Kidney Pathology

absence of one kidney, unilateral or bilateral

what is renal agenesis?

compensatory hypertrophy

what happens to a pts kidney when born w/unilateral kidney agenesis ?

bicornuate uterus

what pelvic anomaly is unilateral kidney agenesis associated with?

death soon after birth

what happens to pts born with bilateral kidney agenesis?

rare, third smaller kidney

what is supernumerary kidney?

ectopic/ pelvic kidney

which congenital kidney anomaly is associated with a shorter ureter and failure to ascend through fetal development?

UPJ obstruction, ureteral reflux, infection, multicystic renal dysplasia

what are risk factors associated with ectopic kidney/ pelvic kidney?

empty renal fossa, kidney located in lower abdomen/ pelvis, potentially malrotated

sono appearance of ectopic/ pelvic kidney?

kidneys fused at inferior poles across midline, connected by isthmus of functioning or nonfunctioning fibroitic tissue , separate collecting systems

what is a horseshoe kidney?

bilateral low-lying medially placed kidneys, partial or complete fusion, isthumus ANTERIOR to AO

sono appearance of horseshoe kidney?

signmoid kidney

which congenital kidney anomaly is a variant of horseshoe kidney?

superior pole of one kidney fused with inferior pole of contralateral kidney creating an "S" shape

what is a signmoid kidney?

both kidneys are fused on one side of the body , two separate collecting systems, & normal adrenal gland locations

what is crossed fused renal ectopia?

appear as one single, large kidney, irregular contour, inferior pole directed medially/ malrotated, empty renal fossa on contralateral side

sono appearance of crossed fused renal ectopia?

check pelvis, ask pt is theyve had renal sx, look in chart for hx of agenesis, etc.

what should you do if you do not see a kidney is the expected location?

AKA duplex collecting system, may involve kidney, ureter or pelvis

what is a duplicated collecting system?

duplicated collecting system

what is most common congenital urinary anomaly?

increase in renal length, two distinct collecting system (renal sinus), ridge of cortex extending through kidney, superior system is most likely obstruct, possible ureterocele

sono appearance of duplicated collecting system?

duplicated collecting system runs all the way through kidney, column of bertin stops

how can you differentiate between a duplicated collecting system and a hypertrophied column of bertin?

acquired, benign fluid-filled mass, found in 50% of pts > 55 yrs, usually incidental finding, aymptomatic

what is a simple cyst of the kidney (cortical cyst)?

anechoic, hyperechoic thin walls, smooth borders, posterior enhancement, no cals, nodules or septa, DOES NOT communicate with collecting system

sono appearance of simple kidney cyst?

simple cyst (cortical cyst)

which kidney pathology is this?

varied echogenicity, septations, layering, wall calcifications

sono appearance of complex kidney cyst?

complex cyst

which kidney pathology is this?

bosniak classifications

which is the tier of classification of renal masses called? (based off loco, size, shape, echo texture, etc.)

rare, kidney cysts that are located in renal hilum and protrude into renal sinus, causing obstruction/ hydornephrosis (commonly mistaken for hyrdo)

what are PARApelvic kidney cysts?

parapelvic cysts

what kind of renal cyst is commonly mistaken for hydronephrosis?

asymptomatic, hematuria, HTN

clinical findings of PARApelvic cysts?

anechoic, well-defined, single & large, DOES NOT communicate with collecting system, can mimic hydro, located in renal hilum

sono appearance of parapelvic cyst?

parapelvic cyst

which kidney pathology is this?

originate in renal sinus, located in or around renal pelvis, lymphatic origin, may protrude into parenchyma, asymptomatic, DOES NOT cause obstruction

what are PERIpelvic kidney cysts?

usually small & multiple, irregualr shape, extend radially from renal hilum, frequently bilateral, may be difficult to differentiate from hydro.

sono appearance of PERIpelvic cysts?

inherited disorder, AKA adult polycystic kidney disease, normal parenhcyma replaced with cysts, presents age 30-40 yrs, increased incidence of calculi & infection

what is autosomal dominant polycystic kidney disease (APKD)?

cerebral berry aneurysms, arterial aneurysm of the circle of willis

what brain pathology is autosomal dominant polycystic kidney disease associated with?

