Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
113 Cards in this Set
- Front
- Back
Normal measurement for kidney |
9-12 cm length 5cm wide 2.5 thick (AP) [but really ~5cm] |
|
Where are the kidney's located |
retroperitoneal cavity, near posterior wall below diaphram Rt. slightly lower than lt. kidney Both move ~1 in w.inspirations |
|
Two primary functions of the urinary system |
excreting waste and regulating the composition of blood |
|
Urinary system consists of ... |
kidney's, ureters, bladder and urethra |
|
Job of the ureters |
carry urine from the kidneys to the bladder |
|
A cyst like enlargement of the distal end of the ureter |
ureterocele- if ureterocele turns inside out it ,may be ome an obstruction |
|
A large muscular bag which urine collects |
bladder |
|
The bladder wall should measure |
3mm distended and ~6 mm non-distended |
|
A membranous tube that passes from the ant. part of the urinary bladder that carries urine to the outside of the body |
urethra |
|
Closure of the urethra |
stricture |
|
Inflammation of the mucous membrane in the urethra |
urethritis |
|
Difficult urination or painful urination |
dysuria |
|
Inflammation of the bladder |
Cystitis |
|
Open bladder surgery |
cystostomy |
|
Removal of the bladder |
cystectomy |
|
What are some renal symptoms |
flank pain, polyuria, oliguria, fever, urgency, hematuria |
|
What are laboratory tests |
urinalysis, blood urea nitrogen, serum creatinine, specific gravity, hematocrit, hemoglobin |
|
This laboratory test is essential to detect urinary tract disorders . The presence of an acute infection causes hematuria and pyuria |
urinalysis |
|
This laboratory test measures the kidney's ability to concentrate urine. Especially low in cases of renal failure, glomerular nephritis and pyelonephritis |
specific gravity |
|
A change in this Laboratory test occurs with acute hemorrhagic processes secondary to disease or blunt trauma |
hematocrit |
|
Laboratory test where the concentration of urea nitrogen in blood and is the end product of cellular metabolism. |
blood urea nitrogen |
|
A laboratory test where ________ is present in urine when extensive damage or destruction of the functioning erythrocyte occurs |
hemoglobin |
|
Laboratory test where blood serum creatinine levels are said to be more specific and more sensitive in determining renal impairment than BUN. |
serum creatinine |
|
Functional units of the kidney |
nephron |
|
Located at the base of the pyramids and separate the medulla from the cortex |
arcuate arteries |
|
The Bowman's capsule surrounds the |
glomerulus |
|
Renal fascia is aka _______ and it surrounds the true capsule |
Gerota's fascia |
|
Prominent invaginations of the cortex |
columns of bertin |
|
A bulge of cortical tissue on the lateral surface of the left kidney |
dromedary hump |
|
_______ is a triangular echogenic area typically located anteriorly and superiorly.
Result of partial fusion of two embryonic parenchymal masses called _______ during normal development. |
junctional parenchymal defect
renunculi |
|
Developmental variation that is usually present in children up to 5 years old and may be present in 51% of adults
surface of kidney indented between calyces, broccoli appearance. |
Fetal lobulation |
|
A condition characterized by deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy
This excess fat may affect renal tissue |
sinus lipomatosis |
|
Absence of the kidney or failure of the kidney to form, may be bilateral or unilateral |
renal agenesis |
|
Incomplete development of the kidney usually with fewer than five calyces
Often appears with one normal kidney |
renal hypoplasia |
|
Rare condition of a double collecting system,
1) which has two ureter per kidney that enters the bladder
2) Has two ureter leaving kidney but join together to form one before entering the bladder
|
complete duplication
incomplete duplication |
|
A kidney is not located in its usual position. Kidney fails to ascend from its origin in the true pelvis |
renal ectopia |
|
The most common renal anomaly occurring in 1/400 births. Fusion of the lower poles |
horseshoe kidney |
|
An uncommon variant of the horseshoe kidney. In a sigmoid kidney both the upper and the lower poles are fused. [typical horseshoe kidneys fused only at lower poles] |
Sigmoid kidney |
|
The most common renal mass lesion with its origin unknown they are considered acquired probably arising form obstructed ducts or tubules |
simple renal cyst |
