Renal Pathology US
Terms
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- When localizing for a kidney biopsy, the needle should be directed
- lateral aspect of the lower pole 10 degrees cephalad
- Common sonographic features of acute medical renal disease include:
- increased renal cortical echogenicity, accentuated coticomedually defintion, and increased renal size
- severe reduction in glomerular filtration rate
- acute renal failure
- severe reduction in glomerular filtration rate by certatin etiologic factors such as:
- bilateral renal artery occlusion; bilateral renal v. thrombosis; heart failure; hypotension; septicemia; acute tubular necrosis; urinary tract obstruction; interstial nephritis
- Once ARF has been established as the diagnosis, sonographys role is to evaluate for
- hydronephrosis
- The most common cause of acute renal failure
- acute tubular necrosis
-
may result from a variety of processes including toxic and ischemic insults leading to widespread tubular epithelial cell damage; can be reversible
- acute tubular necrosis
- Sonographic findings associated with ATN are:
- an enlarged renal transplant and increased resistive index
- dilation of the pelvicalyceal collecting system caused by obstruction
- hydronephrosis
- The term _____ is used when there is non obstructive dilation of the collecting system
- pelvocaliectasis
- False positive dianoses of obstruction result from numerous causes:
- overhydration, overly full bladder, diuretics, large extrarenal pelvis, prominent hilar vessels and peripelvic cysts
- obstructive nephropathy is diagnosed using a threshold resistivity index of
- greater than .7
- Determining obstrution is only relevant in ____obstruction
- acute
- A Common congenital anomaly. A contralaterl multicystic dysplastic kidney is associated with this.
- Ureteropelvic Junction obstruction
- the most common site for obstruction. Renal calculi are the most common of obstructions with acute flank pain
- uterovesicle junction
- usually associated with partial or complete ureteral duplication and obstruction of the pole collecting system
- ectopic uretocele
- caused by an aperistalic distal uretal segment can cause functional obstruction. Typically the lower ureter is dilated, but ureteric dilation can exted all the way to calyces
- primary megaureter
- the apex of the bladder points ____and is connected to the umbilicus by the ________
- anteriorly; median umbilical ligament
- most common primary bladder neoplasm
- transitional cell carcinoma
- benign but premalignant tumors that have a sonographic appearance identical to early TCC
- bladder papilloma
- primary bladder neoplasm that is associated with chronic infection, stones, or strictures. There is a high incidence of this following schistomsomiasis.
- Squamous Cell Carcinoma
- acutely there is diffuse or focal bladder wall thickening
- cystitis
- cystic dilation of the urachus which is a fibrous cord extending from the umbilicus to the vertex of the bladder. Sonographically seen as a cystic structure superior and anterior to the bladder
- urachal cysts
- bladder wall thickening and trabeculation occur with any type of bladder outlet obstruction.
- bladder outlet obstruction
- the following are causes of bladder outlet obstruction
-
prostate carcinoma
TCC
BPH
Neurogenic bladder dysfunction
ectopic ureteroceles
bladder stones
blood clots - 50% of ppl over age 50 years old have _______cysts
- simple
- A simple cyst includes:
-
enhancement
absence of internal echoes
sharply defined far wall
thin wall thickness
round or ovoid shape - Most renal cysts are ___and do not communicate with the collecting system
- simple cortical cysts
- arise from the renal pelvis, infundibula or calyces but have the ultrasound appearacnce of simple cysts
- pyelogenic
- ______are parenchymal cysts that bulge into the central sinus of the kidney which may cause symptoms and can be mistaken on sonograms for hydronephrosis
- parapelvic cysts
- ___-are lymphatic cysts in the central sinus; these have an identical appearance and cannot be distinguised from parapelvic cysts
- peripelvic
- a ____may mimic a simple cyst.
