Chapter6 Part2 START HERE

What is nephrocalcinosis?

Diffuse deposition of calcium salts within the renal parenchyma.

Which part of the kidney is most commonly affected by nephrocalcinosis?

The renal medulla.

How does nephrocalcinosis differ from urinary calculi?

Nephrocalcinosis is calcification within the renal parenchyma; urinary calculi are stones within the collecting system.

What metabolic abnormality commonly causes nephrocalcinosis?

Hypercalcemia, meaning excessive calcium in the blood.

What are major risk factors for nephrocalcinosis?

Hyperparathyroidism, renal tubular acidosis, medullary sponge kidney, and excess vitamin D.

What is urinary tract obstruction?

A blockage that interferes with normal urine flow anywhere from the renal pelvis to the urethra.

What are common bottleneck sites for urinary obstruction?

The ureteropelvic junction, ureterovesical junction, bladder neck, and urethral meatus.

What can cause upper urinary tract obstruction?

Stones, strictures, congenital abnormalities, and tumors.

What can cause lower urinary tract obstruction?

Benign prostatic hyperplasia, urethral strictures, tumors, and bladder calculi.

What are common manifestations of urinary tract obstruction?

Flank pain, decreased urine output, difficulty urinating, and hematuria.

What is the first-line imaging examination for urinary tract obstruction?

Ultrasound.

How may urinary tract obstruction be relieved urgently?

By ureteral stent placement or nephrostomy drainage.

What is a renal cyst?

A fluid-filled sac located within or on the kidney.

How are most simple renal cysts discovered?

Incidentally, because they are usually asymptomatic.

How does a simple renal cyst usually appear?

As a solitary, benign, fluid-filled cyst without complex internal features.

What features may make a renal cyst complex?

Septations, calcifications, hemorrhage, or a solid component.

How are asymptomatic simple renal cysts usually managed?

They usually require no treatment.

What is polycystic kidney disease (PKD)?

A genetic disorder characterized by multiple fluid-filled cysts that enlarge and distort the kidneys.

Which form of PKD is most common and usually presents in adults?

Autosomal dominant polycystic kidney disease (ADPKD).

At what age does ADPKD commonly become apparent?

Approximately 30 to 50 years of age.

Which gene mutations are commonly associated with ADPKD?

PKD1 or PKD2 mutations.

Which form of PKD usually presents in infancy or childhood?

Autosomal recessive polycystic kidney disease (ARPKD).

What are common manifestations of PKD?

Hypertension, flank pain, hematuria, and enlarged palpable kidneys.

What important vascular complication is associated with ADPKD?

Intracranial aneurysm and possible rupture.

What ultrasound appearance did the professor associate with PKD?

A cluster-of-grapes appearance caused by multiple renal cysts.

What is another name for renal cell carcinoma?

Hypernephroma.

What is the most common primary malignant renal tumor in adults?

Renal cell carcinoma.

Approximately what percentage of renal malignancies are renal cell carcinomas?

About 85% to 90%.

What is the strongest emphasized risk factor for renal cell carcinoma?

Smoking.

Where does renal cell carcinoma commonly metastasize?

The lungs.

What is the gold-standard imaging examination for evaluating renal cell carcinoma?

CT, which evaluates tumor size, local invasion, and vascular involvement.

What is the primary treatment for localized renal cell carcinoma?

Partial or radical nephrectomy.

What is another name for Wilms tumor?

Nephroblastoma.

What is Wilms tumor?

The most common primary malignant renal tumor in children, arising from embryonic renal precursor cells.

What is the peak age range for Wilms tumor?

Approximately 2 to 5 years of age.

What is the classic presentation of Wilms tumor?

A painless palpable abdominal mass in a young child.

Where does Wilms tumor commonly metastasize?

The lungs.

What imaging examination is primarily used to stage Wilms tumor?

CT.

What is the most common histologic type of bladder carcinoma?

Urothelial carcinoma, formerly called transitional cell carcinoma.

What is the most significant risk factor for bladder carcinoma?

Smoking.

What occupational exposures increase the risk of bladder carcinoma?

Exposure to dyes, rubber, and industrial chemicals.

What is the classic manifestation of bladder carcinoma?

Painless gross hematuria.

What is the gold standard for diagnosing bladder carcinoma?

Cystoscopy with direct visualization and biopsy.

What procedure is commonly used to remove a superficial bladder tumor?

Transurethral resection of bladder tumor (TURBT).

Why does bladder carcinoma require lifelong monitoring?

It has a high recurrence rate.

What is renal vein thrombosis?

Formation of a thrombus in a renal vein that impairs venous drainage from the kidney.

In which pediatric group is renal vein thrombosis especially associated with dehydration?

Severely dehydrated neonates and children.

What are major risk factors for renal vein thrombosis?

Nephrotic syndrome, dehydration, trauma, and renal tumors.

What complications can renal vein thrombosis cause?

Renal infarction, chronic kidney disease, and pulmonary embolism.

What is the initial vascular imaging examination for renal vein thrombosis?

Doppler ultrasound.

What CT study evaluates renal vein thrombosis?

CT venography, not CT arteriography.

What is acute kidney injury (AKI)?

A sudden decline in renal function, formerly called acute renal failure.

What happens to GFR and BUN in acute kidney injury?

GFR decreases and BUN rises because nitrogenous wastes accumulate.

What do oliguria and anuria mean?

Oliguria is low urine output; anuria is little or no urine output.

What are the three categories of acute kidney injury?

Prerenal, intrinsic renal, and postrenal.

What causes prerenal AKI?

Reduced renal perfusion, commonly from hypovolemia, shock, or heart failure.

What causes intrinsic renal AKI?

Direct kidney injury such as acute tubular necrosis, glomerulonephritis, or acute interstitial nephritis.

What causes postrenal AKI?

Urinary tract obstruction caused by conditions such as stones, tumors, or urethral obstruction.

What is the first imaging examination used in AKI to rule out obstruction?

Ultrasound.

What is chronic kidney disease (CKD)?

A progressive and usually irreversible loss of renal function.

What are common causes of chronic kidney disease?

Diabetes, hypertension, chronic glomerulonephritis, polycystic kidney disease, and recurrent urinary obstruction.

What laboratory changes occur in chronic kidney disease?

Elevated BUN, decreased GFR, hyperkalemia, metabolic acidosis, and anemia.

Why can chronic kidney disease cause anemia?

Damaged kidneys produce less erythropoietin.

What is the primary imaging modality for chronic kidney disease?

Ultrasound.

How may a chronically diseased kidney appear on ultrasound?

Small and hyperechoic with loss of normal renal architecture.

Is chronic kidney disease usually reversible?

No. It is generally progressive and irreversible.

What kidney functions does dialysis replace?

Removal of wastes, removal of excess fluid, and correction of electrolyte imbalance.

Is dialysis a cure for kidney failure?

No. It is life-sustaining treatment but not a cure.

How does hemodialysis clean the blood?

Blood is removed from the body, passed through a dialyzer, and returned to the patient.

What is the preferred long-term vascular access for hemodialysis?

An arteriovenous fistula.

What may be used for temporary hemodialysis access?

A central venous catheter.

How does peritoneal dialysis work?

Dialysis solution enters the abdominal cavity and the peritoneal membrane acts as a natural filter before the fluid is drained.