Urinary Patho

Urinary system consists of…

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

- 2 Kidneys (upper)

- 2 Ureters (upper)

- Urinary bladder (lower)

- Urethra (lower)

GU tract congenital anomalies are what?

more common than other organ systems

What can anomalies cause

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

What kidney sits lower

right (liver vs. spleen)

How do kidneys assist in homeostasis

They detoxify the blood, maintain normal pH, iron, and salt levels in the blood. also work to regulate blood pressure by producing the enzyme renin

Urine is formed and excreted through ____ and _____ of blood

filtration and reabsorption

How much urine is made per day

1-1.5L

Nephron

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

Reservoir until excretion

urinary bladder

Gerota’s Fascia

Covers kidney and adrenal gland.

Cortex

Outer Portion/Renal parenchyma

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

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

What muscles are posterior to kidneys

Psoas, Quadratus Lumborum

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)

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 indication for kidneys

Flank pain, hematuria, abnormal labs/ images, abdominal trauma, pre and post transplant eval,

Normal kidney length

9-12 cm

Echogenicity for cortex

hypo or isoechoic compared to liver/spleen

Echogenicity for pyramids

anechoic

Echogenicity for renal sinus

hyperechoic

Renal Agenesis

Absence of kidney on one side (unilateral) large kidney on contralateral side

Left kidney agenesis is more common. +Men. Bilateral agenesis often presents in utero with oligohydramnios and pulmonary hypoplasia, and is incompatible with life.

Dromedary Hump

Local/anterior bulge of anterior border of the kidney

dromedary hump image

Junctional Parenchymal Defect (JPD

Wedge-shaped hyperechoic defect, anterior, usually right

JPD image

Hypertrophied Column of Bertin (HCB)

Layer of renal cortex is folded toward the center of kidney. Normal vs HCB

HCB image

Hypoplasia

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

hypoplasia image

Hyperplasia

Overdeveloped kidney (LARGE). 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. +Men. Generally unimpaired – but if obstruction present, surgery possible

horseshoe kidney image

Crossed Ectopia

One kidney lies across the midline and is fused to the other kidney. Second most common fusion anomaly.

crossed ectopia image

Ectopic Kidney

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

ectopic kidney

Double Collecting System (aka Duplex Kidney)

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

image of duplex kidney

sonographically of duplex kidney

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

Nephrolithiasis (kidney stones)

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

clinical indications for 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 are kidney stones usually diagnosed

Radiography, IVU, Retrograde Pyelogram, Ultrasound, and CT

treatment options for kidney stones

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

nephrolithiasis prognosis

excellent

Kidney stone image

Hydronephrosis

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 for hydronephrosis

Most common cause is calculus/stone. Signs/Symptoms include flank pain and blood or pus in urine. May have abnormal labs if damage is present.

Treatment options for hydronephrosis

removal of stone

prognosis for hydronphrosis

excellent if caught prior to damage

hydronephrosis image

Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Genetic condition, formation of innumerable tiny cysts.

Four kinds: Perinatal, neonatal, infantile, and juvenile.

clinical indications for ARPKD

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

How is ARPKD usually diagnosed

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

Treatment options for ARPKD

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

prognosis for ARPKD

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

Radiological images description for ARPKD

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

ARPKD images

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

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.

ADPKD indications

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 ADPKD usually diagnosed

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

Treatment options for ADPKD

Medications, lifestyle modifications, dialysis, transplant.

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

Radiological Images description ADPKD

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

ADPKD image