- renal pseudoaneurysm
- originate from uriniferous tubules
- simple cysts
- calyceal diverticula
- pyelogenic
- parenchymal
- parapelvic
- lymphatic cysts
- peripelvic
- cysts with a single thin septation, minimal wall calcification internal echoes caused by artifact or hemmorage or lobulated shapes
- atypical renal cysts
- Atypical renal cysts contain:
-
multiple thick septaions
irregular walls
large solid components - autosomal dominant (adult) usually presents as bilateral renal enlargement caused by numerous cysts of varying sizes
- APKD
- Assosicated findings in APKD include
- liver pancreas, and spleen. Advanced stages lead to renal failure
- autosomal recessive associated with marked renal dysfunction and lung hypoplasia incomplatible with normal life. THis disease may be detected with oligodydramnios.
- Infanitile Polycystic Kidney Disease
- Presents later with symptoms related to coexistent heptabiliary dysfunction
- infantile PKD
- IPKD is associated with
- periportal hepatic fibrosis
- ADULT POLYCYSTIC KIDNEY DISEASE is associated with ______
- Berry aneurysm
- abdominal mass in the newborn. result of atresia of the ureteropelvic junction during fetal development (8-10 weeks)
- multicystic dysplastic kidney (potter type II)
- MCDK can be ____or ____
- unilateral or bilateral
- Ultrasound is used to distinguish MCDK from _____
- hydronephrosis
- The sonographic findings of MCDK are:
-
-cysts of varying shape and size
-absence of communication between cysts
-absence of renal sinus
-absence of renal parenchyma - dysplastic cystic dilatation of medullary portions of collecting ducts
- medullary sponge kidney
- up to 80% of patients on chronic hemodialysis will develop multiple small cysts within the native kidneys
- acquired cystic disease
- Between ___and ___% of these patients develep renal neoplasms with acquired cystic disease
- 8% and 20%
- multisystemic disorder associated with renal cyst formation and multiple renal angiomyolipomas.
- tuberous sclerosis
- patients present clinically with mental retardation, seizures, and cutaneous lesions
- tuberous sclerosis
- renal cell carcinoma is also known as
-
hypernephroma adenocarinoma
- most common solid renal mass in the adult.
- renal cell carcinoma
- ___is recommended in most cases for renal cell carcinoma
- nephrectomy
- There is a high incidence of RCC in patients with ______
- von hippel lindau syndrome
- There is also a high incidence of RCC in patients with
- acquired cystic kidney disease undergoing dialysis
- a slightly increased incidence of ___is reported in autosomal dominant polycystic kidney disease, tuberous sclerosis, and other disease and syndromes associated wtih multiple renal cysts
- RCC
- Increased incidence of RCC Ca associated with:
-
von Hippel-Lindau syndrome
Acquired cystic kidney disease
Polycystic kidney disease
tuberous sclerosis - Sonographically, ____ is usually a unilateral encapsulated solid mass that is hypo or isoechoic relative to normal adjacent renal parenchyma.
- RCC
- RCC vascularity appears as a ____ waveform or high systolic and high diastolic arterial flow (arterio-venous shunt pattern)
- low resistance
- Most solid masses should be considered malignant because RCC's constitute ___ to ___ of adult renal neoplasms
- 80% to 85%
- ONe exception with RCC is that of a homogenous highly echogenic mass, which is more likely to be an ____
- angiomylipoma
- Whenever a solid renal mass is detected, RCC should be suspected and other areas of evaluation should include the:
-
-ipsilateral renal vein
-inferior vena cava
-contralateral kidney and renal v
-retroperitoneum
-liver - also known as renal hamartoma..are highly echogenic benign tumors; occur in patients with tuberous sclerosis
- angiomyolipomas
- angiomylipomas appear as
- homogenous hyperechoic renal mass
- AN angiomylipoma's echogenicity is greater than or equal to the ____
- renal sinus fat
- considered the benign (
- renal adenoma
- an adenoma of greater than 3cm should be considered
- malignant
- by definition, adenomas lack ___features and do not ____
- invasive ; metastisize
- Sonographically adenomas are ____or ____ relative to adjacent renal parenchyma
- hypochoic or isoechoic
- over 90% of malignancies that involve the renal pelvis and ureter are
- Transitional cell carcinoma
- The majority of TCC's arise in the
- bladder
- benign counterpart of TCC, and tend to be smooth and more rounded than TCCs but have a high risk of later developing into TCC's.
