mm) located in the medulla
-in children there may be also hepatic fibrosis and splenomegaly

40

What is Autosomal-dominant polycystic kidney disease (ADPKD)?

-common genetic disease in women and men
-bilateral disease characterized by multiple cysts located in the renal cortex and medulla

41

T/F: ADPKD cysts vary in size and may be asymmetrical?

T

42

When does ADPKD manifest?

-not until 4th or 5th decade of life
-by age 60, 50% will have end stage renal disease

43

Symptoms of ADPKD: 7

-pain
-hypertension
-palpable mass
-hematuria
-headache
-UTI
-renal insufficiency

44

Complications of ADPKD:

-infection
-hemorrhage
-stone formation
-rupture of cysts
-renal obstruction

45

Associated abnormalities of ADPKD:

-cysts in liver, spleen, pancreas, thyroid, ovary, testes, breast
-cerebral berry aneurysm (Circle of Willis) cerebral arteries
-increased incidence of renal cell carcinoma
-AAA

46

Statistics of Cerebral Berry Aneurysm

16% have it, 9% die from rupture

47

Sonographic findings of ADPKD in the fetus:

-moderately enlarged hyperchoic kidneys
-increased corticomedullary differentiation
-further screening necessary
-not compatible with life

48

Sonographic findings of ADPKD in adults:

-bilateral renal enlargement
-multiple cysts in both cortex and medulla
-advanced cases-normal parenchyma replaced with multiple cysts and kidneys lose shape
-cysts may grow large enough to obliterate renal sinus
-internal debris in cysts
-Walls of cysts may calcify, stones may form within cysts
-complicated cysts may result in spontaneous bleeding

49

What is multicystic dysplastic kidney?

non hereditary renal dysplasia that usually occurs unilaterally

50

What is the most common form of cystic disease in neonates?

multicystic dysplastic kidney

51

T/F: bilateral disease of multicystic dysplastic kidney is incompatible with life?

True

52

Complications of multicystic dysplastic kidney:

-hypertension
-hematuria
-infection
-flank pain

53

Son. finding of multicystic dysplastic kidney in neonates and children:

-kidneys appear enlarged

54

Son findings of multicystic dysplastic kidney in adults:

-kidneys small and calcified
-multiple cysts varying in size with no normal renal parenchyma

55

What is medullary sponge kidney?

-rare, non-hereditary benign renal disease
-congenital but may not be diagnosed until adulthood

56

What is medullary sponge kidney associated with?

dilated collecting tubules and cysts that form in the medulla

57

Son findings of of medullary sponge kidney:

-medulla is very echogenic
-may have associated calcium stones (nephrocalcinosis)

58

What is medullary nephrocalcinosis?

-calcium that forms in the medullary pyramids
-hyperechoic medullary pyramids with or without shadowing

59

What is medullary nephrocalcinosis associated with?

-medullary sponge
-hyperparathyroidism
-cushing syndrome
-adrenal gland tumors
-oral pharmocological doses of vitamin E, calcium, steroid use and malignant neoplasms

60

T/F: sonographic appearance of renal masses is specific

False, nonspecific

61

What is the first finding suggesting a mass may be present?

abnormal contour

62

List malignant renal masses:

-renal cell carcinoma
-transitional cell carcinoma
-Wilm's tumor
-renal lymphoma

63

What is most common of all renal tumors, (85%)?

renal cell carcinoma

64

Renal cell carcinoma, AKA:

adenocarcinoma or hypernephroma

65

Who is renal cell carcinoma likely to affect?

-twice as common in males as females
-6th decade of life

66

T/F: If caught early, prognosis for renal cell carcinoma is good?

True

67

Clinical symptoms of renal cell carcinoma:

-nonspecific
-hematuria
-flank pain
-palpable mass

68

Staging of renal cancer uses the

Robson system

69

Sonographic findings of renal cell carcinoma

-most are unilateral
-isoechoic, hypoechoic solid mass
-may be complex due to areas of necrosis

70

Stage 1 of renal cell carcinoma

confined to the kidney

71

Stage 2 of renal cell carcinoma

spread to the perinephric fat but within Gerota's fascia

72

Stage 3 A of renal cell carcinoma

perinephric involvement with spread to renal vein and or IVC

73

Stage 3 B of renal cell carcinoma

perinephric with regional lymph node enlargement

74

Stage 3 C of renal cell carcinoma

perinephric involvement with venous and lymph node involvement

75

Stage 4 of renal cell carcinoma

invasion of adjacent structures, distal metastasis

76

Where does transitional cell carcinoma originate from?

the transitional epithelial lining of the urinary tract system

77

Transitional cell carcinoma is more common in

males, usually after 60 years old

78

Symptoms of transitional cell carcinoma

-painless hematuria
-blood clots

79

Son. findings of transitional cell carcinoma:

-most commonly seen in the bladder, but can be anywhere in urinary system
-bladder tumors found in trigone area and the lateral borders of bladder
-bladder tumors are focal non mobile masses within the bladder lumen
-masses in renal pelvis are more easily ID'd than those in the renal sinus

80

What is squamous cell carcinoma?

