urinary system ppt test 3 Flashcards by Miss Nancy

Urinary System Anatomy- 4 parts

Kidneys
Ureters
Bladder
Urethra

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types of PATHOLOGY

Renal masses
Obstructive uropathy
Inflammatory diseases
Vascular pathology
Renal failure

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3 types of renal masses

Cystic - anechoic, smooth walls, posterior enhancement

Solid - nongeometric shape with irregular borders, poorly
defined interface, low-level internal echoes

Complex - Shadowing; characteristics of both cystic and
solid components

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type of renal mass

anechoic, smooth walls, posterior enhancement

cystic

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type of renal mass

nongeometric shape with irregular borders, poorly
defined interface, low-level internal echoes

solid

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type of renal mass

Shadowing; characteristics of both cystic and
solid components

complex

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This is a term used when the calyces and renal pelvis have a
compressed appearance due to the accumulation of excessive
(nontumorous) fatty tissue within the renal sinus

RENAL SINUS LIPOMATOSIS

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what is this

fat around the kidney

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2 types of cystic disease placement

perirenal
subcapsular

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t/f

cystic disease can be hereditary and non hereditary

true

Non-hereditary
◦ Developmental
◦ Acquired
Hereditary

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name that pathology

Unknown origin
Serous fluid collection originating in the renal cortex
Uncommon before 40 years
Found in 50% of people over 50 years old
May be multiple (rarely more than 4 per kidney

simple cyst

they are unilocular

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name that pathology

-Anechoic, well-defined mass located at the renal hilum
-No communication with collecting system
-Spherical in shape
-Patient may present with hypertension, hematuria, or
hydronephrosis from pressure the cyst applies to
surrounding structures

PARAPELVIC CYST

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name that pathology

Hereditary
Characterized by bilaterally enlarged and cyst-filled
kidneys
Two types:
◦ Adult (APKD)
◦ Infantile (IPKD

POLYCYSTIC KIDNEY DISEASE

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name that pathology

-Fairly common
-Autosomal dominant trait—genetic
-Characterized by enlarged, palpable, cyst-filled
kidneys – May create mass effect
-Usually manifests during the 3rd or 4th decade
-Clinically presents as dull, aching pain of the abdomen
or back; possibly hematuria and hypertension
-Associated with cysts in the liver, pancreas, and berry
aneurysms of brain

ADULT POLYCYSTIC KIDNEY DISEASE

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sonographic appearance of which pathology

Bilateral
Kidneys appear enlarged, with numerous discrete
cysts in the cortical regions
Should also scan liver, pancreas, and spleen for
cysts

POLYCYSTIC KIDNEY DISEASE

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name that pathology

Autozomal recessive (bilateral)
Multiple cystic dilations of the collecting ducts
Usually presents in young adults- incidental
finding
Normal renal function
Cysts are usually very small (<2 cm) usually
cannot be diagnosed sonographically

MEDULLARY CYSTIC DISEASE

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name that pathology

Occurs with the destruction of renal tissue
May or may not communicate with the collecting
system
Sonographic appearance varies - must differentiate
with clinical history

ACQUIRED CYSTS

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types of AQUIRED CYSTS
Includes:

Hematomas
Inflammatory cysts (abscess)
Uremic renal cystic disease in patients
undergoing dialysis

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An abscess to the renal cortex is called a ____________________________ (usually results from the union of several
small abscesses)

renal carbuncle

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SONOGRAPHIC APPEARANCE of a pathology

-Anechoic to hypoechoic complex mass
-Irregular borders
-May contain debris, septa, gas
-May cause acoustic shadowing
-Perirenal - may displace the kidney and can be
separated from the parenchyma
-Decreased movement of the kidney on inspiration and
expiration

RENAL & PERIRENAL ABSCESS

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Many patients on hemodialysis develop bilateral cystic
disease and carcinoma
Incidence increases with time (especially after 3 years)

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3 types of BENIGN NEOPLASMS

Angiomyolipoma
Adenoma
Oncocytoma

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name that pathology

-Most common benign renal tumor
-More common in right kidney
-80% of cases occur in women
-Occurs in 80% of patients with tuberus sclerosis
-Composed of fat cells intermixed with smooth muscle cells and
blood vessels
-Asymptomatic
-Sonographically appears as a focal, solid, hyperechoic mass
-May have posterior enhancement
-Vary from 1 - 20 cms

ANGIOMYOLIPOMA

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name that pathology

-Usually less than 1 cm; rarely larger than 3 cm
-Asymptomatic unless large
-Can cause painless hematuria
-Sonographically presents as a highly vascular tumor
with many internal echoes and increased sound
attenuation
-May have calcifications

ADENOMA

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name that pathology -A class of very large vascular adenomas -Usually cannot be distinguished sonographically from a typical renal cell carcinoma -Well-defined, smooth, homogeneous -May demonstrate a central stellate scar (can differentiate from renal cell carcinoma)

