Renal

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1

How are the kidneys protected?

True capsule

Perirenal fat

Gerota's fascia

ribs

2

What is the true capsule?

surrounds the kidneys

3

What is the perirenal fat?

encloses the kidneys and adrenals

4

What is Gerota's fascia?

surrounds the perirenal fat

5

What is the length of the kidneys?

9-12 cm long

6

What is the width of the kidneys?

5 cm wide

7

How thick are the kidneys?

2.5 cm thick

8

Which kidney lies lower than the other?

right

due to liver

9

Are the kidneys stationary?

no

move with inspiration

10

What is the function of the kidneys?

excretory

equilibrium of blood

produce renin

Erythropoietin

11

What is Erythropoietin?

stimulates the production of RBCs

12

What does the corpuscle consist of?

Afferent & Efferent arterioles

bowmen's capsule

Glomerularis

13

Where does the arcuate artery lie?

at the cortical medulary junction

14

Explain the flow of urine after leaving the collecting ducts.

minor calyces

major calyces

renal pelvis

ureters

15

Which is the darkest area of the kidneys?

cortex

16

What does the parenchyma of the kidneys consist of?

Cortex

arcuate arteries

Medulla

pyramids

renal sinus

renal pelvis

17

How many renal pyramids are there in each kidney?

8-18

18

What is the shape of the renal pyramid?

Triangular

base & apex

19

How long are the ureters?

20 cm

20

Where do the kidneys lie?

T12 - L4

21

What does the posterior surface of the kidneys lie?

quadratus lumborum muscle

Psoas muscle

22

What is the hilum of the kidney?

area of insertion

renal vein

2-3 branches of renal artery

Nerves

lymphatic vessels

ureters

23

What is the arterial supply of the kidneys?

2-3 branches of renal arteries

segmental

interlobar

arcuate

interlobular

afferent

efferent

24

What is the venous flow of the kidneys?

interlobular vein

arcuate vein

interlobar vein

segmental vein

renal vein

25

What does the bladder consist of?

muscular bag

smooth muscle that distends as the bladder fills

26

Where do the ureters enter the bladder?

at the posterior trigone region

27

What is the urethra?

membranous tube that extends from the anterior portion of the bladder to the out side body

28

How many sphincters are there in the urethra?

2

internal

external

29

What window is used to scan the right kidney?

liver

30

What window is used to scan the left kidney

spleen

31

What patient position used be used for a renal exam?

supine

decubitus

32

What does the renal parenchyma consist of?

from the sinus to the outer renal surface

columns of bertin

medulla

33

What does the renal medulla consist of?

renal pyramids separated by band of renal parenchyma extending toward the renal sinus.

34

What is the appearance of the renal sinus?

hyperechoic.

35

Explain the difference in the appearance of the kidneys with acute and chronic conditions.

Acute condition tend to enlarge the kidneys

Chronic conditions tent to make dense echogenic, small kidneys

36

Explain type 1 renal parenchymal changes.

change echogenicity

preserve shape

echo intensity equal or greater than the liver & spleen

echo intensity equals the renal sinus

37

Explain type 2 renal parenchymal changes.

Architecture changes

distort the cortex

obliterate the corticomedullary zone differentiation

38

What are the renal variants?

Supernumerary kidney - duplication

columns of bertin

Dromedary hump

junctional parenchymal defect

duplex collecting system

Sinus lipomatosis

39

What is Supernumerary kidney?

duplication of one or both kidneys

40

What is columns of bertin?

normal variant

invagination of normal cortex into renal sinus

41

What is a common problem with the column of Bertin?

can be confused for a mass

to correct this try a different window to see if parenchyma is the same in both view.

42

What is Dromedary hump?

cortical bulge on lateral borders caused by pressure from spleen in fetal period

43

What is the problem with a Dromedary hump?

it is easily confused with a neoplasm

to correct this try a different window to see if parenchyma is the same in both view.

44

What is junctional parenchymal defect?

normal extension of the renal sinus

triangular defect in upper pole of kidney

45

Explain the sonographic appearance of junctional parenchymal defect?

very reflective hypoechoic triangular in upper pole

*if more than one is seen than something else other than junctional parenchymal defect

46

What is duplex collecting system?

band of renal cortical that divides the sinus into two chambers each with its own ureter.

