Unit 10- Benign Tumors + Renal Disease

What are characteristics of a Benign Renal Adenoma?

• Asymptomatic

• Well defined

• Hyperechoic to hypoechoic masses

• Calcifications in renal cortex

• Hypovascular

What are the sonographic findings for an Oncocytoma?

• Well defined mass of epithelial cells

• Hypoechoic

• Homogenous

• Spoke wheel pattern of enhancement with central scar

Adenomas and Oncocytomas can resemble malignant tumors, but the sonographer should not rule out ____ as a possibility

RCC

What is an Angiomyolipoma (AML)

• Most common benign renal tumor

• Contains fat, muscles, and vessels

• More common in females

US Appearance of an Angiomyolipoma (AML):

• Focal, solid

• Hyperechoic

• Well defined borders

• Posterior acoustic enhancement

• Solitary (usually)

  • Multiple or bilateral-

    • Tuberous sclerosis

What are these images showing?

Angiomyolipoma

What are the characteristics of a Lipoma?

• Consists of Fat cells

• Females >Males

• Asymptomatic

• Normal Lab values

• May cause hematuria

What is the sonographic appearance of a Lipoma?

• Well- defined

• Echogenic

What are the Differential Diagnosis of a Lipoma?

• Fibromas

• Adenoma

• Angiomyolipoma

What is this image showing?

Lipoma

What is Group 1 Intrinsic Renal Disease?

• Generalized increase in cortical echoes

• Results from deposition of collagen & fibrous tissue

What Diseases are included in Group 1 intrinsic renal disease?

• Interstitial Nephritis

• Acute Tubular Necrosis

• Amyloidosis

• Diabetic Nephropathy

• Lupus

• Myeloma

What is Group 2 Intrinsic Renal Disease?

• Loss of Anatomic Detail

• Cortex & medullary regions

• Indistinguishable

What diseases are included in Group 2 Intrinsic Renal Disease?

• Chronic pyelonephritis

• Renal tubular ectasia

• Acute bacterial nephritis

What is seen with end-stage renal disease and renal atrophy?

• Increased echogenicity

• Decreased in Size

• Cortical thickness <5mm

What is seen with Acute renal disorders?

• Renal enlargement

• Decreased parenchymal echogenicity

• Interstitial edema

  • Renal vein thrombosis

  • Pyelonephritis

  • Renal-transplant rejection

What is Acute Glomerulonephritis?

• Necrosis &/or proliferation of cellular elements in glomeruli

• Results in enlarged & poorly functioning kidneys

• Secondarily affected:

  • Vascular elements

  • Tubules

  • Interstitium

US Appearance of Acute Glomerulonephritis?

• Increased cortical echoes

• Normal to enlarged kidneys

• Normal medulla

What are the symptoms of Acute Glomerulonephritis?

• Nephrotic Syndrome

• HTN

• Anemia

• Peripheral Edema

What is this image showing?

Acute Glomerulonephritis

What is Acute Interstitial Nephritis?

• Associated with infectious/inflammation processes:

  • Scarlet fever

  • Diphtheria

  • Allergic reaction

What are the symptoms of Acute Interstitial Nephritis?

• Azotemia

• Rash

• Fever

US appearance of Acute Interstitial Nephritis?

• Enlarged + mottled kidneys

• Increased cortical echogenicity

What is Lupus Nephritis?

• Connective Tissue Disorder – results from an abnormal immune system

  • Females > Males

  • 20 – 40 years of age

  • 50% involve kidneys

What are the renal manifestations of lupus nephritis?

• Hematuria

• Proteinuria

• HTN

• Renal Vein Thrombosis

• Renal insufficiency

US appearance of Lupus Nephritis:

• Increased cortical echogenicity

• Renal Atrophy

What is this image showing?

Lupus Nephritis

What are the Renal Dysfunction indicators of AIDS

• Uremia

• Azotemia

• Acute tubular necrosis

• Nephrocalcinosis

• Interstitial nephritis

• Focal segmental glomerulosclerosis

US appearance of AIDS affecting the kidney:

• Kidneys normal size to enlarged

• Echogenic parenchyma

• Increased cortical echogenicity

What is this image showing?

AIDS in the Kidney

Renal Involvement is common in _____ ____ _________

Sickle Cell Nephropathy

Renal involvement with Sickle Cell Nephropathy includes:

• Glomerulonephritis

• Renal vein thrombosis

• Papillary necrosis

• Hematuria

US appearance of Acute Sickle Cell Nephropathy:

• Acute (0-4 days) renal vein thrombosis

  • Enlarged kidneys

  • Decreased echogenicity

US appearance of Subacute Sickle Cell Nephropathy:

• Subacute (4-14 days) thrombosis

  • Enlarged kidneys

  • Increased cortical echogenicity

With Sickle Cell Nephropathy, diagnosis is specific if _______ is seen:

Thrombosis

What is Hypertensive Nephropathy?

• Uncontrolled HTN

  • Progressive renal damage

  • Azotemia

US appearance for Hypertensive Nephropathy:

• Small kidneys with smooth borders

• Scarring

• Lobar infarction

What is this image showing?

Hypertensive Nephropathy

What is Papillary Necrosis (Condition)

• •Papilla swells & communication with calyceal system occurs

• •Papilla may calcify

• •Papilla may slough into collecting system

What are the causative factors of papillary necrosis?

• **Diabetes*

• Analgesic abuse

• UTI

• RV Thrombosis

• Prolonged hypotension

• Urinary tract obstruction

• Dehydration

• Sickle cell anemia

• Tuberculosis

• Renal transplant

What are the symptoms of Papillary Necrosis?

• Hematuria

• Flank pain

• Dysuria

• Fever

• HTN

• Acute renal failure

US appearance of Papillary Necrosis:

• Fluid spaces at cortical-medullary junction corresponding to pyramid distribution

• Round or triangular shaped

• Mimics calculi

What is this image showing?

Papillary Necrosis

What is renal atrophy?

Intrarenal anatomy is preserved with uniform loss of renal tissue

US appearance of Renal Atrophy?

• Smaller Kidneys

• Highly enlarged renal sinus

• Thin cortical rim

  • < 5mm is abnormal

Renal ______ ________ occurs secondary to renal atrophy

Sinus Lipomatosis

Renal Sinus Lipomatosis US appearance:

• Enlarged kidneys

• Highly echogenic & enlarged renal sinus

• Thin cortical rim

What is this image showing

Renal Atrophy Sinus Lipomatosis