quiz 10 dmis 1105 urinary system (mainly kidneys)

The Urinary System Consists of

Upper urinary tract & lower urinary tract (bladder and urethra).

The upper urinary tract consists of the

2 Kidneys, 2 Ureters

The lower urinary tract consists of the

Urinary bladder,Urethra

The genitourinary tract (GU tract) congenital anomalies are

more common (more than other organ systems).

Anomalies in the GU tract can cause:(

obstruction or stasis, create infections, impair renal function, and/or prompt stone formation

Kidneys are in what position term

retroperitoneal

The right kidney sits lower than the left why

the liver and spleen are on the right and positioned lower

The kidneys are organs that are vital for

homeostasis.

list the function of the kidneys

they detoxify the blood, maintain normal pH, iron, and salt levels in the blood.

kidneys also (hint BP)

work to regulate blood pressure by producing the enzyme renin.

Lack of healthy function is life threatening

true

Urine is formed and excreted through

filtration and reabsorption of blood which results in approximately 1 to 1.5L of urine per day. (cleans the blood: puts good stuff back into circulation, bad stuff excreted).

Nephron is a

Functional unit of the kidney responsible for formation of urine (filtration).

the Bladder is the

reservoir until excretion.

Gerota’s Fascia

Covers kidney and adrenal gland.

Cortex

Outer Portion/Renal parenchyma that is from the wide end (base) of the pyramid to the capsule. normal: greater than 1 cm (otherwise called Cortical Thinning)

Medulla

Inner portion from base of pyramids to center of kidney

Pyramids

Anechoic triangles of collecting tubules that are between the cortex and sinus in the medulla. Well seen in neonates and pediatric patients.

Sinus

Hyperechoic area that contains the calyces, fat, renal pelvis, connective tissue, vessels and lymphatics.

Renal Pelvis

Funnel shaped area between the major calyces and ureter

Hilum

Area where the vein/artery/ureter enter/exit.

Nephron

Functional unit of kidney

Both urine and blood tests are used to

evaluate renal function

A urinalysis for renal function includes but is not limited to

an evaluation for the presence of bacteria, pus, blood, and protein in the urine.

BUN (blood urea nitrogen) measures the amount

of urea nitrogen, a byproduct of protein metabolism that occurs within the liver and is excreted by the kidneys.

Creatinine measures the amount

of creatinine phosphate.

LDH

(lactate dehydrogenase) is an additional enzyme found within the blood that may be used to monitor renal function and other abnormalities, including some forms of cancer.

GFR (glomerular filtration rate) can be used to evaluate

the overall function of the kidneys.

Clinical Indications: can include what type of pain

Flank and/or back pain

Clinical Indications:Signs or symptoms that may be referred from the kidney and/or bladder regions such as

hematuria

Clinical Indications: regarding lab findings, what exactly?

Abnormal laboratory values or abnormal findings on other imaging examinations suggestive of kidney and/or bladder pathology

Clinical Indications: its best for a follow up of…

Follow up of known or suspected abnormalities in the kidney and/or bladder

Clinical Indications: Evaluation of?

suspected congenital abnormalities

Clinical Indications: its important for which type of pre/post evaluations

Pre transplantation and post transplantation evaluation andPlanning and guidance for an invasive procedure.

kidney protocol: Kid Long RT MED/LAT

Long sweep w images medial to lateral

kidney protocol:Kid Trans RT S/I – Transverse sweep w images superior to inferior*REPEAT on LT

ECHOGENICITY OF THE Cortex

hypo or isoechoic compared to liver/spleen

ECHOGENICITY OF THE Pyramids

anechoic

ECHOGENICITY OF THE Renal Sinus

hyperechoic

Renal Agenesis

It’s the Absence of kidney on one side (unilateral) large kidney on contralateral side. (Compensatory Hypertrophy)

which type of renal Agenesis is most common?

Left kidney agenesis is more common. In Men.

when does Bilateral agenesis often present

in utero with oligohydramnios and pulmonary hypoplasia, and is incompatible with life.

Dromedary Hump

Local/anterior bulge of the anterior border of the kidney.

Junctional Parenchymal Defect (JPD)

Wedge

Hypertrophied Column of Bertin (HCB)

Layer of renal cortex is folded toward the center of kidney.

Hypoplasia

Developed but small. Clinical significance depends on volume of output, hypertension generally accompanies this anomaly.

Hyperplasia

Overdeveloped kidney (LARGE).

hyperplasia is Often associated with

renal agenesis or hypoplasia of contralateral kidney.