47

What is the sonographic appearance of a duplex collecting system?

hard to evaluate because we can not see ureters well

central renal sinus appears as 2 echogenic regions

usually hydronephrosis in the upper chamber

48

What is the sonographic appearance of a duplex collecting system in transverse view?

there will be one spot that is all parenchyma

49

How is duplex collecting system confirmed on ultrasound?

demonstrated 2 ureteral on the same side of the bladder

50

What is Sinus lipomatosis?

fat deposits in the renal sinus (more than normal)

enlarges renal sinus

loss of cortical tissue (thinning of cortex)

occurs in old folks

51

What is the sonographic appearance of Sinus lipomatosis

enlarged renal sinus

increased echogenicity

thin cortex

hyperechoic

52

What is the presentation of Sinus lipomatosis?

renal insufficiency

53

What is an Extrarenal pelvis?

larger than normal renal pelvis with long calyces

54

What is the sonographic appearance of Extrarenal pelvis?

appears as a cystic area beyond the confines of the renal border

55

What are renal anomalies?

renal agenesis

solitary kidney

pelvic kidney

Horseshoe kidney

sigmoid kidney

56

What are the problems associated with renal agenesis?

adrenal glands can enlarge to take up space and can be mistaken for kidneys

57

What is renal agenesis?

solitary kidney / missing kidney

contralateral kidney enlarges to compensate

58

What is pelvic kidney?

Kidney stays in pelvis - does not move up to lumbar position

59

What can cause a pelvis kidney?

hormone deficiency

mass

can be asymptomatic

60

Where do kidneys develop?

in the pelvis

9 weeks kidneys move to normal lumbar position

this move is hormone driven

61

Why is bilateral renal agenesis rare?

Fetus usually dies in utero or soon after death

62

What is solitary kidney?

only one kidney

63

What is Horseshoe kidney?

kidneys do not migrate

they touch and fuse with shelf around aorta and IVC

64

What is the problem with horseshoe kidney?

can be mistaken for lymphadenopathy

65

What is Sigmoid kidney?

right kidney jumps and fuses on lower pole of left kidney

66

What is hematuria?

blood in the urine

67

What is polyuria?

too much urine

68

What is oliguria?

scanty urine

69

What are the clinical signs of Urinary system disorders?

fever

flank pain

urination problems

70

What tests are performed to detect urinary system disorders?

Urinalysis

blood test

71

What does a urinalysis test consist of?

Blood

PH

Specific gravity

hemoglobin

protein

creatine

72

What are the blood tests for kidney function?

BUN

Hematocrit

Serum Creatinine

73

What is a PH test?

gauge the acidity or alkalinity of the urine

74

What is PH related to in the kidney?

formation of the renal calculi

75

What is neutral on the PH scale?

7

76

What is acidic on the PH scale?

below 7

77

What is alkaline on the PH scale?

above 7

78

What makes urine alkaline?

calcium or phosphate

79

What makes urine acidic?

Uric acid

80

What is a specific gravity test?

The kidneys ability to concentrate urine

81

What would decrease specific gravity?

lots of fluid

82

What is hemolysis?

breakdown of red blood cells

83

What is the first sign of kidney stones?

hematuria

WBC in urine

84

What does WBCs in urine indicate?

infection in the urinary track

85

What does it mean when hemoglobin is found in the urine?

Sign of kidney failure

kidneys do not like hemoglobin

86

What happens to hemoglobin during hemolysis?

hemoglobin is dumped in the blood

87

What is protein in the blood a sign of?

nephron damage

proteins in blood run through kidneys but should not be in the blood

88

What can hypertension cause in the kidneys?

nephron damage and protein in the blood

89

What is Creatinine?

by product of muscle energy metabolism

90

What should happen to creatinine?

Creatinine should remain constant

it is not reabsorbed

91

What does decreased creatinine mean?

decreased glomerular filtration

92

What is hematocrit?

ratio of plasma to cells

93

What happens to hematocrit during hemorrhage?

decrease

94

What is BUN?

the concentration of urea and nitrogen in the blood

95

What is NH4?

ammonia

toxic byproduct of nitrogen

96

What happens to NH4?

converted by the liver to BUN

excreted by the kidneys

97

What does it mean if BUN is increased in the blood?

impaired renal function

98

What does increased Serum Creatinine in blood mean?

impaired renal function

99

Which is more specific to kidneys BUN or creatinine?

serum creatinine

100

Why would a renal exam be performed?

evaluation of:

renal size

parenchyma

renal sinus

congenital anomlies

101

What is a simple renal cyst?

tend ot originate in the renal cortex

thought to be a retention cyst due to obstruction

50% of people over 50

102

What is a simple renal cyst filled with?

serious fluid

103

What two types of complex renal cysts?

infected - pus

hemorrhagic - blood

104

What is the sonographic appearance of a simple renal cyst?

smooth wall

anechoic

through transmission

105

What is a parapelvic cyst

found in the renal hilum these are not true cysts

developed from the lymphatic system.

cause obstruction.