|
Originate from the renal sinus, does not communicate with the collecting system. Most patients are asymptomatic |
parapelvic cysts |
|
Condition found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis |
acquired cystic kidney disease |
|
Polycystic kidney disease may present in one of two forms and they are |
infantile autosomal recessive ' and adult dominant form |
|
Bilateral enlarged kidney, cysts too small to be seen.maybe seen in utero. lung hypoplasia.portal HTN. Dilatation of the renal collecting tubules causes renal failure and in later form of the disease liver involvement is seen A fairly rare genetic disorder. |
autosomal recessive polycystic kidney disease or infantile polycystic disease |
|
A common genetic disease that occurs in both men and women. It is a bilateral disease that is characterized by enlarged kidneys with multiple asymmetrical cysts varying in size Pt. s/s HTN, renal failure, flank/abd. pain, fever chills, uremia, hematuria, palpable mass |
adult polycystic kidney disease autosomal dominant polycystic kidney disease |
|
About 1/3 of patients with polycystic renal disease also have |
polycystic liver disease |
|
A developmental anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilatation of the distal collecting ducts (ducts of Bellini)
aka: intratubular renal calcification |
medullary sponge kidney
sono: hyperechoic pyramids
|
|
The most common of all renal neoplasms and represents 85% of all kidney tumors. appears bilateral in 60-70 y.o. aka hypernephroma or Grawitz tumor |
Renal cell carcinoma or hypernephroma |
|
Accounts for 90% of malignancies that involve the renal pelvis, ureter and bladder and for up to 7-10% of all renal tumors multifocal tumor men (2x) > woman Papillary or flat (papillarty more common) |
transitional cell carcinoma |
|
Rare with a 3% occurrence. A secondary process more common Non h\Hodgkin lipoma more common than Hodgkin a bilateral invasion with multiple nodules |
renal lymphoma |
|
The most common peds. abd malignancy & most common solid renal tumor in peds pts. 1-8 y.o. Peak incidence is seen at 2.5-3 years 90% < 5 y.o. 70% < 3 y.o. ANOREXIA, PALPABLE MASS |
nephroblastoma or Wilms' tumor
|
|
The most common benign renal tumor. it is composed of varying proportions of fat, muscle, and blood vessels 0.07- 0.3 % occurance however 80% cases female and rt kidney tumor 1-20 cm |
renal angiomyolipoma |
|
Another uncommon renal tumor that is usually benign. Incidence is increased in the middle aged or elderly patient Well defined mass w/Spoke wheel pattern of enhancement and central scar |
oncocytoma
extremely difficult to differentiate from RCC |
|
most common of the mesenchymal type of tumors Consist of fat cells |
lipomas |
|
Necrosis or proliferation of cellular elements occurs in the glomeruli Increased corticol echoes many s/s: HTN, anemia, edema |
acute glomerulonephritis |
|
A connective tissue disorder result of abnormal immune system females > males 20-40 y.o. peak incidence
kidneys affected in 50% of cases |
lupus nephritis |
|
Unexplained uremia or azotemia may indicate renal dysfunction from ______ (a highly contagious disease spread mainly by unprotected sexual activity or infected needles) |
AIDS |
|
most commonly parenchymal disease (the loss of renal function as a results of disease) |
chronic renal disease |
|
The separation of renal sinus echoes by interconnected fluid filled calyces |
hydronephrosis
sono: dilated renal collectingsystem obstructive hydro has RI > 0.7, 6-72 hrs after onset |
|
What are the 4 grades of hydronephrosis |
Grade I- small fluid filled separation
Grade IV- prominant dilation of collecting system, thinning of renal parenchyma |
|
Occurs when pus is found within the collecting renal system secondary to long standing obstruction |
pyonephrosis
sono: low level echos, fluid-debris level |
|
Occurs when air is present in the parenchyma diffuse gas forming parenchyma
May be causes by Escherichia coli Bacteria (E.coli) |
emphysematous pyelonephritis
sono: enlarged kidney hypoechoic & inflammed |
|
An uncommon renal disease associated with chronic obstruction and infection destruction of parenchyma and infiltration of lipid laden histiocytes "Staghorn" calculus female > male |
xanthogranulomatous pyelonephritis
sono: Staghorn anechoic, w/hyperecho border |
|
Elevated white count, irregular mass, may require aspiration
|
renal abscess |
|
Associated with chronic obstruction and infection.