ONCOCYTOMA

name that pathology Urine flow obstructed Urine formation continues, causing calyces to distend and renal pelvis to dilate Irreversible damage can occur after 3 weeks

OBSTRUCTIVE UROPATHY Obstruction can result from ◦ Developmental defects ◦ Calculi ◦ normal pregnancy ◦ Benign prostatic hypertrophy ◦ Infection or inflammation with scar tissue ◦ Possibly even spinal cord injury

name that pathology -Dilation of the renal pelvis, calyceal structures, and infundibula by urine -Obstruction can be either intrinsic or extrinsic -Sonographic “hallmark” - splaying, spreading, or ballooning of the central echo complex -Dilated ureter helpful in differentiation

HYDRONEPHROSIS

hydronephrosis ratings Mild (aka pelvicaliectasis) ◦ dilatation of the renal pelvis with or without dilatation of the calyces (pelvicalyceal pattern is retained) ◦ Dilatation may also be noted in the extrarenal pelvis ◦ no parenchymal atrophy Moderate ◦ moderate dilatation of the renal pelvis and calyces ◦ blunting of fornices and flattening of papillae ◦ mild cortical thinning may be seen Grade 4 (severe) ◦ gross dilatation of the renal pelvis and calyces, which appear ballooned ◦ loss of borders between the renal pelvis and calyces ◦ renal atrophy seen as cortical thinning

name that pathology Usually develops in the kidney (nephrolithiasis) Increased prevalence in hot climates Appears to have a hereditary predisposition Appears as an echogenic foci < 5 mm with posterior shadowing

UROLITHIASIS

Demonstrate _________________ to DISPROVE a stone in the UVJ alone with sonographic interrogation of the distal ureter

bilateral ureteral jets

The most common place for a urinary stone to become lodged is within the ____________ junction, near the urinary bladder.

ureterovesicle

types of INFLAMMATORY DISEASES

Urinary tract infection (UTI) Acute glomerulonephritis Chronic atrophic nephritis Pyonephrosis

which pathology PREDISPOSING FACTORS: ◦ Diabetes ◦ Immune compromise ◦ Pregnancy ◦ Benign prostatic hypertrophy

URINARY TRACT INFECTION

which pathology Necrosis of cellular elements in glomeruli Results in enlarged, poorly functioning kidneys Suspected when cortical echogenicity exceeds that of liver

ACUTE GLOMERULONEPHRITIS

* Nephritic syndrome is immunologically mediated and is characterized by inflammation in the glomeruli * Berger disease is the most common glomerular disease worldwide, and it’s one of the most common causes of recurrent hematuria. * Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.

which pathology -Acute Bacterial infection (usually ascends from lower urinary tract) -Unilateral or bilateral; Abrupt onset -Characterized by diffuse edema and renal enlargement with intense inflammatory foci -May lead to microabscess formation

ACUTE PYELONEPHRITIS

sonographic appearance -Normal -Homogenous and enlarged (edema) -Hypoechoic -Strong back-wall -As infection progresses - lose distinct central echo complex; blends into edematous parenchyma

ACUTE PYELONEPHRITIS

which pathology Results from recurrent infections Renal scarring involving calyces and pelvis Lose tubular function and ability to concentrate urine Leads to parenchymal atrophy

CHRONIC ATROPHIC NEPHRITIS

which pathology Pus in an obstructed renal collecting system Sonographically appears as low-level echoes within the dilated collecting system

PYONEPHROSIS

which pathology -is defined as a chronic inflammatory disorder of the kidney characterized by a mass originating in the renal parenchyma. -Most cases are unilateral -The kidney is usually nonfunctional.

Xanthogranulomatous Pyelonephritis

-The exact etiology of XGP is unknown, but it is generally accepted that the disease process requires long-term renal obstruction and infection. -Stones (frequently of staghorn proportions) may occur in 75% of patients with XGP but are not required to make the diagnosis. -XGP is often observed in patients with diabetes or in patients who are immunocompromised. -XGP occurs in approximately 1% of all renal infections. -XGP is 4 times more common in women than men and is usually noted in the fifth and sixth decades of life. -XGP displays neoplasmlike properties capable of local tissue invasion and destruction and has been referred to as a pseudotumor. -Adjacent organs including the spleen, pancreas, or duodenum, may be involved.

more on Xanthogranulomatous Pyelonephritis Patients with XGP often appear chronically ill. Symptoms include anorexia, fevers, weight loss, and dull and persistent flank pain. Urine typically has both leukocytes and bacteria present. XGP is notorious for fistulation. Renal cell carcinoma may be indistinguishable from XGP sonographically

types of VASCULAR PATHOLOGY

Infarction Renal artery stenosis

which pathology -Obstruction of the blood supply or drainage by the occlusion or stenosis of a vessel -Initially appears as a hypoechoic mass becoming more echogenic with time -Usually hyperechoic, triangular, focal renal mass