*Confused with hydronephros

106

What are other names for parapelvic cysts?

renal sinus cysts

peripelvic cysts

parapelvic lymphangectasia

107

What is the theory of parapelvic cysts?

obstruction of lymphatics does not communicate to sinus

108

What is the Sonographic Appearance of parapelvic cysts?

Anechoic

Enhancement

May not have smooth walls

109

What are malignant renal cysts?

Von Hippel-Lindau

Tuberous Sclerosis

Dialysis cysts

110

What is Von Hippel-Lindau cyst?

Autosomal dominant

can be anywhere in the body

111

What is Tuberous Sclerosis?

Malignant cysts – show as multiple renal cysts as well as in other areas.

112

What is Dialysis Cysts?

malignant cyst

113

What is the sonographic appearance of Dialysis Cysts?

Multiple

anechoic

smooth walls

enhancement

114

What is Congenital Cystic Disease?

(PKD) is an inherited disorder in which clusters of cysts develop

115

What is the sonographic appearance of Congenital Cystic Disease?

Multiple

Various size

anechoic

smooth walls

enhancement

116

What is Infantile Polycystic Renal Disease?

autosomal recessive disorder

(IPKD) Causing enlarged echogenic kidneys & Bile duct proliferation.

AKA: ARPKD – Potter Type 1

117

When can IPKD be identified?

20 week ultrasound

118

What is the sonographic appearance of Infantile Polycystic Renal Disease?

Enlarged Kidneys

Echogenic

119

What is another name for Infantile Polycystic Renal Disease (IPKD)?

ARPKD – Potter Type 1

120

What is Adult Polycystic Renal Disease?

autosomal dominant disorder

(APKD) Causes hypertension, renal failure and nephromegaly

AKA: ADPKD – Potter Type 3

121

When does APKD usually present?

30 year olds

122

What is the sonographic appearance of Adult Polycystic Renal Disease?

Nephromegaly

123

What is another name for Adult Polycystic Renal Disease (APKD)?

ADPKD – Potter Type 3

124

What is Multicystic Dysplasia Disease?

Most common childhood renal cystic disease.

Non-hereditary

AKA: Potter Type 2

bilateral is fatal

125

What is the sonographic appearance of Multicystic Dysplasia Disease?

Multiple

Size vary

Functioning Kidney enlargement

usually unilateral

affected kidney disapears

126

What is another name for Multicystic Dysplasia Disease ?

Potter Type 2

127

What is Medullary Sponge Kidney?

A rare disease in young to middle age adults Dysplastic cystic dilation of the medullary and papillary portions of the collecting tubules.

128

What is the sonographic appearance of Medullary Sponge Kidney?

Echogenic pyramids

Medullary calcification

129

What is Retroperitoneal Fibrosis?

idiopathic

greater than 50% fibrous

2x more likely in women

extra fibrous tissue forms in the area behind the stomach and intestines. The tissue forms a mass (or masses) that can block the tubes that carry urine from the kidney to the bladder

130

What is the sonographic appearance of Retroperitoneal Fibrosis?

unilateral

hydronephrosis

Hypoechoic

homogeneous mass

131

What is the presentation of Retroperitoneal Fibrosis?

Dull pain in the abdomen that increases with time

Pain and change of color in the legs

anuria

oliguria

Nausea

vomiting

increases BUN

increases creatinine

132

What is Renal Cell Carcinoma?

85% of renal malignancies, twice as common in 60-70 males

133

What is the sonographic appearance of Renal Cell Carcinoma?

Better in CAT scan

Solid mass

Areas of hemorrhage

Areas of necrosis

Calcification

Cystic or complex

134

What is hypernephroma?

AKA Renal cell carsinoma

135

What is adenocarcinoma?

AKA Renal cell carcinoma

136

What is nephrocarcinoma?

AKA Renal cell carcinoma

137

What is Von Grawitz tumor?

AKA Renal cell carcinoma

138

What is the staging of Renal Cell Carcinoma?