This overall renal size is increased Renal parenchyma replaced by cystic spaces |
staghorn calculi
R/O Xanthogranulomatous Pyelonephritis |
|
Removal of donors left kidney, rotated and placed in recipient's right iliac fossa or groin region. end to end anastomosis Used to treat chronic renal failure or end stage renal disease |
renal transplant |
|
A stone located in the urinary system is called |
urolithiasis |
|
A herniation of the bladder wall may be singular or multiple |
bladder diverticulum |
|
In adults 95% are transitional cell carcinoma (tcc). Usually are not detected until they have become advanced |
bladder tumors |
|
Rule of Weigert-Meyer |
In cases of complete double ureter, the ureter from the upper pole of the kidney usually enter the bladder below and medially to the one from the lower pole. |
|
Name 3 primary types of CRF (chronic renal failure) |
Nephron abnormalities vascular abnormalities interstitial abnormalities |
|
Range& duration of ereter Jet |
0.2 - 1.7 m/sec
0.6 - 4.1 sec (w. 30 sec interval) |
|
Name 3 distinct segment of the kidney |
Cortex
Medulla
Fatty Central Renal sinus |
|
Where are the renal arteries located?
what is the best view?
|
Renal arteries are the most posterior sand superior structure with the Hilus
The arcuate arties are located at the base of the renal pyramids & Interlobular alongside
View supine and/or Lt. lateral decubitus on a longitudinal scan Rt. renal art. anechoic structure posterior to IVC (* board ?) |
|
What is the sonographic appearance of the renal medulla?
|
Hypoechoic pyramids are separated by bands of intervening parenchyma that extend toward the renal sinus Smooth outer edge surrounded by reflected echoes of perirenal fat Spleen & Liver acoustic window
|
|
Describe Bertin's Column & how this can be confused with renal Mass
|
Prominent invaginations of cortex at varying depths within medullary substance of kidneys. Hypertrophied columns of Bertin contain renal pyramids; may be difficult to differentiate from avascular renal neoplasm. Columns are more exaggerated in pts w/ complete or partial duplication. |
|
What is a Dromedary Hump?
Where is it found?
|
A bulge of cortical tissue can occur on the lateral border of the kidney; may resemble a renal neoplasm. Usually Lt. Shape of left kidney is affected by the spleen the rest of the renal cortex, and a renal pseudotumor needs to be considered. |
|
Where is the junctional parenchymal defect most commonly found?
What is its appearance on sonographic examination? |
Triangular, echogenic area typically located anteriorly and superiorly
Result of partial fusion of two embryonic parenchymal masses called renunculi during normal development |
|
Fetal Lobulation:
who is most affected?
sonographic appearance. |
Usually present in children up to 5 years of age May persist in up to 51% of adults
Surfaces of the kidneys are generally indented in between the calyces, giving the kidneys a slightly lobulated appearance. |
|
Why does sinus lipomatosis produce such an echogenic renal image? |
Characterized by the deposition of a moderate amount of fat in the renal sinus, with parenchymal atrophy sinus fat hyperechoic |
|
What is the sonographic appearance of an extrarenal pelvis? |
Extrarenal pelvis tends to be larger, with long major calyces. Pelvis appears as a central cystic area that is either partially or entirely beyond the confines of the bulk of the renal substance. |
|
Describe S/S of patient with renal infection or disease process
[see box 14-3 p.374 & Text p. 358] |
Flank pain Increased Temp Hematuria pyuria Increquency in urination Hestitency w/urination Incomplete urination Difficulty urinating Elevated WBC vomiting Wt. loss |
|
Hematuria significance |
May be associated w/ early renal disease
Large amounts of blood may be trauma related i.e. stone |
|
Presence of Hemoglobin |
Presnt w/extensive damage or destruction of renal function |
|
What does BUN abbreviation stand for and how does this test work? |
A common laboratory test used for renal disease stands for: Blood urea Nitrogen.
