URINARY PATHOLOGY POWERPOINT Flashcards
(163 cards)
1
Q
pathology of the urinary system includes (6):
A
- Renal cystic disease
- Hematoma
- Abscess
- Nephritis
- Necrosis
- Renal failure
2
Q
how are renal masses classified w/ sonography?
A
cystic, solid, or complex
3
Q
what are the characteristics of a simple cyst?
A
Smooth, thin, well-defined border
Round or oval shape
Sharp interface between the cyst and renal parenchyma
No internal echoes (anechoic)
Increased posterior acoustic enhancement
4
Q
true or false? about 50% of pt over age 50 have a simple renal cyst.
A
true
5
Q
what is the criteria of a simple cystic mass
A
simple cyst:
- Smooth, thin, well-defined border
- Round or oval shape
- Sharp interface between the cyst and renal parenchyma
- No internal echoes (anechoic)
- Increased posterior acoustic enhancement
6
Q
simple cyst images
A
simple cyst image
7
Q
what are the characteristics of a solid mass?
A
- Irregular borders
- Poorly defined interface between the mass and kidney
- Low-level internal echoes
- Weak posterior border (because of the increased attenuation of the mass)
- Poor through-transmission
8
Q
true or false? Complex mass shows characteristics associated with both cystic and solid lesions. Areas of necrosis, hemorrhage, abscess, or calcification within the mass
A
true
9
Q
true or false? complex cysts may contain septations, thick walls, calcifications, internal echoes, and mural nodularity
A
true
10
Q
clinical S/S of inflammoatory or necrotic cysts?
A
- Flank pain
- hematuria
- proteinuria
- white blood cells in urine
11
Q
Clinical S/S of renal subcapsular hematoma?
A
- Hematuria
- hematocrit
12
Q
clinical S/S of renal inflammatory processes?
A
- Abscess
- acute onset of symptoms
- fever
- palpable mass
- increased white blood cell count
- pyuria
13
Q
what are the clinical S/S of acute focal bacterial nephritis?
A
- Fever
- flank pain
- pyuria
- elevated blood urea nitrogen (BUN)
- elevated albumin
- increased total plasma proteins
14
Q
clinical S/S of acute tubular necrosis?
A
- Moderate-to-severe intermittent flank pain
- vomiting
- hematuria
- infection
- leukocytosis with infection
15
Q
clinical S/S of chronic renal failure?
A
- Increased concentration of urea in blood
- high urine protein excretion
- elevated creatinine
- presence of granulocytes
16
Q
what are the clinical S/S of renal cell carcinoma?
A
- Erythrocytosis
- leukocytosis
- red blood cells in urine
- pyruia
- increased lactic acid dehydrogenase
17
Q
true or false? polycystic renal disease may present in one of two forms; the infantile autosomal recesssive form and the adult autosomal dominant form.
A
true
18
Q
what is simple renal cystic disease?
A
- Encompasses a wide range of disease processes
- Typical, complicated, or atypical
- May be acquired (nongenetic) or inherited (genetic)
- Can occur in the renal cortex, medulla, or renal sinus
19
Q
what are simple renal cysts? incidence? appearance?
A
- Acquired lesions, probably from obstructed ducts or tubules
- Estimated incidence: 50% of the population older than 50 years of age
- Asymptomatic; incidental finding
- Solitary or multiple
- One or both kidney involvement
20
Q
cysts may be complicated by ______, ______, or _______ and become a complex cyst.
A
hemmorhage, infection, or calcification
21
Q
cysts in the pediatric patient: differentiate a benign cyst from a cystic form of _______. (_____ _____)
A
nephroblastoma (Wilm’s tumor)
22
Q
characteristics of a complex cyst:
A
- May contain septations, thick walls, calcifications, internal echoes, and mural nodularity.
- Considered malignant until proven benign
- Internal echoes are often the result of protein content, hemorrhage, and/or infection.
- Any irregularity at the base of the cyst should be considered a malignant growth.
- If septa is thicker than 1 mm with vascularity on color or power Doppler, the lesion is presumed malignant.
23
Q
The renal sinus parapelvic cysts are ____ cysts that originate from the renal ___, most likely ______ in origin
A
small; sinus; lymphatic
24
Q
do renal sinus parapelvic cysts communicate with the collecting system?
