Urinary System Pathology

With simple renal cysts, ___ is unknown

etiology

Simple renal cysts are common in

adults greater than 50

A complex cyst is normally the result of ___ or ___

hemorrhage; infection

A parapelvic cyst arises in the renal ___

hilum / sinus

Parapelvic cysts are usually ___

asymptomatic

What are symptoms of parapelvic cysts, if any?

- pain

- hypertension

- obstruction

What are sonographic findings of a parapelvic cyst?

- no septations

- irregular borders

What is autosomal dominant genetic disorder that affects multiple areas of the body?

Von Hippel-Lindau disease

Patients with Von Hippel-Lindau disease have a high incidence of ___ and bilateral ___

renal cysts; RCC

What is an autosomal dominant disorder causing benign tumors to grow on multiple organs?

tubular sclerosis

Tubular sclerosis causes ___, ___, and ___

seizures; mental deficiency; adenoma sebaceum

Tubular sclerosis is seen with renal ___ and ___

cysts; angiomyolipomas

What is ACKD?

acquired cystic kidney disease

ACKD is found in patients in renal failure and on ___

dialysis

Dialysis increases incidence of ___, ___, and ___

cysts; adenomas; renal carcinoma

What is seen in up to 7% of patients with ACKD?

- adenomas

- oncocytomas

- RCC

Polycystic kidney disease has two forms: the infantile/juvenile autosomal ___ form and the adult autosomal ___ form

recessive; dominant

With infantile polycystic kidney disease, ___, ___ kidneys are seen in utero causing renal ___ and fetal ___

enlarged; echogenic; failure; demise

What form of polycystic renal disease is associated with microscopic renal cysts?

infantile

What form of polycystic renal disease is associated with hypertension, renal insufficiency, hepatic cysts, Caroli disease, bile duct proliferation, periportal fibrosis, portal varices, and nephromegaly?

juvenile

What form of polycystic renal disease is bilateral and associated with enlarged kidneys, spontaneous bleeding, and kidney tissue completely replaced by cysts?

adult (ADPKD)

What are sonographic findings of polycystic kidney disease?

- diffusely enlarged kidneys

- multiple cysts of varying size

- loss of shape

What is the most common form of cystic disease in neonates?

multicystic dysplastic kidney disease (MCDK)

Is MCDK hereditary?

no, nonhereditary

MCDK appears as multiple ___ cysts of varying sizes with no ___ seen

non-communicating; parenchyma

MCDK is associated with:

- ureteral atresia

- contralateral UPJ

- nonfunctioning kidney

- absent renal artery

___ MCDK is incompatible with life

bilateral

Medullary cystic disease is also called:

medullary sponge kidney (MSK)

MSK is a development anomaly that occurs in the medullary pyramids and consists of ___ dilation of the distal collecting ___

fusiform; ducts

MSK causes ___ and ___

urine stasis; stone formation

MSK is ___ and has an unknown ___

nonhereditary; etiology

What diseases is MSK associated with?

- Caroli's disease

- PKD

- Beckwith-Wiedemann

Nephronophthisis (NPH) is autosomal ___

recessive

Nephronophthisis (NPH) appears sonographically as small ___ kidneys with multiple cysts measuring less than ___

echogenic; 2 cm

Cystic nephroma is a ___ cystic mass that is ___

multiloculated; benign

Cystic nephroma does not communicate with the renal ___

pelvis

What is the most common of all kidney tumors?

renal cell carcinoma (RCC)

RCC is more common in ___ older than ___

males; 70

RCC is associated with ___ and ___

von hippel-lindau disease; chronic dialysis

What are symptoms of RCC?

- hematuria

- flank pain

- palpable mass

How does RCC appear sonographically?

Record

- heterogeneous with hemorrhage and necrosis

- isoechoic or hyperechoic

- can be cystic

- basket sign

RCC has a similar appearance to what normal renal variant?

column of bertin

Grading RCC:

Grade I- ___ to kidney

Grade II- spread to ___, but within ___

Grade III- spread to ___, ___, and regional ___

Grade IV- invasion of neighboring ___

- confined

- perinephric fat; Gerota's fascia

- renal vein; IVC; lymph nodes

- structures

Transitional cell carcinoma (TCC) is a tumor of the renal ___

pelvis

TCC is more frequently found in the ___

bladder

TCC is more common in ___

older males

What is the sonographic appearance of TCC?

- hypoechoic mass within the collecting system

- low vascularity

Renal lymphoma is typically a ___ process

secondary

Which is more common: Non-Hodgkin lymphoma or Hodgkin lymphoma?

Non-Hodgkin lymphoma

Lymphoma is more common as a ___ invasion with multiple ___

bilateral; nodules

Renal lymphoma sonographic features include ___ kidneys with ___ outlines, multiple ___ masses, and enlarged retroperitoneal ___

enlarged; irregular; hypoechoic; lymph nodes

Metastases to the kidneys are relatively common, occurring ___ in the course of the disease

late

What are the most common primary malignancies that metastasize to the kidneys?