bilateral renal enlargment, multiple cysts of varying size, enhancement, irregular margins, normal parenchyma diff to vis, associated w/ liver, oanc, & spleen cysts

sono appearance of APKD?

adult polycystic kidney disease (APCKD)

what is autosomal dominant polycystic kidney disease also known as?

asymptomatic, palp abd mass, HTN, hematuria, flank pain, renal failure

clinical findings of ADPKD?

increased BUN, creatinine, proteinuria

labs associated with ADPKD?

inherited disorder, AKA infantile polycystic kidney disease, abnormal proliferation & dilation of renal tubules resulting in multiple microscopic or tiny cysts, normal parenchyma replaced w/ cysts, incompatible w/ life

what is autosomal recessive polycystic kidney disease (ARPKD)?

in utero or in early life

when is autosomal recessive polycystic kidney disease detected?

bilateral, hyperechoic enlarged kidneys, loss of corticomeduallry differentiation

sono appearance of autosomal recessive polycystic kidney disease?

ability to distinguish between cortex and medulla of kidney, indicative of renal pathology

what is corticomedullary differentiation?

devlopmental anomaly (NOT inherited, common in males, unilateral (bilateral is incompatible w/life), fibrosis of renal parenchyma, poor renal function of affected kidney

what is multicystic dysplastic kidney disease (MCDK)?

multicystic dysplastic kidney disease (MCDK)

what is the most common form of cystic disease in infants?

asymptomatic, palp flank mass

clinical findings of MCDK?

multiple cysts of varying size, little or no normal parenchyma, renal sinus absent, decreased kidney size, normal or enlarged contralateral

sono appearance of MCDK?

cystic kidney disease from pts undergoing dialysis (usually after 3-4 yrs), increases risk of renal cell carcioma

what is acquired cystic kidney disease (ACKD)?

dialysis

what are the risk factors of acquired cystic kidney disease?

bilateral, atrophic kidneys, multiple cysts (>3 cm), variable sizes, usually small, variable echogenicity , cortical thinning

sono appearance of acquired cystuc kidney disease

benign congenital condition, bilateral, dysplastic cystic dilation of collecting tubules, calcium deposits form in the dilated tubules, asymptomatic, no effect on renal function

what is medullary sponge kidney?

increased echogenicity of medullary pyramids, hyperechoic foci in region of renal papillae, widening of distal collecting system, calculus

sono appearance of medullary sponge kidney?

urinary stasis, multiple UTIs, congenital

causes of medullary sponge kidney?

angiomyolipoma

what is the most common benign solid tumor of the kidney?

benign tumor composed of fat, blood vessels, and smooth muscle tissue (increasing risk of hemorrhage > 4 cm)

what is an angiomyolipoma?

asymptomatic, flank pain, gross hematuria, HTN

clinical findings of an angiomyolipoma?

well-defined hyperechoic cortical mass, homogeneous, round, variable size, may distort architecture, usually solitary, common in RK

sono appearance of angiomyolipoma

benign, epithelial cell tumor, asymptomatic, more common in men 70-80 yrs

what is a oncocytoma?

oncocytoma

what is the second most common benign renal mass after angiomyolipoma?

hypoechoic solid mass, hypoechoic central scar, difficult to differentiate from RCC

sono appearance of oncocytoma?

benign solid mass, most common cortical tumor

what is renal adenoma?

male, tobacco use, long-term dialysis

rick factors for renal adenoma?

asymptomatic, painless hematuria

clinical findings of renal adenoma?

well-defined, isoechoic or HYPERechoic cortical mass, internal calcs, VASCULAR, usually < 1 cm

sono appearance of renal adenoma?

mesoblastic nephroma

what is the most common solid renal mass identified in neonates?

Most common solid renal neonatal benign tumor, rare, composed of mesoderm tissue, diagnosed prenatally (polyhydraminos) (meso-middle, blast- embryonic state)

what is mesoblastic nephroma?

varying echogenicity, may completely replace kidney, possible calcs, possible cystic degeneration

sono appearance of mesoblastic nephroma?

