URINARY SYSTEM

school notes

renal artery is _____ and ______ to the renal vein

posterior and superior

what is the layer of connective tissue encapsulating the kidneys and perinephric fat

gerota fascia

what is the process of urine formation

• glomerular filtration

• tubular reabsorption

• tubular secretion

the left renal vein travels

anterior to the aorta

the right renal artery travels

posterior to the ivc

what is this

column of bertin

• invaginations of the cortex between the medullae

what is this

junctional parenchymal defect

what is this

sinus lipomatosis'

• deposition of a moderate amount of fat in the renal sinus

extrarenal pelvis

• cystic area that extends beyond the renal borders

horseshoe kidney

• lower poles of kidneys are fused

• isthmus over aorta in trv plane

cross-fused ectopia

• one kidney displaced across midline and the other fused to the other normally positioned kidney

duplex kidney

complete duplication of collecting system

• two distinct renal sinuses

parapelvic cysts

cysts located in the renal sinus

• do not communicate with collecting system

renal cysts associated with renal neoplasms

• von Hippel-Lindau

  • several areas, abdominal cysts

• Tuberous Sclerosis

  • multiple renal cysts/AMLs

  • mental retardation, seizures

Polycystic Kidney disease types

• ARPKD (recessive)

  • infantile, rare

• ADPKD (dominant)

  • adult, common

Autosomal Recessive polycystic kdiney disease (ARPKD)

• dilation of renal collecting tubules causes renal failure

• can be seen in utero (perinatal)

• juvenile

  • hypertension

  • renal insufficiency

  • nephromegaly

  • periportal fibrosis

sono of ARPKD

• symmetrically enlarged kidneys

• microscopic kidneys

• diffuse echogenicity

• poor cortico-medullary differentiation

what are the s/s of autosomal dominant polycystic kidney disease (ADPKD)

• pain

• hypertension/headache

• palpable mass

• hematuria

• UTI

• renal insufficiency

what is the sono of ADPKD

• bilateral

• enlarged kidneys with multiple macroscopic asymmetrical cysts

what is multicystic dysplastic kidney (MCDK)

• common, nonhereditary

• caused by early in utero urinary tract obstruction

• bilateral in incompatible with life

• large mass at birth

complications of MCDK

• hypertension

• hematuria

• infection

• flank pain

what is sono of MCKD

contralateral UPJ obstruction, nonfunctioning kidney, UNILATERAL

• neonates/children

  • multicystic (bunch of grapes)

  • absence of renal parenchyma, renal sinus, atretic renal artery

• adults

  • small atrophic/calcified kidney, echogenic

what is medullary sponge kidney (MSK)

occurs in medullary pyramids

• dilation of distal collecting ducts, causing stasis of urine and stone formation.

• may be unilateral or segmental

what are the s/s of medullary sponge kidney

• asymptomatic. or

• hematuria, infection, renal stones

what is this

medullary sponge kidney

suspicious cysts look like

• thick walls > 1cm

• irregular walls

• septations

• calcifications

• vascularity in septa/wall

what is the most common renal neoplasm

RCC

• aka: Grawitz tumour, hypernephroma

what is the s/s of RCC

• twice as common in men in their 60/70s

• nonspecific s/s

  • hematuria, flank pain, palpable mass

what is sono of RCC

• solid

• most are isoechoic

• the larger the more heterogenous

• < 3cm they are usually hyperechoic (can look like AML)

• hypo rim, intramural calcifications

• invades IVC and renal veins

• peripheral vascularity “basket sign”

what comprises most of the malignancies that involve the renal pelvis, ureter, and bladder