- papilloma
- rare neoplasm with imaging features similar to but more invasive than TCC. Both TCC and SCC are more commonly detected with intravenous urography or CT than with US
- squamous cell carcinoma
- tend to occur late in the course of disease and most commonly result from primary tumors from the contralateral kidney, lung, colon, skin, head, and neck, breast and uterus
- renal metastases
- usually present as multiple poorly marginated hypoechoic masses. ; may produce an enlarged, inhomogenous kidney without discrete masses
- renal metastases
- results from hematogenous spread
- renal lymphoma
- The ___is a common site of metastatic lymphoma
- kidney
- _____lymphoma involves the kidneys much more commonly than ____disease
- non hodgkins; hodgkins
- Sonographically, ____usually enlarged kidneys with multiple bilateral hypoechoic renal masses
- renal lymphoma
- Occasionally lymphomatous masses may produce ______
- posterior acoustic enhancement
- similar to lymphoma, may cause diffuse enlargement of the kidney; there is usually symmetric bilateral enlargement of the kidneys
- renal leukemia.
- also known as nephroblastoma; malignant tumor that rises from immature renal cells (the childhood equivalent of RCC)
- wilms tumor
- most common solid renal tumor in childhood
- wilms tumor
- In Wilms tumor, majority of patiens are less that __and present with a large asymptomatic flank mass
- 3
- The ____ and ____ should be evaluated for tumor extension.
- IVC and renal V
- Metastasis is common to the :
- lungs liver bones, lymph nodes, adrenals, and retroperitoneum
- Most renal lymphoma results from
- hematogenous spread
- episodic renal infections
- acute pyeloonephritis
- most renal infections occur via an
- ascending route
- Ultrasound findings for a renal infection is:
-
-usually normal appearing kidneys
-renal enlargement
-hypoechoic parenchyma
-compressed sinus due to edema
-absence of sinus echoes in severe infection - presents as a focal wedge shaped area of decreased echogenicity involving a renal lobe
- acute focal bacterial nephritis
- most common in diabetes immunosuppressed patients or patients with urinary tract obstruction.
- emphysematous pylonephritis
- a progressive disorder in which renal scarring is associated with pathologic involvement of the calyces and pelvis; appears as small echogenic kidney
- chronic pyelonephritis
- a type of chronic pyelonephritis. The most common predisposing fators are chronic infection and obstruction of the UPJ from a stagehorn calculus
- xanthogranulomatuous pyelonephritis
- usually the end result of acute bacterial nephritis
- renal abscess
- Ultrasound findings include of renal abscess:
-
debris and fluid filled cystic parenchymal mass
acoustic enhancement - Renal abscess ultrasound findings include:
-
debris and fluid filled cystic parenchymal mass
acoustic enhancement
irregular margins
hyperechoic mass from gas producing organisms - this term has been used to describe multiple small intrarenal abscesses
- renal carbuncle
- purulent material in collecting system almost invariably occurs in patients with renal obstruction.