A
no
25
true or false? renal sinus parapelvic cysts are largely asymptomatic, but may occasionally cause pain, hematuria, hypertension, or obstruction
true
26
a _______ \_\_\_\_\_\_ (renal sinus cyst) is found in the renal hilum but does not communicate with the renal collecting system.
parapelvic cyst
27
which renal cysts are associated with renal neoplasms?
Von Hippel-Lindau
Tuberous Sclerosis
Acquired Cystic Kidney Disease
28
**the sonographic appearance of tuber slcerosis may be difficult to differentiate from ____ \_\_\_\_\_\_\_ _____ disease.**
adult polycystic kidney
29
**autosomal -recessive polycystic kidney disease (ARPKD**) is a ___ disorder that affects \_\_\_\_, chromosome \_\_
rare; infants; 6
30
autosomal -dominant polycystic kidney disease (ADPKD) is a ____ disorder that affects \_\_\_\_, and the severity varies depending upon the \_\_\_\_\_
common; adults; genotype
31
true or false? with ARPKD dilation of the renal collecting tubules causes renal failure, and the liver is involved in the advanced stages.
true
32
What are the 4 kinds of ARPKD and what does the diagnosis depend on?
4 types
* perinatal
* neonatal
* infantile
* juvenile
type diagnosed depends on patient age at the onset of clinical signs
33
the ______ form of ARPKD is found in utero and usually progresses to renal failure, causing pulmonary hypoplasia and intrauterine demise
perinatal
34
what are the signs and findings of juvenile ARPKD?
**these all Cause portal hypertension and esophageal** **varices**
* Hypertension
* Renal insufficiency
* Nephromegaly
* Hepatic cysts
* Bile duct proliferation
* Caroli disease of the liver
* Periportal fibrosis
35
true or false? In older children with juvenile ARPKD, kidneys are enlarged with echogenic cortex and medulla, and corticomedullary differentiation is lacking.
true
36
what condition may also be microscopic or small cysts (1 to 2 mm) located in the medulla; are often associated with hepatic fibrosis and splenomegaly
juvenile autosomal-recessive polycystic kidney disease
(ARPKD)
37
true or false? autosomal-dominant polycystic kidney disease (ADPKD) is a bilateral progressive disease where kidneys are enlarged with multiple asymmetrical cysts (size varies) and are located in the renal cortex and medulla
true
38
what condition doesnt usually manifest until age 40 or 50 when hypertension or hematuria develops, and by age 60, approximately 50% of the patients have end-stage renal disease
autosomal dominant polycystic kidney disease (ADPKD)-*adults*
39
polycystic kidney disease
polycystic kidney disease
40
**the nephroblastoma or ____ \_\_\_\_ is the most common solid renal mass of childhood peaking at age 2 and can reoccur.**
Wilms tumor
41
true or false?
A simple renal cyst is an acquired lesion, probably from obstructed ducts or tubules that is asymptomatic, may be solitary or multiple and involves 1 or 2 kidneys
Estimated incidence: 50% of the population older than 50 years of age
true
42
Images of ADPKD
autosomal dominant polycystic kidney disease
(adult)
Images of ADPKD
autosomal dominant polycystic kidney disease
(adult)
43
images of polycystic kidney disease
images of polycystic kidney disease
44
what disease is this: a diffuse foci calcium deposits are usually located in the medula; may be seen in the renal cortex
nephrocalcinosis
45
what is corticomedullary differentiation?
you can not really differentiate cortex from the medulla; seen w/ MSK
46
Renal cell carcinoma tumors less than 3 cm are usually hyperechoic and it is hard to tell the difference between them and what other pathology?
angiomyolipomas
47
renal lymphoma may be confused with a \_\_\_\_.
renal cyst
48
what are the clinical symptoms of ADPKD?
Pain, hypertension, palpable mass, hematuria, headache, urinary tract infection, renal insufficiency
49
what are the complications of autosomal dominant polycystic disease?
Infection, hemorrhage, stone formation, rupture of cyst, renal obstruction
50
what abnormalities are associated w/ autosomal dependant polycystic kidney disease(ADPKD)?