Stage 1 – confined to kidney

Stage 2 – Spread to fat but contained in Gerota’s fascia

Stage 3 – Spread to renal veins, IVC, regional nodes

Satge 4 - Mets

139

What is the sonographic appearance of Renal Cell Carcinoma?

varied

hyper echoic

no through transmission

140

What is Transitional Cell Carcinoma?

Most common tumor of the renal collecting system.

4:1 male to female ratio

141

Patient has been discovered to have a mass in the renal sinus...What is it most likely?

transitional cell carsinoma

142

What can Transitional Cell Carcinoma cause?

kills off normal tissue and causes necrosis

hematuria - occult blood in urine

143

What is the sonographic appearance of Transitional Cell Carcinoma?

Multiple

Widened renal sinus

144

Which of the following would be a fake positive for hydronephrosis?

lymphangectasia

145

What is Renal Lymphoma?

Non-specific enlargement of the kidney..

Hard

146

Which type of renal lymphoma is more common?

Non-Hodgkin’s lymphoma

147

What is the sonographic appearance of Renal Lymphoma?

Enlarged kidneys

148

What is Wilms Tumor?

Most common solid renal mass in children.

Usually before 3rd birthday

149

What is the sonographic appearance of Wilms Tumor - Nephroblastoma?

Solid mass

150

What is the presentation of Wilms Tumor?

abdominal mass

nausea

vomiting

151

What is Nephroblastoma?

AKA Wilm's tumor

152

What is Adenoma?

Benign counterpart of Renal Cell Carcinoma.

Most common cortical mass.

153

What is the sonographic appearance of Adenoma?

often not seen

hypoechoic

154

What is Angiomyolipoma?

Most common benign renal tumor consists of fat.

within the renal cortex

155

What is the sonographic appearance of Angiomyolipoma?

Focal

Solid

Hyperechoic mass

156

What is Mesoblastic Nephroma?

Most common solid kidney mass in neonate.

more common in males

Benign counterpart of Wilms.

157

What is the cause of Mesoblastic Nephroma?

causes hypertension

causes damage to kidneys

unilateral

158

What is the sonographic appearance of Mesoblastic Nephroma?

Large Flank mass

HTN

159

What is Oncocytoma?

Benign rare mass most common in adult men.

160

What is the sonographic appearance of Oncocytoma?

Large

Well encapsulated

looks like adenoma

161

What is a Renal Fibroma?

50% fibrous

start in the fibrous tissue covering the kidney

more common in women.

162

What is the sonographic appearance of a Renal Fibroma?

small

163

What are the presentations of a Renal Fibroma?

asymptomatic

hematuria

164

What is a Renal Lipoma?

start in the cells of the fat that surrounds the kidney.

They are more common in middle-aged women.

can grow to be quite large.

165

What is the presentation of a Renal Lipoma?

hematuria

166

What is a Renal Leiomyoma?

fibroid

167

What is the presentation of a Renal Leiomyoma

hematuria

168

What is a Renal Hemangioma?

blood vessel collection

169

What is the presentation Renal Hemangioma?

hematuria

170

What is a Acute Glomerulonephritis?

causes edema due to diffuse parenchymal inflammation leading to renal enlargement

171

What is the sonographic appearance of a Acute Glomerulonephritis?

Increased cortical echogenicity

enlargement

172

What is Acute Interstitial Nephritis?

swelling in between the kidney tubules

173

What is the sonographic appearance of a Acute Interstitial Nephritis?

hyperechoic

Large kidneys

Mottled texture

Increased cortical echogenicity

174

What is a Lupus Nephritis?

Autoimmune disease

inflammation of the kidney that is caused by systemic lupus erythematous (SLE)

Renal atrophy.

175

What is the sonographic appearance of a Lupus Nephritis?

Increased cortical echogenicity

super hyperechoic

176

What is AIDS?

Acquired immunodeficiency syndrome.

177

What is the sonographic appearance of the kidneys in AIDS patients?

Increased cortical echogenicity

hyperechoic kidneys

178

What is Hypertensive Nephropathy?

damage to the kidney due to chronic high blood pressure

179

What is the sonographic appearance of Hypertensive Nephropathy?

hypoechoic then hyperechoic

Small

Smooth borders

Internal distortion

Scaring

180

What is Papillary Necrosis?

Fluid filled spaces at corticomedullary junction.

181

What is the sonographic appearance of Papillary Necrosis?

Round or triangular

irregular pyramids

Presentation: abnormal LFTs

Lab Values: Abnormal LFT

182

What is Renal Atrophy?

geriatric condition of parenchymal thinning then lipomatosis

kidneys are shrinking in size due to the loss or inadequate circulation of nephrons

183

What is the sonographic appearance of renal lipomatosis?

thin cortex

184

What is the sonographic appearance of Renal Atrophy?