-rare, highly invasive tumor
-poor prognosis

81

Clinical symptoms of squamous cell carcinoma:

hx of chronic irritation and gross hematuria
-palpable kidney secondary to severe hydronephrosis

82

Son findings of squamous cell carcinoma

-large mass in the renal pelvis
-obstruction from kidney stones

83

What is renal lymphoma?

-usually a secondary process due to lymphoma
-large renal masses that can be numerous and bilateral

84

Renal lymphoma is more common in

non-Hodgkin's lymphoma

85

Clinical symptoms of renal lymphoma

-uncommon
-hematuria
-fever
-flank pain
-palpable mass

86

Sonographic findings of renal lymphoma

-variety of appearances, depends on location
-hypoechoic structures with poor acoustic enhancement
-may exhibit numerous thin septa
-renal parenchyma may exhibit a diffuse hypoechoic pattern because of diffuse infiltration

87

Wilms' tumor AKA

nephroblastoma

88

What is the most common solid renal mass of childhood?

Wilms' tumor/ nephroblastoma

89

When is Wilm's tumor common?

rare in newborn, peaks in second year of life

90

Clinical symptoms of Wilms' tumor?

-palpable mass
-pain
-anorexia
-nausea
-vomiting
-fever
-gross hematuria

91

Son findings of Wilms' tumor

-large flank masses
-well circumscribed
-homogenous
-hypoechoic
-may be complex due to necrosis
-hypertension

92

Son findngs of angiomyolipoma

-brightly echogenic, may have posterior enhancement
-found in cortex
-tendency to hemorrhage (highly vascular)

93

What do lipomas consist of?

fat cells

94

Are lipomas more common in females or males?

females

95

Clinical symptoms of lipoma

-asymptomatic
-may cause hematuria

96

Son findings of lipomas

well defined echogenic mass

97

What do oncocytomas consist of?

large epithelial cells

98

Oncocytomas are found most often in

older men, occur in the parathyroid glands, thyroid and adrenal glands

99

Symptoms of oncocytomas:

typically asymptomatic, but tumor may cause pain and hematuria

100

Son findings of oncocytomas

"spoke-wheel" pattern

101

Mesoblastic nephroma AKA

fetal renal hematoma, a benign counterpart of Wilms tumor

102

What is the most common solid neoplasm in the neonate?

mesoblastic nephroma

103

Is mesoblastic nephroma found more often in men or women?

men

104

What two abnormalities are associated with mesoblastic nephroma?

large flank mass, hypertension

105

Issues associated with renal disease

-generalized increase in cortical echoes which are a result of deposits of collagen and fibrous tissues
-interstitial nephritis
-acute tubular necrosis
-amyloidosis
-diabetic nephropathy
-systemic lupus erythematosus
-myeloma
-loss of normal anatomic detail
-chronic pyelonephritis
-tubular ectasia
-acute bacterial nephritis

106

Endstage renal disease often results in

renal atrophy (seen on u/s by measuring renal length and cortical thickness

107

What acute diseases can produce renal enlargement and decreased parenchymal echogenicity?

-renal vein thrombosis
-pyelonephritis
-renal transplant rejection

108

What is acute pyelonephritis?

Upper UTI, resulting from ascending infection through the ureters

109

Acute pyelonephritis most affects women of what age?

of childbearing age

110

Symptoms of pyelonephritis include:

-sudden onset of flank pain
-fever
-frequency
-hematuria
-dysuria

111

When can a clinical diagnosis for acute pyelonephritis be made?

when urinalysis indicates abnormal bacteria, leukocytes, and RBC

112

Son findings of acute pyelonephritis

-difficult to diagnose son.
-kidneys may be completely normal or slightly enlarged
-dilated blunt calyx
-loss of corticomedullary differentiation

113

What does chronic pyelonephritis result from?

recurrent or untreated UTI's (more common in women)

114

Chronic pyelonephritis may result in

loss of kidney function over time (renal dialysis or transplant may be warranted.)