**it will be in the organs**
* Cysts in the liver, spleen, pancreas, thyroid, ovary, testes, and breast
* Cerebral berry aneurysm
* Abdominal aortic aneurysm
51
true or false? patients w/ autosomal dependant polycystic kidney disease on renal dialysis have increased incidence of renal cell carcinoma
true
52
**true or false? polycystic renal disease may present in one of two forms; infantile autosomal recessive form (rare) and the adult autosomal dominant form**
true
53
**\_\_\_\_\_\_ ______ \_\_\_\_\_\_ disease is a common nonhereditary renal dysplasia that usually occurs unilaterally w/ the kidney functioning poorly, if at all and is the most common form of cystic disease in neonates and is believed to be the consequence of early in utero urinary tract obstruction**
multicystic dysplastic kidney (MCDK)
54
\_\_\_\_ changes usually involve the entire kidney, and bilateral involvement is incompatible with life
dysplastic
55
complications of multicystic dysplastic kidney (MCDK) complications:
* Hypertension
* hematuria
* infection
* flank pain
* Slight increased risk of malignancy if kidney is not removed
56
what are the sonographic findings of multicystic dysplastic kidney in children and adults?
* Neonates and children: Kidneys are multicystic, with the absence of the renal parenchyma, renal sinus, and atretic renal artery.
* Adults: Kidneys may be small (atrophic and calcified) and echogenic.
57
what is nephrocalcinosis?
Renal parenchymal calcium deposits that may be seen in patients with Medullary Sponge Kidney. affects both kidneys and diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex.
58
\_\_\_\_\_\_ \_\_\_\_\_\_\_is most commonly seen with chronic glomerulonephritis, chronic hypercalemic states, sickle cell disease, and rejected renal transplants
Cortical nephrocalcinosis
59
true or false? Calcification seen in nephrocalcinosis may be dystrophic from devitalized tissues, ischemia and/or necrosis, or from hypercalemic states, hyperparathyroidism, renal tubular acidosis, and renal failure.
true
60
**\_\_\_\_ _____ \_\_\_\_\_ is a development anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilation of the distal collecting ducts (ducts of Bellini), causing stasis of urine and stone formation.**
medullary sponge kidney (MSK)
61
\_\_\_\_ _____ \_\_\_\_\_ is an anatomic defect and therefore may be unilateral or segmental, and many patients are asymptomatic.
medullary sponge kidney (MSK)
62
Patients with hematuria, infection, and renal stones should be evaluated for ____ \_\_\_\_ \_\_\_\_.
meduallary sponge kidney (MSK)
63
medullary sponge kidney (MSK) images
64
what are the sonographic findings of meduallary sponge kidney (MSK)?
* Small echogenic kidneys
* Loss of corticomedullary differentiation *(can't tell cortex from medulla)*
* Multiple medullary small cysts under 2 cm
* With MSK, hyperechoic calyces, with or without stones
65
when is a renal mass considered malignant?
* a solid renal mass, is considered malignant unless fat is present.
* renal mass w/ calcifications
* If a cystic renal mass is not simple
66
if a renal mass is not a simple cyst, has calcifications, or is solid what are possible considerations?
* renal pseudotumor
* 10%-15% are METASTASES at time of diagnosis
67
when a renal mass is detected what needs to be sonographically evaluated?
* renal vein and IVC into right atrium to look for thrombus and tumor extension.
* contralateral kidney, liver, and retroperitoneum for metastases.
68
what are the sonographic characteristics of a malignant cystic mass?
* Wall thickness \> 1 mm
* Irregularity at the base of the cyst
* Septations
* Calcifications
* Vascularity in the septa and/or cystic wall
69
**true or false? Renal cell carcinoma my demonstrate renal vein thrombosis or tumor extension into the renal vein and IVC**
true
70
**true or false? renal cell carcinoma may invade the renal vein and IVC with a tumor or thrombosis?**
true
71
a _____ \_\_\_\_\_ projects as a nongeometric shape with irregular borders, a poorly defined interface between the mass and the kidney, low-level internal echoes, a weak posterior border caused by increased attenuation of the mass, and poor through transmission
solid mass
72
characteristics of a solid lesion:
* nongeometric shape w/ irregular borders
* not well defined interface btwn mass and kidney
* low level internal echoes
* increased attenuation *causing a*
* weak posterior border
* poor through transmission
73
\_\_\_ ____ \_\_\_\_, also called hypernephroma, or Grawitz's tumor, is the most common of all renal neoplasms (85% of kidney tumors)
renal cell carcinoma
74
\_\_\_\_ ___ \_\_\_ accounts for 90% of malignancies that involve the renal pelvis, ureter, and bladder.
