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Questions and Answers
What characterizes the kidneys in a patient with chronic renal failure?
What characterizes the kidneys in a patient with chronic renal failure?
- Normal-sized and echogenic kidneys
- Small and echogenic kidneys (correct)
- Large and hypoechoic kidneys
- Hyperdense and enlarged kidneys
Which treatment is considered the first choice for patients with end-stage renal disease?
Which treatment is considered the first choice for patients with end-stage renal disease?
- Hemodialysis
- Renal transplantation (correct)
- Medication management
- Peritoneal dialysis
What common complication can arise in patients with chronic kidney disease receiving hemodialysis?
What common complication can arise in patients with chronic kidney disease receiving hemodialysis?
- Bilateral renal artery stenosis
- Nephrolithiasis
- Acquired cystic disease (correct)
- Acute renal failure
What is the most common underlying cause of renal disease leading to kidney transplantation?
What is the most common underlying cause of renal disease leading to kidney transplantation?
What is a potential cause of poor function in a transplanted kidney shortly after surgery?
What is a potential cause of poor function in a transplanted kidney shortly after surgery?
What is the main function of the kidneys in the urinary system?
What is the main function of the kidneys in the urinary system?
Which kidney is typically positioned more inferiorly than the other?
Which kidney is typically positioned more inferiorly than the other?
Which embryonic structure gives rise to the permanent kidney?
Which embryonic structure gives rise to the permanent kidney?
What is the approximate size of a normal kidney?
What is the approximate size of a normal kidney?
What is the primary role of the ureters?
What is the primary role of the ureters?
Which layer surrounds the kidneys and provides cushioning?
Which layer surrounds the kidneys and provides cushioning?
What is the anatomical position of the left kidney relative to the pancreas?
What is the anatomical position of the left kidney relative to the pancreas?
During the 4th week of development, which embryonic structure does not function?
During the 4th week of development, which embryonic structure does not function?
What characteristic of the area affected by renal infarction can be observed within 24 hours following arterial occlusion?
What characteristic of the area affected by renal infarction can be observed within 24 hours following arterial occlusion?
Which condition is characterized by the bacterial invasion of renal parenchyma?
Which condition is characterized by the bacterial invasion of renal parenchyma?
Which imaging findings are typically associated with acute pyelonephritis?
Which imaging findings are typically associated with acute pyelonephritis?
What is a common route through which most renal infections occur?
What is a common route through which most renal infections occur?
What defines acute focal bacterial nephritis?
What defines acute focal bacterial nephritis?
In which patient demographic is emphysematous pyelonephritis more commonly observed?
In which patient demographic is emphysematous pyelonephritis more commonly observed?
What artifact can be produced by anaerobic bacteria in emphysematous pyelonephritis?
What artifact can be produced by anaerobic bacteria in emphysematous pyelonephritis?
What is the typical imaging appearance of a kidney affected by emphysematous pyelonephritis?
What is the typical imaging appearance of a kidney affected by emphysematous pyelonephritis?
What does the junctional parenchymal defect appear as on an ultrasound?
What does the junctional parenchymal defect appear as on an ultrasound?
What is the characteristic appearance of the hypertrophic column of Bertin on an ultrasound?
What is the characteristic appearance of the hypertrophic column of Bertin on an ultrasound?
Which of the following best describes an extrarenal pelvis as seen on an ultrasound?
Which of the following best describes an extrarenal pelvis as seen on an ultrasound?
What is the significance of analyzing urea nitrogen, creatinine, and uric acid levels in a patient?
What is the significance of analyzing urea nitrogen, creatinine, and uric acid levels in a patient?
How is serum creatinine produced in the body?
How is serum creatinine produced in the body?
Which structures are best visualized in the transverse plane during kidney ultrasound?
Which structures are best visualized in the transverse plane during kidney ultrasound?
What condition is indicated by the presence of a hypoechoic renal pyramid on an ultrasound?
What condition is indicated by the presence of a hypoechoic renal pyramid on an ultrasound?
What is the normal serum creatinine threshold level for healthy individuals?
What is the normal serum creatinine threshold level for healthy individuals?
What sonographic finding is indicative of acute transplant rejection?
What sonographic finding is indicative of acute transplant rejection?
Which resistive index (RI) value indicates transplant dysfunction?
Which resistive index (RI) value indicates transplant dysfunction?
What is a common symptom of renal artery stenosis?
What is a common symptom of renal artery stenosis?
What is a characteristic finding in renal artery thrombosis on ultrasound?
What is a characteristic finding in renal artery thrombosis on ultrasound?
What condition is associated with the presence of abdominal mass in neonates?
What condition is associated with the presence of abdominal mass in neonates?
Which of the following findings is typically associated with renal vein thrombosis?