Most common solid renal mass in adults & primary cx of kidney, malignant, AKA hypernephroma or Von Grawitz

what is renal cell carcinoma (RCC)?

hypernephroma or Von Grawitz or adenocarcinoma

another names for renal cell carcinoma?

renal cell carcinoma (RCC)

what is the most common solid renal mass in adults?

renal cell carcinoma (RCC)

what is the most common primary malignancy of the kidney?

LUNGS (#1), liver, & long bones

most common place for RCC to metastasize?

gross hematuria, uncontrolled HTN, palp mass, flank pain

clinical findings of RCC?

irregular mass, (unilateral), ISOECHOIC, large- HYPOechoic, small-HYPERechoic, central scar, focal bulge, indisticnt borders, HYPERvascular, extension into renal vein & IVC

sono appearance of RCC?

Most common malignant pediatric mixed tumor composed of embryonal elements, usually <5 yrs AKA nephroblastoma

what is Wilms tumor?

nephroblastoma

what is Wilms tumor also known as?

wilms tumor or nephroblastoma

what is the most common renal tumor identified in pediatrics pts?

wilms tumor or nephroblastoma

what is the most common malignant tumor found by sonography in pediatric pts?

beckwith-wiedemann, hemihypertrophy (one side of body is enlarged) sporadic anirdia (born w/o eye iris) , males, omphalocele (protruding organs)

risk factors of nephroblastoma?

palp flank mass, HTN, fever, gross hematuria, abd pain, N/V

clinical findings of nephroblastoma or wilms tumor?

large, solid, well-defined renal mass, commonly homogeneous & echogenic, calcs uncommon, intramural vascular flow, displacement of IVC/AO, metasasis to RV,IVC, liver, other kidney, lymph nodes

sono appearance of nephroblastoma or wilms tumor?

primary malignancy of lung, breast, GI tract, contralateral kidney, non-hodgkins lyphoma, leukemia, asymptomatic

what is metastatic renal tumor?

multiple small hypoechoic masses, diffusely enlarged inhomogeneous kidney

sono appearance of metastatic renal tumor?

kidney stones or uretal stones, mainly composed of calcium, can cause obstruction or hydro, common in men

what is nephrolithiasis/ urolithiasis?

idopathic, dehydration, urinary stasis (not completely voiding) , hypercalciuria (high calcium in urine)

causes of nephrolithiasis?

asymptomatic, renal colic, flank pain, fever, chills, dysuria (painful urination), hematuria

clinical findings of nephrolithiasis?

HYPERechoic focus/ foci, can be located in pelvis, ureter, or kidney, shadowing, color doppler twinkle artifact, demonstrate ureteral jets to assess patency

sono appearance of nephrolithiasis?

large stone in renal pelvis, branching into several calyces

what is staghorn calculus?

Atherosclerosis al vessels, punctate or linear, may or may not shadow, does NOT obstruct or cause hydro

What is renal vascular calcifications?

calcium deposits in parenchyma (medulla/ pryamids), incidental finding

what is nephrocalcinosis?

asymptomatic, HYPERPARATHYROIDISM (controls calcium levels) , hypercalcemia, hypercalciuria, renal failure

clinical findings of nephrocalcinosis?

medullary- HYPERechoic medullary pyramids, normal cortical echogenicity cortical- multiple echogenic foci in cortex, twinkle, shadowing, diff to differentiate from stones

sono appearance of nephrocalcinosis

dilated collecting system, obstruction of urine flow, unilateral or bilateral

what is hydronephrosis/ hydroureter?

ureterovesical junction (UVJ) (bladdder + ureter /distal)

what is the most common site of renal calculi in adults?

ureteropelvic junction obstruction (ureter + renal pelvis/ proximal)

what kind of renal obstruction is the most common cause of pediatric hydronephrosis?

dilation of calyces

what is caliectasis hydronephrosis?

caliectasis, pelviectasis, & pelvicaliectasis

what are subtypes of hydronephrosis?

dilation of renal pelvis

what is pelviectasis hydronephrosis?

dilation of calyces and renal pelvis

what is pelvicaliectasis hydronephrosis?

HTN, renal failure, sepsis, congenital, intrinsic, or extrinsic

what can hydronephrosis cause?

renal calculi, mass, malformed UVJ, BPH, urethral obstruction, pregnancy

causes of hydronephrosis?