transitional cell carcinoma
75
\_\_\_\_\_ to the kidneys are common, occuring late in disease. secondary malignancies are bilateral in 1/3 of pt and multiple in 50%.
metastases
76
the most common primary malignancies to metastisize to the kidneys include carcinoma of the ___ or ___ and renal cell carcinoma of the ____ \_\_\_\_
lung or breast
contralateral kidney
77
renal cell carcinoma facts
* Most common malignant tumor of the kidney
* Metastasizes to opposite kidney
* 2x as common in men, usually 6th -7th decade of life
* Solid mass sometimes has calcifications
* Extension into renal v or IVC is common
78
\_\_\_ ___ \_\_\_\_ (hypernephroma or Grawitz tumor) is the most common renal neoplasm, 2x as common in men age 60-70, with non specific clinical presentation and s/s may include hematuria, flank pain, and palpable mass.
renal cell carcinoma
79
what is the pathology shown
renal cell carcinoma
sonographic appearance of most RCCs: solid w/ no preference for right or left kidney, or location inside
80
clinical presentation, and S/S of renal cell carcinoma
* Clinical presentation: nonspecific
* Patient may report
* hematuria
* flank pain
* palpable mass.
81
true or false? an entirely cystic tumor is very rare w/ renal cell carcinoma.
true
82
what pathology is shown?
renal cell carcinoma
83
**sonographic findings of renal cell carcinoma (RCC**):
* Most isoechoic; some hyperechoic.
* The larger the tumor, more heterogeneous its echotexture, (caused by intratumoral hemorrhage and necrosis)
* Tumors \< 3 cm- usually hyperechoic;looks very similar to echogenic fat-containing tumors similar to angiomyolipomas (difficult to tell apart)
* *hypoechoic rim- vascular* *pseudocapsule* *on color Dopple*r
* **intratumoral calcifications-specific for RCC**
84
A renal cell carcinoma tumor \< 3cm are usually hyperechoic and distinguishing them from echogenic fat containing tumors similar to ____ is difficult
angiomyolipomas
85
image: small hyperechoic renal cell carcinoma
color Doppler shows peripheral vascularity of the tumor (**basket sign)**
* hypoechoic rim represents vascular pseudocapsule on color Doppler
86
Doppler characteristics of renal cell carcinoma.
* hypoechoic rim represents vascular pseudocapsule on **color Doppler**
* intratumoral calcifications are considered specific for RCC
* typical flow pattern in **spectral Doppler**
* ↑ systolic & ↑ end diastolic arterial flow; ↓ resistive index (RI)
87
**\_\_\_\_ ____ \_\_\_\_** may be papillary (more common) or flat
transitional cell carcinoma
88
true or false? _Papillary_ transitional cell carcinoma(TCC) has an an exophytic polypoid appearance attached to the mucosa
true
89
true or false? papillary transitional cell carcinoma (TCC) is usually a low-grade malignancy which tends to have a more benign course
true
90
small ___ \_\_\_ ___ tend to be flat, generally high-grade malignancy tumors that spread easily to the other tissues and organs
transitional cell carcinoma (TCC)
91
which pathology?
Patient may have gross or microscopic hematuria and flank pain.
Differential diagnosis: Other tumors of the renal pelvis: squamous cell tumor, adenoma, blood clot, or fungus ball
Transitional cell carcinoma
92
what are the transitional cell carcinoma (TCC) differentials?
* Other tumors of the renal pelvis
* squamous cell tumor
* adenoma
* blood clot
* fungus ball
93
sonographic appearance of transitional cell carcinoma (TCC)
* hypoechoic mass in collecting system, low vascularity on color Doppler
* Calcifications very rare
* May invade adjacent renal parenchyma forming an infiltrating mass, usually preserves renal contour
94
what is squamous cell carcinoma?
**a rare, highly invasive tumor w/ poor prognosis.**
*image:* 6*0 year old w/ Metastatic disease. (A)Sagittal RT kidney shows irregularly shaped mass filling the renal sinus (B) transverse squamous cell carcinoma*
95
what are the clinical and sonographic findings of squamous cell carcinoma?
* Clinical findings
* History of chronic irritation and gross hematuria
* Palpable kidney secondary to severe hydronephrosis
* Sonographic findings
* Large mass in renal pelvis.
* Obstruction from kidney stones may also be present.