Which of the following findings is typically associated with renal vein thrombosis?
What does the presence of parvus tardus waveform indicate?
What does the presence of parvus tardus waveform indicate?
What post-operative fluid collection can occur within 24 hours?
What post-operative fluid collection can occur within 24 hours?
What is the primary cause of chronic pyelonephritis?
What is the primary cause of chronic pyelonephritis?
What is a common sonographic finding in chronic pyelonephritis?
What is a common sonographic finding in chronic pyelonephritis?
Which condition is characterized by purulent material in the collecting system?
Which condition is characterized by purulent material in the collecting system?
What is a rare form of chronic pyelonephritis associated with chronic infections?
What is a rare form of chronic pyelonephritis associated with chronic infections?
What does a fungal ball typically appear as on imaging?
What does a fungal ball typically appear as on imaging?
What is required to treat pyonephrosis?
What is required to treat pyonephrosis?
Which of the following is NOT a typical sonographic finding in xanthogranulomatous pyelonephritis?
Which of the following is NOT a typical sonographic finding in xanthogranulomatous pyelonephritis?
What condition can cause elevated liver enzymes, leukocytosis, and fluid collections?
What condition can cause elevated liver enzymes, leukocytosis, and fluid collections?
Flashcards
Kidneys
Kidneys
Two bean-shaped organs located in the retroperitoneal space, responsible for filtering waste products from the blood and producing urine.
Renal Cortex
Renal Cortex
The outer layer of the kidney, containing the glomeruli and tubules.
Renal Medulla
Renal Medulla
The inner layer of the kidney, containing the collecting ducts and loops of Henle.
Renal Sinus
Renal Sinus
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Medullary Pyramids
Medullary Pyramids
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Renal Pelvis
Renal Pelvis
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Calyces
Calyces
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Ureter
Ureter
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Acquired Cystic Disease
Acquired Cystic Disease
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Dialysis-Related Acquired Cystic Disease
Dialysis-Related Acquired Cystic Disease
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Renal Transplantation
Renal Transplantation
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Diabetes
Diabetes
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Acute Tubular Necrosis (ATN)
Acute Tubular Necrosis (ATN)
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Junctional Parenchymal Defect
Junctional Parenchymal Defect
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Hypertrophic Column of Bertin
Hypertrophic Column of Bertin
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Extrarenal Pelvis
Extrarenal Pelvis
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Serum Creatinine
Serum Creatinine
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Transverse Plane
Transverse Plane
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What is a junctional parenchymal defect?
What is a junctional parenchymal defect?
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What is a Hypertrophic Column of Bertin?
What is a Hypertrophic Column of Bertin?
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What is an Extrarenal Pelvis?
What is an Extrarenal Pelvis?
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Renal Artery Stenosis
Renal Artery Stenosis
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Resistive Index (RI)
Resistive Index (RI)
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Parvus Tardus
Parvus Tardus
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Renal Artery Thrombosis
Renal Artery Thrombosis
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Renal Vein Thrombosis
Renal Vein Thrombosis
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Renal Cell Carcinoma
Renal Cell Carcinoma
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Wilm's Tumor
Wilm's Tumor
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Mesoblastic Nephroma
Mesoblastic Nephroma
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Renal Infarction
Renal Infarction
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Sonographic Findings of Renal Infection
Sonographic Findings of Renal Infection
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Acute Pyelonephritis (APN)
Acute Pyelonephritis (APN)
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Focal Bacterial Nephritis
Focal Bacterial Nephritis
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Emphysematous Pyelonephritis (EPN)
Emphysematous Pyelonephritis (EPN)
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Reverberation or Comet-Tail Artifacts
Reverberation or Comet-Tail Artifacts
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Gas Within Renal Parenchyma on Ultrasound
Gas Within Renal Parenchyma on Ultrasound
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Nephrectomy for EPN
Nephrectomy for EPN
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Xanthogranulomatous Pyelonephritis (XGP)
Xanthogranulomatous Pyelonephritis (XGP)
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Pyonephrosis
Pyonephrosis
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Fungal Ball
Fungal Ball
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Candida
Candida
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Poorly Defined Low-Density Areas
Poorly Defined Low-Density Areas
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Hyperechoic Debris
Hyperechoic Debris
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Cortical Thinning
Cortical Thinning
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Chronic Pyelonephritis
Chronic Pyelonephritis
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Study Notes
Kidney Anatomy
- Kidneys are paired organs, lie against deep back muscles, lateral to vertebrae.
- Right kidney is slightly more inferior than the left.
- They produce urine.
- Paired ureters carry urine from the kidneys to the bladder.
- The urinary bladder stores urine.
- The urethra drains urine from the bladder to the outside of the body.
Kidney Embryology
- Three pairs of kidneys develop sequentially: pronephros, mesonephros, metanephros.