TCC

what are the two types of TCC

• Papillary

  • more common

• Flat

  • smaller TCCs tend to be these

s/s of TCC

• gross or macroscopia hematuria

• flank pain

sono of TCC

• hypo mass in collecting system

• low vascularity

• may invade adjacent renal parenchyma

what is squamous cell carcinoma

rare, highly invasive tumour

• hx of chronic irritation and gross hematuria

• palpable kidney secondary to severe hydronephrosis

sono of squamous cell carcinoma

• large mass is evident in renal pelvis

• obstruction from kidney stones

renal lymphoma

secondary is more common

• bilateral invasion with multiple nodules

sono of renal lymphoma

• enlarged, hypo kidneys

• may simulate renal cyst without enhancement

• very hypo, poorly defined margins

  • can be confused fro cyst

what is the m/c malignant renal tumour in pediatric pts

Wilms tumour (Nephroblastoma)

what is s/s of nephroblastoma (wilms)

• palpable mass

• non specific

  • pain, fever, malaise, weight loss, hematuria, hypertension

what is sono of wilms tumour

• large, well circumscribed

• homogenous

• anechoic/cystic spaces

• can invade LNs, renal veins, IVC

what is the most common benign renal tumour

angiomyolipoma

what are angiomyolipomas highly associated with

tuberous sclerosis

sono of renal adenomatous tumours

may be indistinguishable from RCC

• solid

• hyper to hypo

• hypo vascular

sono of oncocytoma

extremely difficult to differentiate from RCC

• hypoechoic in 50% of cases

• spoke wheel with central scar

what is this

lipoma

what is acute glomerulonephritis

• necrosis or proliferation occur in glomeruli

• enlarged poorly functioning kidneys

• suspected when echogenicity of renal parenchyma exceeds that of liver

s/s of acute glomerulonephritis

• nephrotic syndrome

  • massive protein uria

  • hypoalbuminea

• hypertension

• anemia

• peripheral edema

what is acute interstitial nephritis associated with

infectious diseases

• scarlet fever, diphtheria

sono of acute interstitial nephritis

• enlarged mottles kidneys

• increased renal cortical echogenicty

what is lupus nephritis

• connective tissue disorder

• affects women 20-40 more

s/s

• hematuria, proteinuria, hypertension, RV thrombosis, renal insufficiency

sono of lupus nephritis

increased cortical echogenicity

renal atrophy

what does aids of kidney appear as

echogenic, enlarged kidneys

acute renal failure

• can be caused by hypoperfusion of kidney

• parenchymal disease, trhombosis, outflow obstruction

• malignancy of bladder, prostate, uterus, ovaries, rectum

what is the most common renal disease to produce acute renal failure

acute tubular necrosis

what is the sono of acute tubular necrosis

bilaterally enlarged kidneys, hyperechoic pyramids

• can appear as nephrocalcinosis

what is chronic renal disease

loss of renal fucntion as a result of disease

• glomerulonephritis, chronic pyelonephritis, renal vascular disease, diabetes

sono of chronic renal disease

• diffuse echogenic kidney with loss of normal anaotmy

• nonspecific

Hydronephrosis common causes

• UPJ obstruction (m/c)

• UVJ/ distal urethral obstruction (by bladder)

• duplication of the collecting system

what are s/s of hydronephrosis

• renal insufficiency

• low urine output

• hypertension

sono of hydronephrosis

• fluid-filled renal collecting system

• thin parenchyma

• hydroureter decrease

• absent jets

highr RI > 0.7 suggests acute urinary obstruction

pyonephrosis

pus within collecting system

• usually secondary to long standing ureteral obstruction from calculus

shows low level echoes with a fluid-debris level

emphysematous pyelonephritis

• when air is in parenchyma

• may be caused by E.coli

• diabetic pts

enlarged hypoechoic and inflamed kidneys

nephrocalcinosis

deposit of calcium in kidney

• both kidneys affected

• focal increases i echogenicity in renal pyramids

• can be seen in medulla and cortex

renal artery stenosis

> 180cm/s PSV

• absence of early systolic peak

• tardus parvus waveform

if a urolithiasis causes obstruction ______ will be seen

hydronephrosis

what is the m/c bladder tumour

TCC

s/s of bladder tcc

• gross hematuria

• dysuria

• urinary frequency or urgency

what is this

bladder diverticulum