115

Clinical symptoms of chronic pyelonephritis include:

-fatigue
-hypertension
-flank pain
-hematuria

116

Son findings of chronic pyelonephritis:

-dilated blunt calyces
-cortical thinning
-if disease is unilateral , the contralateral kidney may enlarge to compensate

117

What does renal failure disallow?

normal removal of accumulated metabolites from blood

118

Pre nenal causes of renal failure:

-loss of profusion due to thrombosis
-shock
-sepsis
-embolization
-heart failure

119

Intra renal causes of renal failure:

-parenchymal disease
-chronic infections
-renal ischemia
-AIDS
-Exposure to toxins

120

Post renal causes of renal failure:

-obstructive uropathy
-increase incidence with uncontrolled diabetes
-uncontrolled hypertension

121

Lab tests that find renal failure:

-Elevated BUN creatinine
-Decrease serum calcium
-low urinary specific gravity
-proteinurea
-RBC and WBC in urine
-anemia

122

Son findings of renal failure

-decrease renal size
-increase parenchymal echogenicity-fibrosis and scarring

123

What are renal stones made of?

-calcium
-uric acid
-xanthine
-cystine

124

Renal stones AKA:

urolithiasis

125

Majority of renal stones are made with

Calcium

126

T/F: Renal stones may be found anywhere in the urinary system?

True

127

What demographics have higher instances of renal stones?

-men
-U.S.

128

Staghorn calculi:

when stones fill the entire collecting system and become a solid mass

129

As stones pass thru the ureter they usually become lodged where?

at the renal pelvis and ureterovesicle junction causing excruciating pain

130

If pain is localized in the flank area, where is the stone likely located?

the kidney or proximal ureter

131

Clinical symptoms of renal stones

-hematuria
-RBC in urine
-WBC in urine
-bacteria in urine

132

Treatment for renal stones depends on size and location:

-lithotripsy
-percutaneous nephrolithotomy
-ureteroscopic stone removal

133

If stones cause obstruction there will be :

hydronephrosis and depending on the location the ureter may be dilated superiour to the level of obstruction

134

Son findings of renal stones

-very echogenic
-sharp, marginated, clean shadows

135

What is hydronephrosis?

dilation of the renal pelvis and calyces caused by an obstruction of the urinary tract..if obstruction is at the level of the urethra then bilateral hydronephrosis will occur

136

Causes of bilateral hydronephrosis:

-stones lodged in urethra
-enlarged prostate
-bladder tumors
-posterior urethral valve syndrome in infants and young boys

137

Causes of unilateral hydronephrosis

-congenital disorders
-acquired syndromes
-tumors
-inflammatory disorders
-blood clots
-pregnancy
-stones

138

With hydronephrosis, if obstruction is not corrected, severe deterioration of what may occur?

renal cortex

139

Hydronephrosis clinical symptoms:

-flank pain
-nausea
-vomiting
-elevated BUN and creatinine

140

Sonographic findings for hydronephrosis:

-hypoechoic /cystic area within the renal sinus

141

Grade 1 of hydronephrosis:

small separation of calyceal pattern

142

Grade 2 of hydronephrosis

bear-claw effect, with fluid extending into the major and minor calyceal system and thinning of the renal parenchyma

143

Grade 3 of hydronephrosis

massive dilation of the renal pelvis with loss of renal parenchyma

144

Trauma in the kidneys:

linear absence of echoes in area of traumatized kidney

145

Renal infarction is usually caused by:

RA obstruction

146

Results of renal infarction:

-kidney reduced in size
-complete occlusion/multiple infarcts results in small hyperechoic endstage appearing kidney

147

Renal abscess AKA:

renal carbuncle

148

Clinical symptoms of abscess:

-fever
-leukocystosis
-flank pain

149

Perforation of renal abscess in surrounding area

-marked fever
-abdomen board-like rigidity with flank pain

150

Where does a renal transplant go?

right side of pelvis within retroperitoneum

151

Indications for renal transplant:

-vascular compromise
-renal failure
-infection

152

Lymphocele

-predominantly anechoic mass 4-8 weeks post transplant
-can contain septations/debris
-can cause obstruction when large
-can be drained, may reoccur

153

Urinoma:

post-op complication with in first 2 weeks-ureter anastimosis leak

154

Hematoma for renal transplant

arise soon after surgery
-new-anechoic
-old-hyperechoic
-contain debris

155

Son findings of acute rejection of renal transplant:

-enlarged kidney
-decreased cortical echogenicity
-indistinct corticomedullary boundaries
-prominent hypoechoic pyramids
-peri-transplant fluid collections

156

Severe rejection of renal transplant result in :

-marked hemorrhage in parenchyma
-high-resistive waveforms, decreased, absent, or reversed end diastolic flow, >0.7
-Acute tubular necrosis
-renal artery thrombosis
-RV thrombosis
-Urinary obstruction
-cyclosporing toxicity