96
\_\_\_\_ (Wilms' tumor) is the most common abdominal malignancy in children and the most common solid renal tumor in pediatric patients age 1-8.
nephroblastoma
97
renal _____ is the most common benign renal tumor, and is composed of varying proportions of fat, muscle and blood
angiomyolipoma
98
a ____ is a cystlike enlargement of the lower end of the ureter caused by congenital or acquired stenosis of the distal end of the ureter
ureterocele
99
different forms of ____ includign membranous, idiopathic, membranoproliferative, rapidly progressive, and poststreptococcal can be associated w/ abnormal echopatterns from the renal parenchyma on a sonogram
glomerulonephritis
100
\_\_\_ ____ \_\_\_ has been associated w/ the infectious process of scarlet fever and diphtheria
acute interstitial nephritis
101
**a ____ is a cystelike enlargement of the lower end of ureter. it can be congenital or acquired and may cause obstruction or infection.**
ureterocele
102
**the Doppler signal of a renal transplant is the same as a normal kidney. A resistive index (RI) of __ is considered to be in the upper limit of normal**
0.7
103
**in chronic renal disease, including ____ \_\_\_\_, the kidneys appear diffusely enlarged w/ a loss of normal anatomy.**
chronic pyelonephritis
104
Primary \_\_\_\_\_involvement of the kidneys is rare; the secondary form is more common
lymohomatous
105
Secondary form of ____ \_\_\_\_may occur as a hematogenous spread or as a direct extension via the retroperitoneal lymphatic channels with a contiguous spread from the retroperitoneum.
renal lymphoma
106
\_\_\_\_\_ \_\_\_\_\_is more common than Hodgkin lymphoma.
Non-Hodgkin lymphoma
107
\_\_\_\_\_is more common as a bilateral invasion with multiple nodules.
Lymphoma
108
renal lymphoma sonographic findings:
* Kidneys are enlarged; hypoechoic, relative to the renal parenchyma.
* similar to renal cyst w/out acoustic enhancement.
* rare- halo of hypoechoic mass in the perinephric regions.
* renal tumors that are
* very hypoechoic w/ poorly defined margins, w/out posterior enhancement --may be confused for “renal cysts.”
109
renal tumors that are very hypoechoic w/ poorly defined margins, w/out posterior enhancement may be confused for ___ \_\_\_\_
renal cysts
110
Metastases to the kidneys is common. the most common primary malignancies that metastasize to the kidneys include carcinoma of the \_\_\_, \_\_\_, or renal cell carcinoma of the _____ \_\_\_\_\_
lung; breast; contralateral kidney
111
Sonographic findings of renal metastases:
* Multiple, poorly marginated, hypoechoic masses seen
* possible renal enlargement w/out a discrete mass
* may spread beyond renal capsule & invade the venous channel, w/ cells extending into the IVC and right atrium; eventually metastasizes to lungs.
* multifocal (uncommon).
* (similar to renal cell carcinoma)
112
**what is the most common** **abd****. malignancy and most common solid renal tumor in pediatric patients, w peak incidence approx. 2.5 to 3 years of age, and is more common in patients w/ horseshoe kidney**
Nephroblastoma (Wilm's Tumor)
113
what are the clinical signs of Nephroblastoma (Wilms Tumor)
* abdominal flank mass
* hematuria
* fever
* anorexia
114
what is our job when we see a mass ?
Determine whether the mass is cystic or solid, and confirm that it is renal in origin.
115
* Nephroblastoma (Wilm’s tumor) sonographic findings:
is mass cystic or solid, and confirm it is renal in origin.
* varies; hypoechoic to moderately echogenic.
* usually one kidney involved
* some will have renal vein thrombosis and/or vena cava or atrial thrombus
* Venous obstruction may result with findings of leg edema, varicocele, or Budd-Chiari syndrome. **(because mass caused this)**
116
true or false? all renal tumors are assumed malignant until proven otherwise
true
117
Benign Renal tumors clinical findings:
* Patient is usually asymptomatic.
* Flank pain is present if the mass is large or if hemorrhaging from the mass has occurred.
118
what are two kinds of benign renal tumors?
Adenomas and oncocytomas
119
What is the most common benign renal tumor; composed of fat, muscle and blood. very common in pt with tuberous sclerosis, and may be multifocal varying in size (1 cm -20 cm)?