- RCC of contralateral kidney

- carcinoma of lungs or breast

What is the most common abdominal malignancy in children?

nephroblastoma

What is another name for nephroblastoma?

Wilms tumor

Nephroblastoma is typically found in children ages ___

2-5

What are symptoms of nephroblastoma?

- abdominal flank mass

- hematuria

- fever

- anorexia

Nephroblastoma may be found with ___ obstruction with findings of leg edema, varicocele, or Budd-Chiari syndrome

venous

What is the most common benign renal tumor?

renal angiomyolipoma (AML)

Renal angiomyolipoma (AML) is composed of ___, ___, and ___

fat; muscle; blood vessels

Sonographically, renal angiomyolipoma (AML) appears ___

hyperechoic

Angiomyolipoma (AML) occurrence:

80% in ___

80% in ___

80% in ___

females; right kidney; patients with tuberous sclerosis

Renal adenomas and oncocytomas are ___ and ___

uncommon; benign

Adenomas are ___

hypovascular

Oncocytomas resemble a ___ ___ pattern with a central ___

spoke wheel; scar

Lipomas consist of ___

fat

Lipomas are more common in ___

females

Sonographically, lipomas appear well-defined and ___

echogenic

Lipomas can appear ___

anywhere

Intrinsic renal disease can be classified into two groups:

1. produces increased ___ echoes; caused by deposition of collagen and fibers

2. produces loss of anatomic ___ and inability to distinguish ___ from ___

cortical

detail; cortex; medulla

Intrinsic renal disease group 1 includes

- interstitial nephritis

- acute tubular necrosis (ATN)

- amyloidosis

- diabetic nephropathy

- systemic lupus erythematosus (SLE)

- myeloma

Intrinsic renal disease group 2 includes

- chronic pyelonephritis

- renal tubular ectasia

- acute bacterial nephritis

End stage intrinsic disease leads to ___

atrophy

In acute glomerulonephritis, ___ and/or ___ of cellular elements occurs in the glomeruli

necrosis; proliferation

The end result of acute glomerulonephritis is ___, poorly ___ kidneys

enlarged; functioning

Acute glomerulonephritis is seen sonographically with increased ___ echoes

cortical

What are symptoms of acute glomerulonephritis?

- nephrotic syndrome

- hypertension

- anemia

- peripheral edema

Acute interstitial nephritis is associated with the infectious processes of ___ and ___, or as an ___ to certain drugs

scarlet fever; diphtheria; allergic reaction

What are symptoms of acute interstitial nephritis?

- uremia

- proteinuria

- hematuria

- rash

- fever

- eosinophilia

Acute interstitial nephritis causes ___ and ___ kidneys

enlarged; mottled

Sonographically, acute interstitial nephritis appears with increased ___ ___

cortical echogenicity

Lupus nephritis is an ___ disorder that causes ___, ___, ___, renal vein ___, and renal ___

autoimmune; hematuria; proteinuria; hypertension; thrombosis; insufficiency

Lupus nephritis appears sonographically with increased ___ and renal ___

echogenicity; atrophy

Acquired immunodeficiency syndrome (AIDS) causes unexplained ___ and ___ resulting in renal ___

uremia; azotemia; dysfunction

Sonographically, a patient with AIDS will have ___ kidneys that may be ___

echogenic; enlarged

Sickle cell nephropathy causes ___, renal vein ___, papillary ___, and ___

glomerulonephritis; thrombosis; necrosis; hematuria

Renal papillary necrosis (RPN) is caused by ___, ___, ___, and other diseases

sickle cell; diabetes; kidney transplant

What has an important role in necrosis?

ischemia

What are symptoms of renal papillary necrosis (RPN)?

- hematuria

- flank pain

- dysuria

- fever

- hypertension

- acute renal failure (ARF)

Sonographically, renal papillary necrosis (RPN) appears as round or triangular ___ spaces at the ___ junction

fluid; corticomedullary

Renal atrophy is a ___ loss of renal tissue with preservation of ___ anatomy

uniform; intrarenal

What occurs secondary to renal atrophy?

renal sinus lipomatosis

With renal atrophy, kidneys appear ___ with a highly ___ sinus and a thin cortex

enlarged; echogenic

Acute renal failure (ARF) is a sudden ___ in kidney function that results in retention of ___ products and imbalance of electrolytes and fluids

decline; waste

Prerenal failure is caused by ___ of the kidney

hypoperfusion

Postrenal failure results from ___ obstruction and is ___

outflow; reversible

An extremely large echogenic renal sinus that appears to engulf the entire renal parenchymal outline suggests:

lipomatosis

Adult polycystic disease may be characterized by all except which of the following?

The involved kidneys are small and extremely echogenic

Xanthogranulomatous pyelonephritis can have all of the following sonographic findings except:

Decreased renal size

In cases of nephrocalcinosis, calcium deposits are usually located in the:

medulla