Urea Nitrogen should be excreted in urine by kidney. If elevated amounts in blood may signify kidney not doing it's job. urea nitrogen is metabolic waste an end product of cellular metabolism |
|
What are the clinical symptoms of renal cystic disease? |
Encompasses a wide range of disease processes
May be acquired (nongenetic) or inherited (genetic)
Can occur in the renal cortex, medulla, or renal sinus |
|
Describe the sonographic appearance of a simple renal cyst |
Solitary or multiple One or both kidney involvement May be complicated by hemorrhage, infection, or calcification and become a complex cyst
Cyst in the pediatric patient Differentiate a benign cyst from a cystic form of nephroblastoma (Wilm’s tumor). |
|
Simple Renal cyst stats |
Acquired lesions, probably from obstructed ducts or tubules Estimated incidence: 50% of the population older than 50 years of age Asymptomatic; incidental finding |
|
Chronic renal failure |
Loss of renal function s/s: Increased concentration of urea in blood, high urine protein excretion, elevated creatinine, presence of granulocytes |
|
Renal Cell Carcinoma (RCC) s/s: |
Erythrocytosis, leukocytosis, red blood cells in urine, pyruia, increased lactic acid dehydrogenase |
|
Acute tubular necrosis s/s: |
Moderate-to-severe intermittent flank pain, vomiting, hematuria, infection, leukocytosis with infection |
|
Most Common Disease of the Bladder?
(Dr.P) |
Cystitis/UTI |
|
Most Common Malignancy of the Adult Bladder? (Dr.P) |
TCC-Transistional Cell Carcinoma |
|
Most Common Pediatric Neoplasm of the Bladder? (Dr.P)
|
Rhabdosarcoma |
|
Most Common Renal Disease? (Dr.P) |
CRF- Chronic Renal Failure |
|
Most Common Tumor of the Kidney? (Dr.P) |
Benign |
|
Most Common Malignant Renal Tumor in Adults? (Dr.P) |
RCC- Renal Cell Carcinoma |
|
Most Common Malignant Renal Tumor in Pediatrics? (Dr.P) |
Nephroblastoma
a.k.a Wilms' |
|
Most Common Renal Cystic Disease in Pediatrics? (Dr.P) |
MCDK-
MultiCystic Dysplastic Kidney Disease |
|
AML |
AngioMyoLipoma Most common benign CA Distinct hypoechoic area 80% female 80% Rt. side AML NO VASCULARITY on color Doppler D.Dx. RCC=basket sign |
|
NephroCalcinosis |
Parenchymal calcification usually medulla, infreq. cortex Bilateral Increased corticol echoes w/spared pyramids In Medullary nephrocalcinosis=pyramids hyperechoic to surrounding tissues |
|
Characteristic of Malignant cystic mass |
Wall thickness > 1 mm Irregularity at Base of cyst Septations Calcifications Vascularity at sepations and/or wall |
|
Name 4 kinds of ARPKD |
Perinatal neonatal infantile juvenile |
|
ARPKD sono |
enlarged echogenic cortex & medulla multiple cyst's ~1-2 mm hepatic fibrosis spleenomegaly |
|
ADPKD sono |
BILATERAl enlarged kidney assymetrical cysts cyst's in liver, spleen, pancrease, thyroid, ovary, testicle and breats |
|
MCDK multicystic dysplastic kidney sono |
Ureter atresia, contralat. ureteropelvic obstruction, non fx. kidney
peds: Multicystic with an absence of renal parenchyma, sinus & atretic renal artery
Adults: small kidney, atrophy, calcified
|
|
Atresia: |
Absence of a normal opening, or failure of a structure to be tubular |
|
MSK medularry sponge kidney sono: |
May be unilateral or segmental
Occurs in medullary pyramids cystic or fusiform dilation of distal collecting ducts
maybe associated with many congenital and inherited disorders that should be R/O i.e. MCD, PCD, Caroli's and congenital Hepatic fibrosis |
|
MCD Medullary Cystic Disease |
Hyperechoic calycys with or without stones sm. echogenic kidney loss of corticomedullary differentiation multiple medullary cysts |
|
RCC |
Most isoechoic the larger the tumor the more heterogengous lesion < 3 cm usually hypoerechoic High systolic & high Diastolic artial flow w/ low resistive index |
|
TCC` |
papillary or flat hypoechoic mass in collecting system low vascularity on Doppler Rare calcification May invade adjacent renal parenchyma |
|
Squamous Cell CA |
Paplable kidney 2nd to hydronephrosis
Large mass is evident in renal pelvis
may have obstruction from kidney stones |
|
Renal lymphoma |
Rare primary common as secondary: maybe hematogenous spread or direct via retroperitoneal lympharic channels Common as bilateral invasion enlarged kidney, hypoechoic, cyst without enhancement, |
|
Benign Renal tumors |
Ademoma & Oncocytoma |