URR 48 Flashcards
(102 cards)
1
Q
A renal transplant is most commonly performed due to end stage renal disease caused by:
A
diabetes
2
Q
For a renal transplant, the donor must have similar ____ to recipient
A
human lymphocyte antigens
3
Q
from recently deceased donor; lasts 7-10 years
A
cadaveric allograft
4
Q
from living person; lasts 15-20 years
A
living donor allograft
5
Q
Renal allografts are typically placed in the:
A
right pelvis
6
Q
When a combined renal and pancreas transplant is performed, the pancreas is placed in the ____ and the kidney is placed on the ___
A
right iliac fossa
left
7
Q
For a renal transplant, the donor ____ is usually connected to the recipient ____ (arteries)
A
renal artery
external iliac artery
8
Q
In a renal transplant, the donor ____ is usually connected to recipient ____ (veins)
A
renal vein
external iliac vein
9
Q
Contraindications for a renal transplant
A
preexisting infection
serious cardiac or peripheral vascular disease
metastatic disease
10
Q
Usually the ___ kidney is harvested for a renal transplant due to the longer renal vein
A
left
11
Q
Renal transplant post op lab testing
A
BUN
creatinine
urinalysis
12
Q
Elevated ____ levels are the most common indicator of transplant malfunction
A
creatinine
13
Q
used to assess allograft function and transplant success
A
Glomerular filtration rate
14
Q
A ___ or ___ array probe __MHz to ___MHz commonly used due to superficial placement of renal allograft
A
curvilinear
phased
5
7.5
15
Q
Post renal transplant Doppler sites
A
iliac anastamosis sites
main renal arteries
main renal vein
parenchymal arteries and vein
16
Q
Normal sonographic appearance of transplanted kidney
A
smooth contour, homogenous, hypoechoic parenchyma, central echo complex, small hypoechoic pyramids
17
Q
___ arteries can provide a better flow assessment in the kidneys
A
interlobular
18
Q
Normally, pulsatility progressively ___ as you near the cortex
A
decreases
19
Q
For a post op renal transplant exam, Doppler __, ___, and ___ for the renal arteries
A
PSV
RI
AT
20
Q
___ turbulence at the anastamoses sites is normal
A
mild
21
Q
Venous samples post op renal transplant sites include____. ___, and ___
A
parenchyma
hlium
main renal veins
22
Q
Resistive index equation
A
PSV-EDV divided by PSV
23
Q
Normal RI
A
<0.7
24
Q
An RI >0.7 can be related to ___, ___, ___, and ___
A
medical renal disease
renal obstruction
renal vein thrombosis
allograft rejection
25
Complications of renal transplant
rejection
arterial stenosis
arterial thrombosis
venous thrombosis
obstruction of collecting system/hydronephrosis
infection
acute tubular necrosis
perirenal fluid collections
AV fistula
pseudoaneurysms
26
Where does arterial stenosis commonly occur in a renal transplant?
