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Urinary System
Urinary/ Renal Pathology
83
Pathology
Undergraduate 1
01/17/2013

Additional Pathology Flashcards

 


 

Cards

Term
simple cyst
Definition
  • common in half of adults over 50
  • chances increase with age
  • asymptomatic
  • usually found in renal cortex but can occur anywhere in the kidney
  • May hemorrage causing internal echoes
  • significant: distorts the calyces, obstructs the kidney

 

 

Term
What does a simple cyst look like?
Definition

round

oval

anechoic

thin well defined walls

enhancment

absence of color flow

Term

Parapelvic cyst

 

aka

 

Renal Sinus Cysts

Definition
  • asymptomatic
  • may cause obstruction, infection, hypertension depending on the size and location
  • found in the renal hilum or sinus
  • can be confused with hydronephrosis
  • DOES NOT communicate with the collecting system

 

 

Term
What does Hydronephrosis appear as?
Definition
cauliflower appearence
Term

Polycystic renal disease

Adult polycystic kidney disease (APKD)

Autosomal dominant polycystic kidney disease (ADPKD)

Definition
  • decreased renal function sometimes leads to renal failure: hypertension, uremia, abdominal/flank pain, fever, chill with infection
  • Hematuria
  • Bilateral enlarged kidneys
Term
What do polycystic renal disease look like?
Definition
  • Bilateral enlarged enlarged kidneys
  • Multiple cysts of variable size(usually large)
  • kidneys lose their shape

 

Term

Polycystic renal disease

 

What do patients with APKD look like?

Definition
  • will have cysts in other organs
  • check liver (most common), spleen, pancreas
  • symptoms are usually delayed.......slow growing
  • causes renal failure by age 50
Term

Infantile polycystic kidney disease

(IPKD)

autosomal recessive polycystic kidney disease

Definition
  • Both parents have to have gene to pass to child
  • may be seen during fetal
Term
What does IPKD look like?
Definition
  • bilateral enalrged echogenic kidneys
  • multiple cysts are too small to be seen
  • cysts interfaces cause increase in echogenicity
  • decrease renal function
Term
Medullary Cystic Kidney Disease
Definition
  • rapid progression: kidney failure/death
  • uremia
Term
what does medullary cystic kidney disease look like?
Definition
  • loss of definition between the cortex/ medulla/ sinus junction
  • increased meduallary echogenicity
  • small (microscopic) cysts in the pyramids (interfaces) cause increase in echogenicity of the pyramids
Term
Medullary sponge kidney
Definition
  • rare
  • not hereditary
  • benign
  • found in children
  • renal function usually normal

 

Term
what does Medullary Sponge Kidney look like?
Definition
  • echogenic pyramids
Term

multicystic dysplastic kidney

MDKD

Definition
  1. most common palpable mass in neonates
  2. restrict growth
  3. polyuria
  4. hypertension
  5. unilateral, bhilateral is incompatible with life
  6. kidney is nonfunctional
  7. not herditary

 

Term
What does MDKD (multicystic dysplastic kidney) look like?
Definition
  • multiple cysts varying in size (usually large)
  • difficult to identify the renal sinus
  • children(early stages): large kidney/large cyst
  • Adult(end stage): small kidney
Term
Tuberous sclerosis
Definition
  • autosomal dominant
  • may cause cysts
  • lipomas (fatty tumors)
  • fleshy nodules
  • "tissue growth"
  • fatty nodules
Term

Renal neoplasms

 

neoplasms=new growth

Definition
  • malignant and benign tumors (cannot be differentiated from eachother sonografically)
  • biopsy
  • CT is the modality of choice fror tumor staging
Term
What is always warranted for any suspicious lesion?
Definition
biopsy
Term
what is the modality of choice for tumor staging?
Definition
CT
Term
adenoma
Definition
  • most common cortical renal mass
  • benign
  • asymptomatic
Term
What does an adenoma look like?
Definition
well defined hypoechoic mass
Term
Oncocytoma
Definition
  • benign tumor
  • hemorrage
Term
What does Oncocytoma look like?
Definition
  • well defined
  • spokewheel pattern with a central scar
  • hemorrage
Term

Angiomyolipoma

AML

hamartoma

Definition
  • female
  • uncommon benign tumor composed mostly of fat cells(muscle and blood vessels
  • usually found in renal cortex
  • associated with tuberous sclerosis
  • causes hematuria if ruptures
  • renal funtion is normal
Term
What does angiomyolipoma (AML) (hamartoma) look like?
Definition
  • appears as a focal echogenic homogeneous mass
  • echogenicity exceeds that of the renal sinus
  • may have enhancement
Term
Angio--myo--lipoma
Definition

angio=blood vessel

myo=muscle

lipoma=fat

Term

Renal cell carcinoma

(adenocarcinoma)

(hypernephroma)

(RCC)

Definition
  • hematuria
  • weight loss, fatigue, flankpain, palpable mass, fever with infection
  • most common renal cancer
  • may affect opposit kidney or IVC
  • HYPERVASCULAR tumor
Term
What does renal cell carcinoma (RCC) look like?
Definition
  • varied usually solid mass: hyperechoic, complex, cystic, may have calcifications
  • may extend into the liver, nodes, adrenals
  • may displace the renal pyramids, invade renal architecture

 

Term

What are the stages of RCC?