INFARCTION

The inability of the kidneys to remove accumulated metabolites from the blood MAJOR CAUSES - ◦ Renal pathology ◦ Systemic disease ◦ urologic defects of non-renal origin attributed to surgery or trauma, various medical conditions, pregnancy, and nephrotoxix

RENAL FAILURE

ACUTE RENAL FAILURE Potentially reversible - important to recognize signs and symptoms Two phases: 1 2

◦ Oliguric - Urine output is greatly reduced, bun and creatnine elevated; Complications include hypertension, muscle weakness, GI bleeding, and infection ◦ Diuretic - Few days to 6 weeks later, nephrons recover enough to excrete urine; can cause excessive loss of water and electrolytes

◦ ______________- Urine output is greatly reduced, bun and creatnine elevated; Complications include hypertension, muscle weakness, GI bleeding, and infection

Oliguric

◦ _____________- Few days to 6 weeks later, nephrons recover enough to excrete urine; can cause excessive loss of water and electrolytes

Diuretic

_____________________ is the best measure of kidney function and thus the stage of kidney disease.

Glomerular filtration rate (GFR) GFR a is math formula using the person's age, race, gender and their serum creatinine is used to calculate a GFR.

t/f GFR levels of normal/abnormal are highly dependent on RACE—values are different for Caucasian vs. African American

true

Blood urea nitrogen (BUN) level is another indicator of kidney function. Urea is also a metabolic byproduct which can build up if kidney function is impaired. The BUN-to-creatinine ratio generally provides more precise information about kidney function and its possible underlying cause compared with creatinine level alone. WARNINNG: BUN also increases with DEHYDRATION. Know your patient’s history!

As the kidneys become impaired for any reason, the _________________level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. Values are dependent on gender (female vs males)

creatine

t/f creatine values are dependent on gender

true

Irreversible - diminished function of the nephrons SONOGRAPHIC FINDINGS: ◦ small, shrunken, echogenic kidney is definitive for end-stage renal disease ◦ Dialysis or renal transplantation necessary ◦ May be caused by Renal Artery Stenosis

chronic renal failure

Renal artery stenosis can lead to renal _____________ and irreparable renal compromise.

infarction

where are transplant kidneys located

Graft placed in iliac fossa, anterior to the psoas muscle and iliac veins

The “original” kidneys remain in the patient and are called the “_____________” kidneys

native

TRANSPLANT REJECTION Often result of ________________. Seen about day 2 post transplant—cause of acute rejection

Acute Tubular Necrosis (ATN)

4 types of MALIGNANT NEOPLASM

Renal cell carcinoma Transitional cell carcinoma Wilm’s tumor Metastasis Smoking is a risk factor for both renal cell carcinoma and transitional carcinoma as well as pancreatic cancer

RENAL CELL CARCINOMA aka

Also called a hypernephroma or adenocarcinoma

A form of kidney cancer that involves cancerous changes in the cells of the renal tubule

RENAL CELL CARCINOMA Also called a hypernephroma or adenocarcinoma

Most common malignant tumor of the kidney (85%) Most common in 6-7th decade Twice as common in males

RENAL CELL CARCINOMA Also called a hypernephroma or adenocarcinoma

renal cell carcinoma

Must examine renal vein, IVC, renal hilum, paraaortic lymph nodes, and contralateral kidney for extensions and metastasis

Most common tumor of the renal collecting system (often multiple)

TRANSITIONAL CELL CARCINOMA

METASTATIC RENAL TUMORS Relatively common Most common from malignant melanoma, lymphoma, lungs, breast, stomach, and colon No specific pattern to distinguish from other solid lesions

Urinary Bladder Anomalies Diverticula Posterior urethral valve syndrome Exstrophy Contraction of the bladder neck Ectopic ureter and ectopic ureterocele

Bladder diverticulum

Prostatic urethra is markedly dilated because of an obstruction at or just below the point where the seminal ducts enter

POSTERIOR URETHRAL VALVES

Eversion of the bladder through a defect in the anterior abdominal wall with separation of the pubic symphasis

EXSTROPHY

cyst-like enlargement of the lower end of the ureter formed when the ectopic ureter is obstructed in the area where it enters the bladder, causing its anterior wall to balloon into the bladder

Ureterocele

ECTOPIC URETER AND URETEROCELE ▪Ureter does not insert near the posterolateral angle of a normal trigone ▪Most arise from the superior pelvis of a duplicated kidney

When the bladder wall measures _____________ it is considered abnormal.

5 mm+

BLADDER CALCULI

__________________ is a rare disorder characterized by the formation of cystic malformations in the collecting ducts and the tubular structures within the kidneys (tubules) that collect urine. One or both kidneys may be affected.

Medullary Sponge Kidney

Accounts for majority of palpable abdominal masses in neonate

HYDRONEPHROSIS May be caused by Ureteropelvic Junction Obstruction, Posterior Urethral Valves, or by compression of the ureter

MEGAURETER

The ____________ rule describes the situation when an ectopic ureter from the upper pole moiety ends in a ureterocele in the bladder causing obstruction

Weigert–Meyer