iliac artery anastomosis with the transplant artery
27
Arterial stenosis will show elevated PSV in stenotic area > __-__ cm/sec
250
300
28
____ waveforms will appear in renal parenchymal arteries with a low RI <__ in arterial stenosis
tardus parvus
0.5
29
enlarged, edematous, hypoechoic kidney; diastolic flow reversal in renal artery due to blockage of venous outflow
venous thrombosis
30
Venous thrombosis usually occurs within __ hours of surgery
48
31
#1 cause of acute renal failure in the immediate post-transplant period
acute tubular necrosis
32
In acute tubular necrosis, __ and ___ insults lead to cellular damage
toxic
ischemic
33
Acute tubular necrosis can be related to ___, ___, ___, and ___
heavy metals
antibiotics
anesthetics
solvents
34
Most common post-transplant fluid collection
hematoma
35
A hematoma usually develops within ___ hours after renal transplant
24
36
Post op perirenal fluid collection that appears anechoic, develop early and spontaneously resolve
seroma
37
Perirenal fluid collection that usually develops in the first 2 weeks after renal transplant, appears anechoic
urinoma
38
anechoic with septa in some cases, slow growing 2 weeks to 6 weeks after transplant
lymphocele
39
complex perirenal fluid collection, usually occur later
abscess
40
Hyperacute rejection
occurs during surgery
41
accelerated acute rejection
occurs 2-3 days post op
42
acute rejection
occurs 1-10 weeks post op
43
chronic rejection
occurs 3 months to years post op
44
Symptoms of rejection
oliguria
elevated BUN and creatinine
hypertension
45
____ is preferred for the most accurate diagnosis of kidney rejection
renal biopsy
46
Accelerated acute and acute rejection sonographic appearance
swollen kidney with decreased echogenicity
loss of corticomedullary definition
enlarged renal pyramids
compression of renal sinus
decreased blood flow with increased RI >0.8
47
_____ causes increased PSV at stenosis and decreased kidney perfusion
anastomosis stenosis
48
___ of the native artery can occur during surgery
kinking
49
Diastolic flow reversal in the ____ or ____ arteries can indicate failure
main renal artery
parenchymal
50
Thrombosis of transplant artery or vein will demonstrate _____
decreased or absent flow in the vessel
51
___ thrombosis is more common than ___ thrombosis
venous
arterial
52
Diastolic flow in the main renal artery or intrarenal arteries can indicate ____
venous thrombosis
53
Infarction of the kidney after transplant can be ___ or ___
segmental
global
54
Any cystic structure identified in the renal parenchyma or hilum should be evaluated with color Doppler to rule out ____
pseudoaneurysm
55
55
Sonographic appearance of chronic rejection
small kidney
increased cortical echogenicity
renal sinus indistinguishable from parenchyma
cortical nephrocalcinosis
56
The renal veins drain the ___, ___. and ___
kidneys
ureters
adrenals
57
The right renal vein courses ___ and ___ to the right renal artery
laterally
anteriro
58
The left renal vein courses between the ___ and ___
aorta
SMA
59
The __ renal vein is longer than the __ renal vein
left
right
60
Indications to scan renal veins
renal mass
transplant
nutcracker syndrome
61
most common type of tumor to invade the renal vein of the ipsilateral kidney
renal cell carcinoma
62
SMA compresses left renal vein against the aorta; can lead to renal vein thrombosis with renal vascular congestion
Nutcracker syndrome
63
best seen in transverse view, anterior to renal artery
right renal vein
64
best seen in transverse view, anterior to the aorta and posterior to the SMA
left renal vein
65
The left renal vein is ___ to the SMA
posterior
66
The splenic vein is ___ to the SMA
anterior
67
Mistaking the patent splenic vein for the left renal vein can lead to:
false negative diagnosis of left renal vein thrombosis
68
most common tumor to invade the renal veins
renal cell carcinoma
69
For a Doppler of the renal veins, use a __-__ mm sample size
3
4
70
When doing a Doppler of the renal veins ___ flow with ___ respiratory phasicity will be seen
continuous
minimal
71
A unilateral increase in pulsatility is related to ____ or ___
acute urinary obstruction
distal renal vein thrombosis
72
Renal vein thrombosis can cause ___ and ___
hematuria
acute renal failure
73
Renal vein thrombosis has an increased risk for:
pulmonary embolism
74
Renal vein thrombosis is most commonly caused by:
primary renal disease
75
Causes of renal vein thrombosis
primary renal disease
extrinsic compression
trauma
transplant surgery
dehydration
76
Why is renal vein thrombosis considered a critical finding?
increased embolism risk and potential kidney damage
77
Sonographic appearance of renal vein thrombosis
increased kidney size; hypoechoic renal cortex and decreased corticomedullary differentiation; mottled echogenicity; dilated renal vein and no intrarenal venous flow; increased resistance in renal arteries; RI value >0.7 in the parenchyma
78
Renal artery stenosis caused by __ typically occurs near the renal artery origin, while stenosis caused by ___ typically occurs in the mid to distal renal artery.