 

Definition
  1. Confined to the kidney
  2. Spread to perinephric fat but contained within the Gerotas fascia
  3. Spread to renal vein and IVC
  4. invades neighboring structures
Term

Transitional cell carcinoma

TCC

Definition
  • most common tumor of the collecting system (starts)
  • Hematuria, weight loss, fatigue, fever, flank pain
  • causes hydronophrosis
  • can start in the urinay tract/bladder (bladder mass)

 

Term
What does TCC look like?
Definition
solid hyperechoic massin the renal pelvis
Term

Wilms Tumor

NEPHROBLASTOMA

Definition
  • palpable mass in children
  • abdominal pain, N&V, anorexia, Hematuria
  • usually unilateral
  • look for extension into renal vein and IVC
  • most common renal mass in children
  • may necrose and become cystic
  • usually noticed by 3-5 years of age
  • malignant
Term
What does Wilms tumor (NEPHROBLASTOMA) look like?
Definition
  • look for extension into renal vein and IVC
  • homogeneous/echogenic
  • may necrose and become cystic
  • LARGE/PALPABLE MASS
Term
Renal Lymphoma
Definition
large kidneys containg hypoechoic masses
Term
Where is the most common place for obstruction?
Definition
UPJ
Term
Calculi
Definition
  • compostion can be calcium, uric acid or cystine
  • causes pain/Hydonephrosis if obstructs
  • N&V
  • absence of ureter jets is a sign of obstruction
  • ureteral stone dilates proximal
Term
What does calculi look like?
Definition
  • echogenic foci with shadowing
  • absence of ureter jets is a sign of obstruction

 

Term
Staghorn calculi
Definition
  • large/fills the entire collecting system
  • shadows
  • know all causes of hydronephrosis:instrinsic, aquired
  • anuria or oliguria is a sign of obstruction
Term
What are the causes of hydronephrosis?
Definition
  1. instrinsic
  2. acquired

 

Term
Acute Renal Failure
Definition
  • decreased output
  • hydronephrosis
  • enlarged hypochoic kidneys
  • associated with RAS
Term
Renal Failure
Definition
  • loss of perfusion (blood flow)
  • caused by disease, infection, obstruction
  • increased incidence with diabetes
  • hypertension
Term
What are the labs for renal failure?
Definition
  • increased BUN and creatinine
  • decreased serum calcium, urine specific gravity
  • proteinuria
  • RBC/WBC in urine
  • anemia
Term
Chronic Renal Failure
Definition
  • decrease in kidney size<8cm
  • increased echogenicity due to fibrosis and scarring
  • small echogenic kidney "atrophy"
Term

Glomerulonephritis

(acute)

Definition
  • increased cortical echoes
  • echogenicity exceeds that of the liver

 

Term

Acute Pyelonephritis

APN

Definition
  • Kidneys can be normal or increased in size
  • related to ascending UTI
Term

Acute Tubular Necrosis

ATN

Definition
  • most common renal disease to cause renal failure
  • increased renal size with hyerechoic pyramids
Term
Pyonephrosis
Definition
  • pus
  • sometimes obstructs ureters
  • low level echoes in a dilated collecting system
Term
Abscess
Definition
  • fever, leukocytosis, flank pain
  • varied US appearance
  • may have shaddows from gas
Term
renal atrophy
Definition
small echogenic kidney
Term
Vascular disorders of the kidneys
Definition
  • Normal renal arterial flow demonstrates flow in systole and diastole that is characteristic of a LOW impendence bed
  • Doppler peak systole velocities are generally equal to or less than 100cm/sec
Term

Renal Artery stenosis

RAS

Definition
  • exam is tedious study with a high technical failure rate
  • Doppler of the renal arteries is difficult due to body habitus, motion, tortuous vessels
  • Primarly caused by atherosclerosis/arteriosclerosis
  • It causes renal hypertension, infarction, small kidney, renal insufficiency
Term
What is the exam for RAS?
Definition
  • RAR=renal artery ratio
  • sample doppler tracing are taken from the renal arteries and aorta

 