- pyonephrosis
- The number one indicator of renal parenchyma disease is
- increased echogenicity
- transplant patients; IV drug users; diabetics, those with indwelling catheters, malignancies are at risk for:
- fungal infections
- most common fungal infection
- candida albicans
- most common parasitic kidney infection; worms penetrate skin, find their way to bladder where females lay eggs in bladder
- schistosomiasis
- cyst with daughter cyst, usually solitary; found on poles of kidney;
- echinococcus
- most common in diabetic patients; echogenic foci with dirty shadowing in bladder; gas is present
- emphysematous cystitis
- major injury may find some
- renal failure
- blood found between renal cortex and capsule, renal contour is altered and flat
- subcapsular hematoma
- most common cause of chronic renal failure
- diabetic nephropathy
- most common cause of acute reversible renal failure; causes are hypotension, dehydration, drugs,;
- acute tubular necrosis
- disease affecting the glomerulus; hematuria, hypertension; associated with systemic diseases; may increase size of kidney,cortex echo
- acute glomerulonephritis
-
progession of disease
size decreases
echogenic kidney, smooth - chronic glomerulonephritis
-
irreversible
small shrunken kidneys (echogenic)
leads to transplants or dialysis - chronic failure
-
-tissue outside the uterus
-bladder endometriosis can occur
-appear as a cyst, solid or complex lesion on sono, must be scoped
- endometriosis
-
-connective tissue disorder
-leading cause of death is renal dz
-increased echog. size of kidney varies
-
- systemic lupus erthematousus
- Dialysis patients develop ____and renal ____
- cysts and tumors
-
-chronic inflammation of wall of bladder
-pt has voiding symptoms
-usually females middle aged
-thick walled bladder, with small amt. of urine all pt can tolerate
-thick wall obstruct ureter - interstitial cystitis
-
most common benign tumor
benign counterpt. of RCC - adenoma
-
may be found in kidney, adrenal, thyroid parathyroid, and salivary glands
looks like RCC
very small percent of renal tumors - oncocytoma
-
fat, muscle cells and blood vessel tumor
If small asymptomatic, if large may hemorrhage - angiomylolipoma/hamartoma
-
fatty tissue
hyperechoic - lipoma
-
solid hyperechoic mass found in retroperitoneum
rare - leomyoma
- rare; benign; capillary more common than cavernous ; small hyperechoic lesions; pt has unexplainable hematuria
- hemangioma
- echogenic medulla mass/ rare to be in cortex; rare; benign
- fibroma
- benign; rare; hyperechoic mass, small, hypovascular, found near corticomedullary junction; produce renin; mass causes hypertension
- juxtaglomerular tumor
- most common neonatal neoplasm
- mesoblastic nephroma; fetal hamartoma, congenital wilms tumor
- rare, beign, solid with calcifications
- carciniod tumor
- 86% of primary malignant renal tumors
- RCC
- most common intraabdominal malignant tumor in children (2-5 years); bulky solid; hyperechoic and homogeneous; can be bilateral; but rarely; mets usually
- wilms
- renal sinus is involved in kidney; can have hydro; if in ureter, usually in lower third, hematuria, dysuria; solid mass;
- transitional cell
- less common than TCC; rare; if in bladder, large solid mass;
- squamous cell
- rare, solid mass, assoc. with stones; malignant
- squamous cell
- associated with stones, echo texture destroyed; malignant
- kidney
- Potter type II is the most common cause of abdominal mass in the newborn and is also called
- infantile polycystic disease
- patients with polycystic kidney disease, acquired cystic kidney disease, von hippel landau syndrom and tuberous schlerosis have an increased incidence of
- renal cell carcinoma
- ovre 90% of malignancies involving the bladder, ureter, and renal pelvis are
- transitional cell carcinoma
- the benign counterpart of renal cell carcinoma usually less than 3 cm is called
- adenoma
- another name for hamartoma
- angiomyolipoma
- the benign counterpart of transitional cell carcinomas are
- papilloma
- presents as a hypoechoic wedge shaped area involving a renal lobe
- acute focal bacterial nephritis
- most common cause of acute reversible renal failure is
- ATN
- the most common cause of chronic renal failure is
- diabetic nephropathy
- acute pyelonephritis can be sonographically characterized by
-
-absence of sinus echoes in sever infection
-parechymal change
-compressed sinus due to edema - most common benign tumor of kidney is
- adenoma
- chronic inflammation of the bladder wall leading to patient having trouble tolerating much urine buildup in the bladder. The patient has voiding symptoms and is usually a middle aged female
