Kidneys Pt.2

symptoms of inflammatory or necrotic cysts

flank pain, hematuria, proteinuria, WBCs in urine

Renal subcapsular hematoma signs and symptoms

hematuria, ↓ hematocrit

renal inflammatory processes signs and symptoms

abscess, fever, palpable mass, ↑ WBC, pyuria

Acute focal bacterial nephritis signs and symptoms

fever, flank pain, pyuria, ↑ BUN, ↑ albumin, ↑ plasma proteins

Acute tubular necrosis signs and symptoms

flank pain, vomiting, hematuria, leukocytosis

Chronic renal failure signs and symptoms

↑ urea, ↑ creatinine, ↑ urine protein, granulocytes

Renal Cell Carcinoma signs and symptoms

hematuria, pyuria, ↑ LDH, RBCs in urine

Simple cyst

may occur in cortex, medulla, or renal sinus; may hemorrhage or calcify

Complex cyst

septations, thick walls, calcifications, internal echoes, mural nodules → malignant until proven benign

associated syndromes with renal cystic disease

Von Hippel-Lindau, Tuberous Sclerosis, Acquired Cystic Kidney Disease (esp. dialysis patients)

What are the two polycystic kidney diseases

Autosomal Recessive PKD

Autosomal Dominant PKD

ARPKD

• Infantile; chromosome 6; rare

• Dilation of collecting tubules → renal failure

• Liver involvement → fibrosis, portal hypertension

• Perinatal type → renal failure in utero, pulmonary hypoplasia

• Juvenile form → HTN, nephromegaly, hepatic cysts

ADPKD

• Bilateral; adult onset (40–50 yrs)

• Enlarged kidneys w/ multiple asymmetrical cysts

• Symptoms: pain, HTN, hematuria, UTI, renal insufficiency

• Complications: infection, hemorrhage, rupture, obstruction

• 50% reach end-stage renal disease by age 60

Multicystic dysplastic Kidney (MCDK)

• Nonhereditary; most common in neonates

• Caused by early urinary obstruction in utero

• Usually unilateral; bilateral = incompatible with life

• Complications: HTN, hematuria, infection, flank pain

• Sonographic: multicystic kidney, no renal parenchyma/sinus, atretic renal artery

Medullary Cystic Disease/ Medullary Sponge Kidney

• Developmental anomaly in medullary pyramids

• Cystic dilation of collecting ducts → urine stasis & stones

• Associated with Beckwith-Wiedemann, PKD, Caroli disease, congenital hepatic fibrosis

Renal Mass Evaluation

• Solid → malignant unless fat seen

• Calcifications → malignancy

• Evaluate renal vein, IVC, liver for metastasis

• Malignant cyst features: wall >1 mm, septations, calcifications, vascularity

Renal Tumors are……

Renal Cell Carcinoma (RCC)

Transitional Cell Carcinoma (TCC)

Renal Lymphoma

Secondary Metastases

Nephroblastoma (Wilma’s tumor)

Benign Tumors

Renal Cell Carcinoma (RCC)

• Most common renal cancer; men > women

• 60–70 yrs; symptoms: hematuria, flank pain, palpable mass

• Hypoechoic rim = pseudocapsule; intratumoral calcifications

• High systolic & diastolic flow; low RI

Transitional Cell Carcinoma (TCC)

• From renal pelvis; papillary (common) or flat

• Papillary = polypoid mass, low-grade

• Flat = high-grade; spreads quickly

• Symptoms: hematuria, flank pain

Renal Lymphoma

Usually secondary; non-Hodgkin > Hodgkin

Bilateral, multiple nodules; hypoechoic, enlarged kidneys

Secondary Metastases

From lung, breast, or contralateral RCC

Multiple poorly marginated hypoechoic masses

Nephroblastoma (Wilm’s tumor)

Most common pediatric renal malignancy (age 2.5–3 yrs)

Signs: flank mass, hematuria, fever, anorexia

Benign Tumors

Angiomyolipoma (AML)

Lipoma

Angiomyolipoma (AML)

fat + muscle + vessels; assoc. w/ tuberous sclerosis

Lipoma

fat cells; women > men; well-defined echogenic mass

Renal Disease processes

↑ Cortical echoes: collagen/fibrous deposits (interstitial nephritis, amyloidosis, lupus, etc.)

Loss of normal detail: chronic pyelonephritis, acute bacterial nephritis

Acute Glomerulonephritis

Necrosis/proliferation in glomeruli → enlarged poorly functioning kidneys

Symptoms: HTN, anemia, edema

Sickle cell nephropathy

Hematuria common; enlarged or echogenic kidneys

Renal Atrophy

Tissue loss, preserved anatomy; sinus lipomatosis

Acute Renal Failure

reversible; due to obstruction, infection, ischemia

• Prerenal: ↓ perfusion (CHF, renal artery occlusion)

• Renal: parenchymal disease (ATN, GN, nephritis)

• Postrenal: outflow obstruction (stones, tumors)

Chronic Renal Failure

irreversible; due to glomerulonephritis, diabetes, vascular disease

Small, echogenic kidneys

Acute Tubular Necrosis

most common cause of acute renal failure

Hydronephrosis

• Urine backup → collecting system dilation

• Grades:

  1. Mild (renal pelvis)

  2. Some calyces

  3. Complete pelvocaliectasis

  4. Thinning of parenchyma

• Mimics: extrarenal pelvis, parapelvic cyst, reflux, AV malformation

2 Renal Infections

pyonephrosis

emphysematous pyelonephritis

Pyonephrosis

pus in collecting system → urosepsis; emergency drainage

Emphysematous Pyelonephritis

gas-forming infection (E. coli); unilateral; emergency nephrectomy

Renal Artery Stenosis

common correctable cause of hypertension (atherosclerosis or fibromuscular dysplasia)

Renal infarction

necrosis from blood supply loss

Kidney stones (urolithiasis)

crystals from urine; may cause obstruction; large = staghorn calculi

Bladder Pathology

• Diverticulum: herniation/outpouching of bladder wall

• Tumors: 95% are TCCs; symptoms—hematuria, dysuria, frequency, urgency
  

  • Sonographic: focal wall thickening or intravesical lesion