Uniformly small

Thin cortex (lipomatosis)

185

What is Acute Renal Failure?

kidneys suddenly can't filter waste from the blood.

186

What is the cause of Acute Renal Failure?

hypertension

diabetes

187

What is the sonographic appearance of Acute Renal Failure?

Enlarged Kidneys

Increased echogenicity

Decreased size – Chronic (<8 mm)

188

What is Hydronephrosis?

Accumulation of fluid in calyses

dilation of the renal pelvis and calyces, usually caused by obstruction of the flow of urine.

189

What are the causes of Congenital Hydronephrosis?

ureteropelvic junction obstruction

ectopic ureteroceles

posterior urethral valves (congenital folds stop flow of urine)

bend or kink

190

What is ectopic ureteroceles?

bad insertion

191

What are the causes of intrinsic Hydronephrosis?

clot

stone

tumor

192

What are the causes of extrinsic Hydronephrosis?

pregnancy

fibroid

ovarian mass

benign prostatic hypertrophy (BPH)

urethral obstruction

193

What is the sonographic appearance of Hydronephrosis?

(mild) Grade 1 – slight separation

(moderate) Grade 2 – Further separation

(sever) Grade 3 – Severe dilation of calyces

194

What is Renal Infarction?

Masses along the peripheral renal border.

can appear as a dromedary hump

195

What is the cause of renal infarct?

obstruction of arteries that feed kidneys

196

What is the sonographic appearance of Renal Infarction?

Round or triangular infarct on border

197

What is Chronic Renal Disease?

progressive loss in renal function over a period of months or years.

198

What is the sonographic appearance of Chronic Renal Disease?

Diffusely echogenic

Loss of anantomy

199

What is Acute Tubular Necrosis?

Most common renal disease to cause renal failure.

and problems with rejection

200

What is the sonographic appearance of Acute Tubular Necrosis?

Enlarged kidneys

Hyperechoic pyramids

201

What is Pyonephrosis?

Pus in collecting ducts.

*pus in pelvis

*pus in cayles

secondary to an obstructed ureter

202

What is the sonographic appearance of Pyonephrosis?

Dilated calyces

Low level echoes

203

What is Acute Pyelonephritis?

secondary to a lower UTI.

*tends to start in bladder and move up

204

What is the sonographic appearance of Acute Pyelonephritis?

Both kidneys maybe

Enlarged kidneys

pyramids look mildly complex

205

What is Emphysematous Pyelonephritis?

Air in kidney

Emergency unilateral air in collecting ducts. Caused by E coli.

Emergency nephrectomy

206

What is the sonographic appearance of Emphysematous Pyelonephritis?

...

207

What is Xanthogranulomatous Pyelonephritis?

caused from obstruction and chronic infection.

stone chronic irritation

208

What does Xanthogranulomatous Pyelonephritis cause?

death and destruction of surrounding tissue

209

What is the sonographic appearance of Xanthogranulomatous Pyelonephritis?

Bright staghorn calculus

hyperechoic

complex mass surrounding stone

stone shadow

210

What is Renal Carbuncle?

serious infection worse than a boil

Renal Abscesses of the renal parenchyma

211

What is the sonographic appearance of ?

...

212

What is Renal Perinephric?

Renal abscess – may surround kidney

may be so bad pus can surround kidney

213

What is the sonographic appearance of Renal Perinephric?

complex mass

gas formation

dirty shadowing

214

What is Nephrocalcinosis?

Aggregates of calcium form in the medullary pyramids.

215

What is the sonographic appearance of Nephrocalcinosis?

Shadowing maybe

calcifications

sponge kidney

216

Where is the location of a Renal Transplant?

Placed in pelvis anterior to iliac veins.

217

What is the sonographic appearance of Renal Transplant?

similar to native kidney

found in pelvis anterior to iliacs

218

What is ?

...

219

What is the sonographic appearance of renal transplant rejection?

hyperechoic

220

What is a common cause of rejection of a transplanted kidney?

acute tubular necrosis

obstruction in vein (thrombosis)

hydronephrosis from ureter

221

What is evaluated during a renal transplant exam?

obstruction in vein (thrombosis)

hydronephrosis from ureter

leakage

-at insertion point

-urinoma - at follow up will not change in appearance

-arteriole hematoma


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