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?

<p>Diabetes (D)</p> Signup and view all the answers

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

<p>Acute tubular necrosis (ATN) (D)</p> Signup and view all the answers

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

<p>Produce urine (D)</p> Signup and view all the answers

Which kidney is typically positioned more inferiorly than the other?

<p>Right Kidney (C)</p> Signup and view all the answers

Which embryonic structure gives rise to the permanent kidney?

<p>Metanephros (A)</p> Signup and view all the answers

What is the approximate size of a normal kidney?

<p>9-12 cm in length (B)</p> Signup and view all the answers

What is the primary role of the ureters?

<p>Transport urine from kidneys to the bladder (B)</p> Signup and view all the answers

Which layer surrounds the kidneys and provides cushioning?

<p>Perirenal Fat (C)</p> Signup and view all the answers

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

<p>Medial to the pancreas (C)</p> Signup and view all the answers

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

<p>Pronephros (D)</p> Signup and view all the answers

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

<p>Hypoechoic appearance (A)</p> Signup and view all the answers

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

<p>Acute pyelonephritis (D)</p> Signup and view all the answers

Which imaging findings are typically associated with acute pyelonephritis?

<p>Absence of sinus echoes and renal enlargement (B)</p> Signup and view all the answers

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

<p>Ascension from the bladder (C)</p> Signup and view all the answers

What defines acute focal bacterial nephritis?

<p>Focal infection leading to wedge-shaped hypoechoic areas (B)</p> Signup and view all the answers

In which patient demographic is emphysematous pyelonephritis more commonly observed?

<p>Diabetic patients and immunosuppressed individuals (D)</p> Signup and view all the answers

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

<p>Reverberation or comet-tail artifact (D)</p> Signup and view all the answers

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

<p>Presence of gas within the renal parenchyma (A)</p> Signup and view all the answers

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

<p>Triangular hyperechoic area at the upper pole (C)</p> Signup and view all the answers

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

<p>Renal cortex extending towards the center into the renal sinus (A)</p> Signup and view all the answers

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

<p>A central anechoic area outside of the renal pelvis but communicating with it (D)</p> Signup and view all the answers

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

<p>To evaluate renal function and detect potential abnormalities (D)</p> Signup and view all the answers

How is serum creatinine produced in the body?

<p>From the breakdown of skeletal muscle (D)</p> Signup and view all the answers

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

<p>Renal arteries and veins (D)</p> Signup and view all the answers

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

<p>Normal renal structure (C)</p> Signup and view all the answers

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

<p>1.2 to 2.0 mg/dL (D)</p> Signup and view all the answers

What sonographic finding is indicative of acute transplant rejection?

<p>Decreased kidney echogenicity (A)</p> Signup and view all the answers

Which resistive index (RI) value indicates transplant dysfunction?

<blockquote> <p>0.8 (C)</p> </blockquote> Signup and view all the answers

What is a common symptom of renal artery stenosis?

<p>Sudden onset of hypertension (A)</p> Signup and view all the answers

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

<p>Absence of intrarenal arterial flow (A)</p> Signup and view all the answers

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

<p>Mesoblastic nephroma (D)</p> Signup and view all the answers

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

<p>Dilated thrombosed renal vein (C)</p> Signup and view all the answers

What does the presence of parvus tardus waveform indicate?

<p>Renal artery stenosis (C)</p> Signup and view all the answers

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

<p>Hematoma (C)</p> Signup and view all the answers

What is the primary cause of chronic pyelonephritis?

<p>Obstructive lesions and ureteral reflux (B)</p> Signup and view all the answers

What is a common sonographic finding in chronic pyelonephritis?

<p>Cortical thinning with hyperechoic appearance (B)</p> Signup and view all the answers

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

<p>Pyonephritis (B)</p> Signup and view all the answers

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

<p>Xanthogranulomatous pyelonephritis (A)</p> Signup and view all the answers

What does a fungal ball typically appear as on imaging?

