Urinary System Part 2

Dilation of urinary tract occurs __ to an obstruction

proximal

Define: dilation of renal collecting system secondary to obstruction of urine

hydronephrosis

Hydronephrosis may also be called...

pyelocaliectasis

Classify mild, moderate, and marked/severe hydronephrosis

mild - dilation of renal pelvis

moderate - dilation of pelvis + calices + pyramids

marked - dilation extends into cortex, thinning of parenchyma

Hydro can cause an RI above..

0.7

Define: presence of kidney stones anywhere within the urinary tract

urolithiasis

Define: stones within the kidney

nephrolithiasis

Urolithiasis/kidney stones are more common in male or female?

males

What are kidney stones made of?

calcium oxalate

Define: stone that completely fills and takes on the shape of the renal pelvis

staghorn calculus

What is the most common location for a stone to become lodged in the urinary tract?

ureterovesicle junction, near bladder

What is the pelvic brim?

where ureter crosses the iliac vessels

Stones may not be seen if under __

5 mm

Clinical findings of urolithiasis

- hematuria

- renal colic - pain caused by stones

- oliguria - small amounts of urine

- UTI

What is nephrocalcinosis?

accumulation of calcium within the renal parenchyma

What are the two forms of nephrocalcinosis?

medullary nephrocalcinosis

cortical nephrocalcinosis

Medullary calcinosis may be caused by (3)

- hyperparathyroidism

- hypercalcemia

- medullary sponge kidney

What is medullary sponge kidney?

accumulation of calcium within abnormally dilated collecting ducts located within the medulla

Sono findings of medullary sponge kidney

highly echogenic renal pyramids that may shadow

Nephrocalcinosis might be caused by (3)

- hyperparathyroidism

- AIDS

- malignancy

Sono findings of nephrocalcinosis

small calculi in cortex

Define: most common benign renal tumor (2)

angiomyolipoma/renal hamartoma

Angiomyolipoma consists of..

vessels, muscle, fat

Angiomyolipomas are usually uni or bilat?

unilateral

Are angiomyolipomas usually symptomatic or asymptomatic?

only symptomatic with hemorrhage

What pathology causes multiple bilateral angiomyolipomas?

tuberous sclerosis

Sono findings of angiomyolipomas

- solid hyperechoic mass

- might shadow due to fat

What is the second most common renal mass?

onocytoma

Onocytoma is often found in males or females of what age?

males in their 60s

Sono findings of onocytoma

stellate central scar

Onocytoma is difficult to differentiate from ___ due to central scar

RCC

Hemangiomas consist of ___ and are asymptomatic unless ___ occurs

blood vessels; hemorrhage

Define: asymptomatic, benign, fatty tumor of the kidney

renal lipoma

Renal lipomas are mostly in males or females?

females

Define: benign, vascular, hyperechoic renal mass with internal calcifications

renal adenoma

What can result from blunt trauma to kidney, surgery/biopsy of kidney, and lithotripsy?

renal hematoma

What is a hematoma?

localized collection of blood

Renal hematomas may have a fracture. How will this appear?

linear anechoic region

Acute appearance of a hematoma

anechoic, then hyperechoic, then a focal tumor, then anechoic again

Chronic appearance of a hematoma

may calcify and shadow

Renal cell carcinoma is also called (2)

- hypernephroma

- adenocarcinoma

6 risk factors of RCC

- smoking

- hypertension

- obesity

- tuberous sclerosis

- von hippel lindau

- acquired renal cystic disease

RCC tumor may invade..

renal vein and IVC

This type of cancer is most often found in the renal pelvis

renal transitional cell carcinoma (TCC)

Sono findings of renal TCC

- hypoechoic/isoechoic mass in sinus

- hydronephrosis

Metastases to the kidney are most often from the ___

lungs or breast

Nutcracker syndrome is the compression of ..

the LEFT renal vein between the SMA and abdominal aorta

What is another name for nutcracker syndrome?

renal vein entrapment

With nutcracker syndrome, the left renal vein will reveal ___ with doppler evaluation

elevated pressure

What will be in a urinalysis of a patient with nutcracker syndrome?