- Pronephros is non-functional and disappears.
- Mesonephros is a mid-kidney with partial function in the first trimester.
- Metanephros is the permanent kidney.
Kidney Development
- The urogenital ridge and nephrogenic cord develop from the intermediate mesoderm.
- Pronephros is a remnant of early development.
- Mesonephros is a temporary kidney which persists into the 1st trimester.
- Metanephros becomes the permanent kidney.
Kidney Size and Layers
- Kidneys are typically the size of a clenched fist.
- Length is 9-12 cm, width is 5-7 cm, and height is 2-3 cm.
- Inner-Fibrous Renal Capsule: covers surface and has a shiny appearance.
- Middle- Perirenal Fat (Adipose Capsule): cushions kidneys and holds them in place.
- Outer-Renal Fascia (Gerota's Fascia): dense, fibrous tissue surrounding the kidney, fat, and adrenal gland.
Kidney Location
- Right kidney is superior and lateral to the liver.
- Inferior to liver and superior to the right colic flexure.
- The right adrenal gland is superior and medial.
- Left kidney is superior and medial to the spleen, anterior to upper pole of pancreas.
- Inferior to left colic flexure is the location.
Kidney Histology
- Renal Cortex: outer portion, contains most of the nephrons.
- Renal Medulla: inner portion, composed of renal pyramids.
- Renal Sinus: inner part of the medulla, containing fat, vessels, and collecting tubules.
- Renal Pelvis: Funnel-shaped structure that collects urine from multiple calyces.
- Major & Minor Calyces: extensions of renal pelvis for collecting urine in pyramids.
- Renal Papilla: apex of the pyramids.
- Renal Hilum: medial opening in the kidney for vessel entry and exit to and from the kidney.
- Gerota's Fascia: fibrous capsule enclosing kidneys and adrenal glands.
Kidney Vasculature
- Renal artery supplies arterial blood to the kidneys.
- Branches into segmental, interlobar, arcuate, and interlobular arteries.
- Arteries run perpendicular to renal capsule.
- Interlobular arteries run perpendicular to the kidney capsule.
Kidney Ultrasound Imaging
- Renal cortex: appears isoechoic or hypoechoic relative to liver and spleen.
- Renal pyramids: anechoic
- Renal sinus: hyperechoic
- Amplitudes: Renal medulla < renal cortex < liver < spleen < pancreas < diaphragm < renal sinus = renal capsule
Kidney Congenital Anomalies
- Agenesis (absence of one or both kidneys)
- Hypoplasia (underdevelopment of one or both kidneys)
- Ectopic Kidneys (kidneys in abnormal locations)
- Horseshoe Kidneys (fusion of the lower poles)
- Junctional parenchymal defect (partial fusion of embryonic kidneys)
- Extrarenal pelvis (renal pelvis outside the renal sinus, collects urine before renal pelvis)
- Dromedary hump
- Renal sinus lipomatosis
- Hypertrophic column of Bertin (prominent renal cortical parenchyma)
- Duplication of collecting system
Kidney Functional Anomalies
- Simple renal cyst (50% of population over 50. Most simple)
- Complex renal cysts
- Polycystic kidney disease
- Hydronephrosis (dilation of renal system, causing swelling)
- Urolithiasis (kidney stones)
- Nephrocalcinosis (calcuim buildup)
Kidney Trauma
- Blunt (most common type of trauma to kidneys) from sports injuries, motor vehicle accidents.
- Penetrating (stab wounds, gunshot wounds)
- Contusion
- Laceration
- Renal fracture
- Rupture of major vessels
- Subcapsular hematoma
Kidney Infections
- Acute Pyelonephritis: bacterial infection, upper urinary tract.
- Emphysematous Pyelonephritis: anaerobic bacteria, gas causing reverberation on imaging.
- Chronic Pyelonephritis: prolonged obstruction of urinary tract.
- Xanthogranulomatous Pyelonephritis
- Pynonephrosis: pus in kidney pelvis
- Fungal infections
Kidney Tumours
- Angiomyolipoma: fat, smooth muscle, and blood vessel bundles.
- Oncocytoma: composed of oncocytes.
- Renal cell carcinoma
- Nephroblastoma (Wilms Tumor)
- Renal oncocytoma
- Renal oncocytoma
Kidney Disease
- Glomerulonephritis
- Chronic Pyelonephritis
- Polycystic Kidney Disease
- Acute Kidney Injury (AKI)
- Chronic Kidney Disease (CKD)
- End-stage renal disease
Kidney Transplant
- Renal transplant is a treatment choice for end stage renal disease.
- Transplant complication: renal vein thrombosis, renal artery kinking or thrombosis, fluid collections, renal artery stenosis and rejection.
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