a. fibromuscular dysplasia, extrinsic compression
b. hydronephrosis, fibromuscular dysplasia
c. atherosclerosis, fibromuscular dysplasia
d. extrinsic compression, atherosclerosis
c
79
Why does the systemic BP increase with renal artery stenosis?
a. due to the pain caused by the stenosis
b. due to the kidneys lack of arterial flow
c. due to the overproduction of urine with reduced arterial flow
d. due to the increase in calcium levels in the blood
b
80
If a patient does not take their hypertension medication before a renal Doppler exam, how will this affect the results?
a. overestimated stenosis
b. underestimated stenosis
c. overestimated parenchymal resistance
d. underestimated BUN and creatinine levels
a
81
Which of the following should cause suspicion of renal artery stenosis?
a. young patients with significant hypertension
b. patients with hypertension that is difficult to control with medication
c. all the above
c
82
83
Which of the following system settings will aid in color fill of the arteries?
a. increased wall filter
b. decreased sample size
c. decreased color priority
d. all the above
b
84
How is the renal/aortic ratio calculated?
a. the peak systolic velocity of the renal artery is divided by the peak systolic velocity of the aorta
b. the end diastolic velocity of the renal artery is divided by the end diastolic velocity of the aorta
c. the renal artery diameter is divided by the aortic diameter
d. the resistive index of the renal artery is divided by the resistive index of the aorta
a
85
An indirect evaluation of a kidney that is suspected to have renal artery stenosis is performed by using Doppler to evaluate:
a. the proximal main renal artery
b. the distal main renal artery
c. the hilar segmental artery
d. the parenchymal arteries
d
86
A resistive index over 0.7 in the kidney indicates __, while a resistive index under 0.5 indicates ___.
a. chronic kidney disease, renal vein thrombosis
b. renal vein thrombosis, renal artery stenosis
c. systemic hypertension, congestive heart failure
d. renal artery stenosis, chronic kidney disease
b
87
What is the most common cause of renal disease that leads to renal transplant?
a. analgesic abuse
b. steroid abuse
c. diabetes
d. lupus
c
88
Why is the left kidney typically used from the donor?
a. to avoid damaging the liver
b. because the renal vein is longer
c. because the renal artery is longer
d. to avoid damaging the biliary tree
b
89
What is the most common indicator of transplant malfunction?
a. elevated BUN
b. elevated creatinine
c. elevated glomerular filtration rate
d. elevated hematocrit
b
90
When evaluating a transplant kidney, arterial flow must be evaluated in:
a. upper pole
b. mid pole
c. lower pole
d. all the above
d
91
The #1 cause of acute renal failure in the immediate post-transplant period is:
a. venous thrombosis
b. arterial stenosis
c. acute tubular necrosis
d. AV fistula
c
92
All the following are sonographic signs of acute rejection of a renal transplant, except:
a. swollen kidney with decreased echogenicity
b. prominent corticomedullary definition
c. enlarged renal pyramids
d. decreased blood flow with increased RI >0.8
b
93
What vessels are involved in Nutcracker syndrome?
a. left renal vein
b. SMA
c. aorta
d. all the above
d
94
Tumor invasion of the renal veins typically occurs with:
a. adrenal cortical cancer
b. lymphoma
c. renal cell carcinoma
d. leukemia
c
95
Bilateral increase in renal vein pulsatility is caused by ___, while unilateral increase in renal vein pulsatility caused by ___.
a. congestive heart failure, distal renal vein thrombosis
b. systemic hypertension, congestive heart failure
c. proximal renal artery stenosis, distal renal vein stenosis
d. portal hypertension, systemic hypertension
a
96
All the following are typical complications of renal vein thrombosis, except:
a. hematuria
b. increased risk for pulmonary embolism
c. leukopenia
d. acute renal failure
c
97
Hollow, thick walled muscular structure located in anterior and inferior portion of pelvic cavity
blader
98
The bladder is located ___ to the symphysis pubis
posterior
99
In females, the bladder is located anterior to the ___ and __
vagina
uterus
100
In males, the bladder is located anterior to the ___ and ___
seminal vesicles
rectum
101
Wall layers of the bladder
mucosa
submucosa
muscularis
serosa