- hematuria

- proteinuria

Nutcracker syndrome will display which symptoms in females vs males?

females - pelvic congestion syndrome

males - left testicle pain, left varicocele

What is the most common cause of renal artery stenosis (RAS)?

atherosclerosis

Who is at risk for RAS? (4)

- smokers

- diabetics

- high cholesterol

- hypertension that does not respond to treatment

In young female patients with RAS, what may be the cause?

fibromuscular disease

RAS can lead to ___

infarction

Sono findings of RAS (3)

- thickening and calcification of renal artery

- renal to aorta ratio above 3.5

- tardus parvus waveform

What might cause renal vein thrombosis? 4

- renal tumors

- trauma

- post renal transplant

-Renal infection

Sono findings of renal vein thrombosis (3)

- heterogenous, enlarged kidney

- enlarged renal vein

- absent doppler

What is the BEST indicator of renal transplant rejection?

renal biopsy

Transplanted kidney is aka

allograft

Donor's renal artery and vein are anastomosed to..

recipient external iliac artery and vein

What is considered normal in a transplant kidney that usually wouldn't be?

mild pelviectasis - when the urine collects in the pelvis

What post renal transplant fluid collections are common?

- lymphocele

- urinoma - a collection of urine outside of bladder

- hematoma

- abscess

Normal RI in a transplant kidney renal artery vs abnormal

normal 0.6 - 0.8

abnormal greater than 0.9

What is the most common vascular complication post-transplant?

RAS

RAS in a transplant kidney is diagnosed at a PSV greater than ___

200-250 cm/s

What is the most common cause of congenital hydronephrosis?

UPJ obstruction (ureteropelvic obstruction)

What are other causes of congenital hydronephrosis?

- vesicoureteral reflux (VUR)

- posterior urethral valves (PUV)

- prune belly syndrome

Define: folds of excessive urethral tissue in males that causes dilation of bladder, ureters, and renal collecting systems

posterior urethral valves (PUV)

Define: abdominal wall musculature is stretched by an extremely dilated bladder, mostly in males

prune belly syndrome

aka eagle-barret syndrome

What is the triad for prune belly syndrome diagnosis?

1. absent abdominal musculature

2. undescended testis

3. urinary tract abnormalities

Define: retrograde flow of urine from bladder to ureter, can result in kidney infections and scarring

vesicouretral reflux (VUR)

VUR is most commonly caused by what?

an abnormal angle of insertion of the distal ureter into the bladder, resulting in a faulty valve

Who is at a higher risk for VUR?

- duplicated pelvicaliceal systems

- complete ureter duplication

What is the Weigert-Meyer rule?

in patients with urinary duplications, the upper pole is prone to obstruction while the lower pole is prone to reflux

In patients with urinary duplications, the upper pole is prone to obstruction which leads to...

obstructing ureterocele

What is a better way to image VUR? (2 ways)

- voiding cystourethrogram

- nuclear cystogram

What are 3 treatment options for VUR?

- antibiotics

- surgery

- STING injections

Define using BOTH NAMES: most common malignant abdominal mass in pediatric patients

Wilms Tumor aka nephroblastoma

What syndrome is at a high risk for Wilms tumor?

Beckwith-Wiedemann

Sono findings of Wilms tumor

solid, large, echogenic mass with hypoechoic areas

Is the bladder intra or retroperitoneal?

retroperitoneal

The urethra begins at the ___ of the bladder and ends at the ___

trigone; urethral orifice

Define: remnant of embryonic development, tubular structure that extends from the umbilicus to the apex of the bladder

urachus

Failure of urachus to close in utero can result in (4)

- patent urachus/urachal fistula

- urachal sinus

- urachal cyst

- urachal diverticulum

The ureters enter the bladder ___

posteriorly

Define: cystic dilation of the ureter as it enters the bladder

ureterocele

What may result due to ureterocele, causing infection and stone formation?

urinary stasis

Define: congenitally enlarged ureter

megaureter

Define: enlarged ureter due to reflux or obstruction

hydroureter

What muscle controls the emptying of the bladder?

detrusor muscle

Thickened bladder wall measures ___ while distended

greater than 4 mm

Define: poorly functioning bladder secondary to neurological disorder, detrusor muscle does not work properly

neurogenic bladder

Sono findings of neurogenic bladder (3)

- thickened bladder wall and trabeculae

- urinary retention

- distended bladder but no urgency

Define: outpouching in the bladder wall, seen with a visible neck

bladder diverticulum

Bladder diverticulum may be associated with (2)

- urethral obstruction

- congenital

Define: inflammation of the bladder

cystitis

Is cystitis more common in men or women? Why?

women due to shorter urethra

Sono findings of cystitis (3)

- hypoechoic wall

- focally or diffusely thickened wall

- may contain echogenic material

Chronic cystitis can lead to ___

scarring and trabeculation of bladder wall