Autosomal dominant polycystic kidney disease is a common genetic disease that is found in both men and women. The severity of the disease varies depending upon the genotype. The most common type is PKD I (located on the short arn of the 16th chromosome) that affects the kidneys more severely than PKD2 (located on the long arm of the 4th chromosome). There are a number of persons who have no known genetic disposition to ADPKD; it may result by spontaneous mutations. It is a bilateral disease that is characterized by multiple cysts located in the renal cortex and medulla. The. cysts vary in size and may be asymmetricaL The disease is progressive, which

means it does not usually clinically manifest itself until the 4th or 5th decade. Approximately 50% of the patients by the age of 60 will have end-stage renal disease. Clinical symptoms include: pain (common complaint), hypertension, palpable mass, hematuria, headache, urinary tract infection, and renal insufficiency.

Usually a(n) _________ renal contour is the first finding that a mass may be present and requires further

investigation.

Renal cell carcinoma is the most common of all renal

tumors (85% of all kidney tumors). It is twice as common in males as in females, usually in the 6th to 7th decade of life. The classic clinical presentation is nonspecific; however, the patient may report hematuria, flank pain, and palpable mass. The tumor appears bilaterally in 0.1 % to 1.5% of patients. The incidence is increased in patients with von Hippel-Lindau disease and patients on long-term dialysis.

Sonographic findings include one or more fluid spaces at the ________ junction that corresponds to the

distribution of the renal pyramids.

Chronic renal disease is loss of renal ___________ as a result of disease, most commonly parenchymal

disease

_____________ is when the dilated pyelocalyceal system appears as separation 01 the renal smus echoes by

fluid-filled areas that conform anatomically to the infundibula, calyces, and renal pelvis.

Hydronephrosis with a dilated ureter and bladder indicates obstruction of the _________ junction or of the ___________

There are three grades of hydronephrosis. Grade I entails a small separation of the calyceal pattern, also known as splaying. The sonographer must be able to rule out a peripelvic cyst (the septations may be numerous) or renal vessels in the peri pelvic area. (Color flow Doppler is extremely useful.) An extrarenal pelvis would protrude outside of the renal area, and the sonographer should not confuse this pattern with hydronephrosis. Grade II shows the bear-claw effect, with fluid extending into the major and

minor calyceal systems and thinning of the renal

parenchyma. Grade III represents massive dilation of the renal pelvis with loss of renal parenchyma.

In cases of acute obstruction, the resistive index of the

intrarenal vessels may be greater than 0.70 for 48 to 72

hours after obstruction. The RI returns to nonnal. There

will be no ureteral jet on the affected side, or there will be decreased flow if the obstruction is partial.

_____________ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently

can also be seen in the renal cortex.

A renal __________ occurs when part of the tissue undergoes necrosis after the cessation of the blood

supply, usually as a result of artery occlusion.