Chronic Kidney Disease Overview

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Questions and Answers

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?

Hemodialysis

Renal transplantation (correct)

Medication management

Peritoneal dialysis

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?

Diabetes Signup and view all the answers

What is a potential cause of poor function in a transplanted kidney shortly after surgery?

Acute tubular necrosis (ATN) Signup and view all the answers

What is the main function of the kidneys in the urinary system?

Produce urine Signup and view all the answers

Which kidney is typically positioned more inferiorly than the other?

Right Kidney Signup and view all the answers

Which embryonic structure gives rise to the permanent kidney?

Metanephros Signup and view all the answers

What is the approximate size of a normal kidney?

9-12 cm in length Signup and view all the answers

What is the primary role of the ureters?

Transport urine from kidneys to the bladder Signup and view all the answers

Which layer surrounds the kidneys and provides cushioning?

Perirenal Fat Signup and view all the answers

What is the anatomical position of the left kidney relative to the pancreas?

Medial to the pancreas Signup and view all the answers

During the 4th week of development, which embryonic structure does not function?

Pronephros Signup and view all the answers

What characteristic of the area affected by renal infarction can be observed within 24 hours following arterial occlusion?

Hypoechoic appearance Signup and view all the answers

Which condition is characterized by the bacterial invasion of renal parenchyma?

Acute pyelonephritis Signup and view all the answers

Which imaging findings are typically associated with acute pyelonephritis?

Absence of sinus echoes and renal enlargement Signup and view all the answers

What is a common route through which most renal infections occur?

Ascension from the bladder Signup and view all the answers

What defines acute focal bacterial nephritis?

Focal infection leading to wedge-shaped hypoechoic areas Signup and view all the answers

In which patient demographic is emphysematous pyelonephritis more commonly observed?

Diabetic patients and immunosuppressed individuals Signup and view all the answers

What artifact can be produced by anaerobic bacteria in emphysematous pyelonephritis?

Reverberation or comet-tail artifact Signup and view all the answers

What is the typical imaging appearance of a kidney affected by emphysematous pyelonephritis?

Presence of gas within the renal parenchyma Signup and view all the answers

What does the junctional parenchymal defect appear as on an ultrasound?

Triangular hyperechoic area at the upper pole Signup and view all the answers

What is the characteristic appearance of the hypertrophic column of Bertin on an ultrasound?

Renal cortex extending towards the center into the renal sinus Signup and view all the answers

Which of the following best describes an extrarenal pelvis as seen on an ultrasound?

A central anechoic area outside of the renal pelvis but communicating with it Signup and view all the answers

What is the significance of analyzing urea nitrogen, creatinine, and uric acid levels in a patient?

To evaluate renal function and detect potential abnormalities Signup and view all the answers

How is serum creatinine produced in the body?

From the breakdown of skeletal muscle Signup and view all the answers

Which structures are best visualized in the transverse plane during kidney ultrasound?

Renal arteries and veins Signup and view all the answers

What condition is indicated by the presence of a hypoechoic renal pyramid on an ultrasound?

Normal renal structure Signup and view all the answers

What is the normal serum creatinine threshold level for healthy individuals?

1.2 to 2.0 mg/dL Signup and view all the answers

What sonographic finding is indicative of acute transplant rejection?

Decreased kidney echogenicity Signup and view all the answers

Which resistive index (RI) value indicates transplant dysfunction?

<blockquote> 0.8 </blockquote> Signup and view all the answers

What is a common symptom of renal artery stenosis?

Sudden onset of hypertension Signup and view all the answers

What is a characteristic finding in renal artery thrombosis on ultrasound?

Absence of intrarenal arterial flow Signup and view all the answers

What condition is associated with the presence of abdominal mass in neonates?

Mesoblastic nephroma Signup and view all the answers

Which of the following findings is typically associated with renal vein thrombosis?

Dilated thrombosed renal vein Signup and view all the answers

What does the presence of parvus tardus waveform indicate?

Renal artery stenosis Signup and view all the answers

What post-operative fluid collection can occur within 24 hours?

Hematoma Signup and view all the answers

What is the primary cause of chronic pyelonephritis?

Obstructive lesions and ureteral reflux Signup and view all the answers

What is a common sonographic finding in chronic pyelonephritis?

Cortical thinning with hyperechoic appearance Signup and view all the answers

Which condition is characterized by purulent material in the collecting system?

Pyonephritis Signup and view all the answers

What is a rare form of chronic pyelonephritis associated with chronic infections?

Xanthogranulomatous pyelonephritis Signup and view all the answers

What does a fungal ball typically appear as on imaging?

Hyperechoic nonshadowing mass Signup and view all the answers

What is required to treat pyonephrosis?

Percutaneous or surgical drainage Signup and view all the answers

Which of the following is NOT a typical sonographic finding in xanthogranulomatous pyelonephritis?

Markedly increased echogenicity Signup and view all the answers

What condition can cause elevated liver enzymes, leukocytosis, and fluid collections?

Fungal infections Signup and view all the answers

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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Description

Test your knowledge about chronic renal failure and its associated complications, treatments, and transplant considerations. Dive into the specifics of kidney health and the challenges faced by patients with end-stage renal disease.