Renal Angiomyolpoma
120
renal angiomyoliopoma sonographic findings:
Hyperechoic, depending on the proportion of fat, muscle, and vessels within the mass
121
complications of Renal Angiomyolipoma (AML)
intratumoral hemorrhage
organ displacement
122
DD of renal angiomyolipoma (AML)
* Small (\<3 cm) RCCs are also hyperechoic and may simulate AML.
* Hypoechoic rim,. presented similar to a basket sign on color Doppler, favors RCC
123
what can be seen as either as a nephrogenic adenofibroma or an embryonal adenoma and pt is usually asymptomatic
## Footnote
May be incidental findings if the mass is large or if intratumoral hemorrhage has occurred, and may cause hematuria
Renal Adenomatous Tumors
*describe what you see: hyperechoic or echogenic mass, mid to lower pole of left kidney.*
124
sonographic findings of renal adenomatous tumors
* Appear as solid masses
* Hyperechoic to hypoechoic
* Hypovascular on color Doppler
* May be indistinguishable from RCC
*describe what you see: hyperechoic or echogenic mass, mid to lower pole of left kidney.*
125
what tumor consists of fat cells, more common in women, and pt is asymptomatic; hematuria has been reported.
lipomas
126
sonographic finding of lipomas:
Well-defined echogenic mass within the kidney
127
**what are the two kinds of renal disease processes?**
1. Produces a generalized increase in cortical echoes, which are believed to be the result of a deposition of collagen and fibrous tissue
2. Causes a loss of normal anatomic detail( corticomedullary differentiation), resulting in the inability to distinguish the cortex and medullary regions.
128
acute glomerulonephritis; necrosis and/or proliferation of cellular elements, occur in glomeruli and vessels, tubules, and interstitium are affected second. What is the end result?
End result is enlarged, poorly functioning kidneys.
*no differentiation btwn cortex and medulla*
129
which renal diseases cause a loss of normal anatomic detail, resulting in the inability to distinguish the cortex and medullary regions.
Chronic pyelonephritis, renal tubular ectasia, and acute bacterial nephritis
130
true or false? Systemic lupus erythematosus is a connective tissue disorder believed to result from an abnormal immune system, more common in women age 20-40, with kidney involvement 50% of the time.
true
131
renal manifestations and sonographic finding of lupus nephritis
Renal manifestations are hematuria, proteinuria, hypertension, renal vein thrombosis, and renal insufficiency.
Sonographic findings include increased cortical echogenicity and renal atrophy.
132
what are the sonographic findings of renal dysfunction in a patient with acquired immunodeficiency syndrome (AIDS)
* Echogenic parenchymal pattern
* Increased cortical echogenicity
* Normal sized or enlarged kidneys
* Enlarged and hypoechoic kidneys, if AIDS-related lymphoma or Kaposi sarcoma is present
133
true or false? renal involvement and hematuria is common in patients with sickle cell disease; abnormalities include glomerulonephritis, renal vein thrombosis, and papillary necrosis.
true
134
sonographic findings of sickle cell nephropathy:
In acute renal vein thrombosis, kidneys are enlarged with decreased echogenicity, secondary to edema.
With subacute cases, renal enlargement is present with increased cortical echoes.
135
**is there loss of corticomedullary differentiation w/ AIDS?**
yes
136
true or false? Uncontrolled hypertension can lead to progressive renal damage and azotemia.
true
137
sonographic appearance of hypertensive nephropathy:
* Kidneys are small with smooth borders.
* Superimposed scars of pyelonephritis or lobar infarction may distort the intrarenal anatomy.
* Bilateral small kidneys occur secondary to end-stage disease as a result of hypertension, inflammation, or ischemia.
138
what is a result of numberous disease processes with a
a uniform loss of renal tissue, w/ no change intrarenally, and renal sinus lipomatosis occuring secondary
* More severe lipomatosis results from a huge increase in renal sinus fat content in cases of significant renal atrophy because of hydronephrosis and chronic calculus disease.
renal atrophy
139
what causes renal lipomatosis?
a huge increase in renal sinus fat content in cases of significant renal atrophy because of hydronephrosis and chronic calculus disease.
140
sonographic findings of renal atrophy
* Kidneys appear enlarged with a highly echogenic, enlarged renal sinus and a thin cortical rim.
* Renal sinus fat is easily seen as very echogenic reflections.