Term
What is the formula for RAR?
Definition
  • renal artery peak systolic velcoity divided by aortic peak systolic velocity
  • RAR>3.5 is suspicious for RAS
  • peak main renal artery systolic velocity>180cm/sec with post stenotic turbulence is also suspicious for RAS
  • SPECTRAL BROADENING and TARDUS PARVUS waveform is a sign of RAS
  • RENAL ARFTERIOGRAPHY is aninvasive exam but is commonly used to r/o RAS
Term
What is an indicator of stenosis?
Definition
  • Restsitance is an indicator of stenosis
  • RI of 0.7 is the upper limits of normal
  • as resistance increases the RI will increase
Term
Renal Vein Thrombosis
Definition
  • enlargment of the kidneyin the acute stages
  • vein will be dilated with the absence of doppler flow
  • Clot may be visible as echogenic material in the vein lumen
  • evaluate the IVC for extension
Term
Renal Transplant
Definition
  • the most common place of the transplanted kidney is the RLQ
  • Right iliac region

 

 

Term
What is the fluid collection post op renal transplant?
Definition
  • lympoceles occur as early as 1 week post op
  • usually found medially or inferior to the lower pole of the kidney
  • LARGE, anechoic, may have septaions and debri
  • urinomas occur within 1-2 weeks post op
  • hypoechoic
  • hematomas most complex appearing
Term
Bladder Diverticuli
Definition
  • herniation of bladder wall (outpouchings)
  • may be congenital or acquired
Term

Bladder Inflammation

(cystitis)

Definition
  • appear normal on ultrasound
  • repeated infections will cause the bladder wall to become thickened due to scarring and fibrosis
  • wall thickness between 3-6mm
Term
rejection
Definition
  • major complicatoin of renal transplant is graft rejection
Term
what are the early signs of rejection?
Definition
  • overall increase in size decreases echogencity
  • baseline sonograms are done to document size of kidney after transplant
Term
what are the later rejections of transplant?
Definition
  • enlargement of pyramids
  • (swelling) hypoechoic cortex and cortical thickening
  • distortion of renal outline
  • patchy sonolucent areas
Term
decreased renal function
Definition
the most common indication for post op renal transplant complications
Term

ATN

(acute tubular necrosis)

Definition
  • the most common cause of post op renal transplant failure (50%)
  • occurs after loss of blood supply to the kidney
  • associated with prolonged ischemia
  • creatinine is elevated
  • USF no early change in kidney
  • difficult to distinguish from rejection
  • hypotension
Term
Obstructive Nephropathy
Definition
  • early signs of obstruction are anuria or severe oliguria
  • USF hydronephrosis
Term
Extraperitoneal fluid collections
Definition
  • URINOMA
  • ABSCESS
  • HEMATOMA
  • LYMPHOCELE
Term
Cyclosporine toxcity
Definition
anti rejection drug toxicity
Term
Infarction
Definition
  • occurs when an organ or part of an organ undergoes necrosis due to lack of blood flow
  • seen in the first 24 hours the infarcted part may appear hypoechoic

 

Term
What is seen later with infaction?
Definition
  • infarcted area will become smaller and more echogenic secondary to scarring
  • complete arterial occlusion or multiple infarcts will result in a small hyperechoic kidney
Term
Bladder Tumors
Definition
  • 95% are transitional cell carcinoma
  • (TCC) usually not detected until advanced
  • can cause hydronephrosis if obstructed
Term
Hematuria
Definition
  • can be seen as low level echoes in bladder
  • decub patient to see if mobile
Term
Bladder Calculi
Definition
dense foci will shadowing, gravity dependant
Term
Uretocele
Definition
  • cystic like enlargement of the lover end of the ureters
  • congenital or inquired
  • usually small and asymptomatic
  • large ones cause obstruction (bladder outlet obstruction)
  • infection
Term
Obstruction
Definition
  • the most common site of obstruction by calculi is at the UPJ
  • uretovesical (narrowest part)
  • CHECK URETER JETS
Term

Candle sign

 

Definition
low continuously ureter jets is seen with partial obstruction or a uretocele
Term
Bladder Volume
Definition
V=length x heighth x width x .623
Term
Trigone of bladder
Definition
the area between the neck and apex
Term
Urachal cyst
Definition
  • urachus is fibrous tissue extending from the naval to the bladder
  • it is a remnant of part of the duct of the allantois of the embryo
  • congenital
  • fluid is trapped ina section of the urachus
Term
Foley Catheter
Definition
  • indwelling (stays in all the time)
Term
Conditions that cause incomplete emptying of the bladder?
Definition
  1. Calculi
  2. Neoplasms
  3. Catheter
  4. Tumor
  5. Inflammation
  6. Stricture
  7. Pregnancy
Term
What are the most common complications of the renal transplant?
Definition
  1. Rejection
  2. Decreased renal function
  3. ATN
  4. Obstructive nephropathy
  5. extraperitoneal fluid collections
  6. cyclosporine toxicity
  7. infarction
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