- interstitial cystitis
- when calcium deposits result in echogenic medullary pyramids without posterior acoustic shadowing
- medullary sponge kidney
- patients who present clinically with mental retardation, seizures and skin lesions and have multiple angiomyolipomas
- tuberous sclerosis
- when fluid/debris levels are found in a dialted renal collecting system, patient has increased white count:
- pyelonephritis
- describes multiple small intrarenal abscesses
- carbuncle
- if an obstruction involves a blockage at the junction of the distal ureter and bladder this is called
- UVJ obstruction
- When a cystic kidney structure lies just outside the hilum of the kidney where the vessels exit the kidney, no flow is found within and no hydronephrosis is seen, this most likely represents
- extrarenal pelvis
- the main criteria one must decide when separating hydronephrosis vs renal cystic diseases is
- ecommunication will or will not occur between the fluid collections
- ureteroceles are found
- at the ureterovesicale junction
- The most common cause of distal ureteral obstruction
- stones
- in cases of primary megaureter, which segment is typically dilated:
- distal
- urachal cysts are usually found:
- superior, anterior to bladder
-
signs of bladder outlet obstruction include all except :
smooth thin bladder wall
trabeculations
bladder wall thickening
distended bladder - smooth thin bladder wall
- parapelvic cysts are located in the
- renal hilum
- a cause of nonobstructive hydronephrosis is
- overhydration
- a cyst like enlargement of the distal end of the ureter is called
- ureterocele
- sonographic appearance of chronic pyelonephritis
- inability to distinguish the cortex from medullary
- a renal sonogram is performed. The finding of hypoechoic areas adjacent to the renal sinus is most consistant with
- renal pyramid
- dilatation of the renal pelvis with thinning of the renal cortex is characteristic of
- hydronephrosis
- renal v. thrombosis may be seen in pts. with
- rcc
- a triangular shaped lesion on the perpherial border of the kidney most likely represents
- junctional parenchymal defect
- left renal v courses
- anterior to aorta
- rcc commonly invades the IVC via the
- renal v
- an extremely large echogenic renal sinus that appears to engulf the entire real parenchymal outline suggests
- lipomatosis
- the differential consideration of pseudohydronephrosis can be made if the
- bladder is too full
- benign fatty tumor of kidney
- angiomyolipoma
- hydronephoris may be best demonstrated sonographically by which of the following pattern
- fluid filled pelvocaliceal collecting system
- describes a bladdr diverticulum
- herniation of bladder wall
- a congenital obstruction found in utero as well as in infants is
- uteropelvic junction obstruction
- parapelvic cysts are located in
- renal hilum
- a cystlike enlargement of the distal end of the ureter is called
- ureterocele
- appearance of chronic pyelonephritis
- inability to distinguish the cortex from medullary regions
- a dilated renal pelvis without ureteral dilation is seen in patients with
- upj
- renal vein thrombosis may be visualized in patients with
- rcc
- an extremely large echogenic renal sinus that appears to engulf the entire renal parenchymal outline suggests:
- lipomatosis
- Potter Type II is also called
- multicystic dysplastic disease
- Patients with polycystic kidney disease, acquired cystic kidney disease, von hippel landau syndrome and tuberous sclerosis have an increased chance of
- rcc
- over 90% of malignancies involving the bladder, ureter, and renal pelvis are
- transitional cell carcinoma
- benign counterpart of rcc is
- adenoma
- another name for renal hamartoma
- angiomyolipoma
- most common cause of acute reversible renal failure
- ATN
- acute pyelonephritis can be sonographically charactized by all except
- small renal size
- when calcium deposits result in echogenic medually pyramids without posterior acoustic shadowing
- medullary sponge kidney
- if an obstruction involves a blockage at the junction of the distal ureter
- uvj
- when a cystic structure lies just outside the hilum of the kidney where the vessels exit the kidney, no flow is found within, and no hydronephrosis is seen this is
- extrarenal pelvis
- urachal cysts are mostly found
- superior anterior to bladder
-
signs of bladder outlet obstruction include all except
trabeculations
bladder wall thickening
distended bladder
smooth thin bladder wall - smooth thin bladder wall