141
when do we see: excretory and regulatory functions of the kidneys are decreased in both acute and chronic renal failure.
renal failure
142
true or false? Acute renal failure (ARF) is a common medical condition caused by a variety of diseases or pathophysiologic mechanisms that progressively destroys nephrons
true
143
true or false?
Prerenal failure:
* Caused by decreased perfusion of the kidneys
* Renal vein thrombus, congestive heart failure (CHF), renal artery occlusion
* diagnosed w/ laboratory data, and color Doppler
true
144
**true or false?** ATN is most common cause of renal failure and is reversible demonstrating enlarged kidneys w/hyperechoic pyramids
## Footnote
**DD is nephrocalcinosis**
true
145
true or false?
## Footnote
Chronic renal disease has multiple causes, adn sonographically has Increased echogenicity and loss of cortico-medullary differentiation
146
sonographic findings of oncocytoma:
Hypoechoic in more than 50% of cases
“Spoke-wheel” patterns of enhancement evident with a central scar
Extremely difficult to differentiate from RCC
147
What renal tumor is uncommon, usually benign, occurs more in middle-aged and older patients, is usually asymptomatic, but may cause pain and hematuria., w/ average size of 6cm
oncocytoma
148
sonographic findings of acute tubular necrosis?
* Bilaterally enlarged kidneys w hyperechoic pyramids; can revert to a normal appearance
* **DD: Nephrocalcinosis**.
* Calculi may be too small to cause dilation and shadowing of the pyramids.
* As renal function improves, echogenicity decreases (medulla or cortex).
* If it reverses, it is probably acute tubular necrosis.
149
Three main types of chronic renal failure and the sonographic finding:
* Nephron
* Vascular
* Interstitial
Sonographic findings :
Diffusely echogenic w/ loss of normal anatomy; nonspecific
If chronic renal disease is bilateral,then small kidneys
May be the result of hypertension, chronic inflammation, or chronic ischemia.
150
**\*what is hydronephrosis and describe the 4 grades?**
Splaying of the central sinus due to fluid backing up
* Grade I slight splaying
* Grade II glove or bear claw appearance
* Grade III massive dilatation of renal pelvis
* Grade IV thinning of the renal parenchyma
151
how do we locate hydronephrosis sonographically?
Scan ureters and bladder to locate level of obstruction image kidneys post void
152
Mild Hydro- grade I
Hydronephrosis; minimal
153
Hydronephrosis Grade II
Hydronephrosis; moderate
154
Hydro- Grade III
Hydronephrosis; Severe
155
Hydronephrosis w/ hydroureter
Obstructive Hydronephrosis (Cont.)
156
acquired causes of hydronephrosis: (puts pressure on ureter, bladder)
Acquired causes
* Bladder tumors
* Carcinoma of the cervix
* Calculi
* Neurogenic bladder ( elderly, diabetic)
* Normal pregnancy
* Pelvic mass
* Prostatic enlargement
* Retroperitoneal fibrosis
157
intrinsic Causes of Hydronephrosis:
Intrinsic causes
* Calculus
* Stricture
* Inflammation
* Pyelonephritis
* Congenital
* Bladder neck obstruction
* Posterior urethral valves
* Ureterocele
* Ureteropelvic junction (UPJ) obstruction
158
what is the most common renal disease to produce acute renal failure and can be reversible?
acute tubular necrosis
159
conditions that mimic hydro:
* **\*Extrarenal pelvis**
* **\*Parapelvic cysts**
* **Reflux**
* **renal artery aneurysm**
* **Arteriovenous malformation**
* **congenital**
* **papillary necrosis**
* **diuresis**
160
**Pyonephrosis; occurs when pus is found within the collecting renal system, associated w/ severe urosepsis**
**A true urologic emergency that requires urgent intravenous antibiotherapy or percutaneous drainage or both.**
**Usually occurs secondary to long-standing ureteral obstruction from calculus disease, stricture, or congenital anomaly.**
**Sonographic findings include the presence of low-level echoes with a fluid-debris level.**
161
what is emphysematous pyelonephritis?
* Occurs when air is in the parenchyma
* May be caused by Escherichia coli bacteria
* Generally found unilaterally
* May be the cause for an emergency nephrectomy
* Sonographic findings include enlarged hypoechoic and inflamed kidneys
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Calculous of urinary system- \_\_\_\_\_\_
calc of kidney-\_\_\_\_\_\_
urolithiasis; Nephrolithiasis
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