Horseshoe Kidney

Most common fusion anomaly. Lower poles of the kidneys are joined across the midline by a band of soft tissue. Most common in Men. Generally unimpaired but if obstruction present, surgery possible

Crossed Ectopia

One kidney lies across the midline and is fused to the other kidney.

which anomaly is the second most common fusion anomaly

crossed ectopia

Ectopic Kidney

Having one kidney that is out of its normal position (from birth, failure to ascend).

Double Collecting System (aka Duplex Kidney)

Duplication of collecting system may be complete (2 ureters) or incomplete (1 ureter).

Sonographically

Band of cortical tissue seen throughout a mid area section of the kidney that can be seen in both long and trans.

Disease/Condition Name: Nephrolithiasis (kidney stones) Definition

Stones in the kidney.

what are nephrolithiasis composed of?

They are composed of calcium and salts. Kidneys are the second most common area for calculi in the body.

Clinical Indications/Risk Factors/Related Labs of Nephrolithiasis:

Causes include metabolic disorders (calcium), high calcium intake, and chronic UTI’s. Common in Men >30 years old. Patients will present with acute back/flank pain that may radiate into the ipsilateral groin. Possible dysuria, hematuria, cloudy urine, fever, and/or chills.

How It’s Usually Diagnosed: Nephrolithiasis

Radiography, IVU, Retrograde Pyelogram, Ultrasound, and CT.

Treatment Options for Nephrolithiasis

Depending on size, may pass naturally (strainer), or lithotripsy, medication, or surgery.

Prognosis for Nephrolithiasis

Excellent if no damage.

describe the Anatomical Image of Nephrolithiasis: Hyperechoic structure(s) with posterior shadowing.

Disease/Condition Name: Hydronephrosis Definition

Obstructive disease of the urinary system dilatation of calyces and renal pelvis with urine. Long term can cause atrophy and loss of renal function.

Clinical Indications/Risk Factors/Related Labs of Hydronephrosis

Most common cause is calculus/stone.

Signs/Symptoms of Hydronephrosis include

flank pain and blood or pus in urine. May have abnormal labs if damage is present.

How Hydronephrosis is Usually Diagnosed

Sonography. CT, Nuclear Medicine, and IVU are other choices but contrast, exposure, and invasiveness make them less likely.

Treatment Options for Hydronephrosis

Removal of stone/blockage.

Prognosis of Hydronephrosis

Excellent if caught prior to destruction of nephrons (compression), and/or infection.

describe the Anatomical Image of Hydronephrosis

Sample Grading

Disease/Condition Name: Autosomal Recessive Polycystic Kidney Disease (ARPKD)Definition

Genetic condition, formation of innumerable tiny cysts.

what are the Four kinds Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Perinatal, neonatal, infantile, and juvenile.

Clinical Indications/Risk Factors/Related Labs of Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Portal hypertension (in severe cases), Renal insufficiency,shown via elevated BUN/Creatinine, decreased GFR.

How is Autosomal Recessive Polycystic Kidney Disease (ARPKD) Usually Diagnosed

Often during ultrasounds in pregnancy. Enlarged hyperechoic kidneys, oligohydramnios, and pulmonary hypoplasia.

Treatment Options for Autosomal Recessive Polycystic Kidney Disease (ARPKD)

If prolonged survival (past birth) kidney/liver transplant.

Prognosis for Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Severity/progression vary. Often poor, due to lack of fluid and lung development. With prolonged survival kidney/liver transplant may help.

describe the Radiological Images of Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Enlarged hyperechoic kidneys. May see hepatic fibrosis and splenomegaly in severe cases (with prolonged survival).

Disease/Condition Name: Autosomal Dominant Polycystic Kidney Disease (ADPKD)Definition

More common than ARPKD. Bilateral renal enlargement due to formation of many cysts of various sizes. The cysts gradually enlarge as the patient ages. Over time cysts will compress and destroy normal tissue.

Clinical Indications/Risk Factors/Related Labs Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Chronic UTI’s, Stone Formation, Back Pain, Headache, Increasing Abdomen Size, High blood pressure, Renal Insufficiency. (50% diagnosed with renal hypertension)(50% will need dialysis or transplant due to renal failure). Increased Bun & Creatinine, Decreased GFR.

How is Autosomal Dominant Polycystic Kidney Disease (ADPKD) Usually Diagnosed

Typically seen sonographically around 20 to 30 years of age with sonography, MRI, CT, Xray.

Treatment Options for Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Medications, lifestyle modifications, dialysis, transplant.

Prognosis for Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Worse as pt gets older due to complications relating to: HTN Renal Insufficiency and then failure with a need for dialysis, transplant.

describe the Radiological Images for Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Cysts may also be present in the liver, pancreas, and/or spleen. Multiple cysts noted.