<p>Hyperechoic nonshadowing mass (C)</p> Signup and view all the answers

What is required to treat pyonephrosis?

<p>Percutaneous or surgical drainage (B)</p> Signup and view all the answers

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

<p>Markedly increased echogenicity (A)</p> Signup and view all the answers

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

<p>Fungal infections (A)</p> Signup and view all the answers

Flashcards

Kidneys

Two bean-shaped organs located in the retroperitoneal space, responsible for filtering waste products from the blood and producing urine.

Renal Cortex

The outer layer of the kidney, containing the glomeruli and tubules.

Renal Medulla

The inner layer of the kidney, containing the collecting ducts and loops of Henle.

Renal Sinus

The central space within the kidney, containing the renal pelvis, calyces, vessels, and fat. It's filled with fluid and appears as a darker region on imaging.

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Medullary Pyramids

Triangular structures located in the renal medulla, forming the functional units of the kidney that collect urine from the nephrons.

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Renal Pelvis

A funnel-shaped structure located within the renal sinus, collecting urine from the calyces and passing it to the ureter.

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Calyces

Small, cup-like structures that collect urine from the nephrons and drain into the renal pelvis.

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Ureter

A muscular tube that carries urine from the kidney to the bladder.

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Acquired Cystic Disease

A condition developed by patients on dialysis where multiple cysts form throughout both kidneys, leading to decreased kidney function. The kidneys often appear shrunk and echogenic on ultrasound.

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Dialysis-Related Acquired Cystic Disease

A common complication of CKD (Chronic Kidney Disease) in patients on dialysis. It leads to the development of multiple cysts throughout the kidneys.

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Renal Transplantation

The treatment of choice for end-stage renal disease. A healthy kidney from a living or deceased donor is surgically implanted into the patient.

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Diabetes

The most common cause of renal disease leading to kidney transplantation.

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Acute Tubular Necrosis (ATN)

A potential complication after renal transplantation. It refers to damage to the tubules of the transplanted kidney, leading to poor function.

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Junctional Parenchymal Defect

A triangular, hyperechoic area seen on the anterior aspect of the upper pole of the kidney, representing a partial fusion of the fetal kidney lobes.

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Hypertrophic Column of Bertin

A thickened portion of the renal cortex that extends into the renal sinus, appearing as a bulge.

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Extrarenal Pelvis

A condition where the renal pelvis is located outside the kidney, but still connected to the kidney via the ureter.

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Serum Creatinine

A break-down product of skeletal muscle filtered by the kidneys, used to assess renal function.

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Transverse Plane

The renal arteries and veins are best seen in this plane because the sound waves are perpendicular to the vessels, allowing for a clearer image.

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What is a junctional parenchymal defect?

Triangular hyperechoic area found on the anterior aspect of the upper pole of the kidney. It is a remnant of the fetal kidney lobulation, often mistaken for a tumor.

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What is a Hypertrophic Column of Bertin?

A thickened portion of the renal cortex that extends into the renal sinus, appearing as a bulge. It is a normal variant and should not be mistaken for a tumor due to its typical location.

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What is an Extrarenal Pelvis?

A condition where the renal pelvis is located outside the kidney, but still connected to the kidney via the ureter. This is a normal anatomical variation and is easily identified on ultrasound.

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Renal Artery Stenosis

Renal artery stenosis is a narrowing of the renal artery, which can lead to reduced blood flow to the kidney and hypertension.

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Resistive Index (RI)

A resistive index (RI) is a measurement of the resistance to blood flow in a vessel, often used to assess the health of a transplanted kidney.

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Parvus Tardus

Parvus Tardus describes a small, slow pulse waveform in the renal artery, indicating possible renal artery stenosis.

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Renal Artery Thrombosis

Renal artery thrombosis is a blockage of the renal artery, often causing sudden pain, hematuria, and a rise in blood pressure.

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Renal Vein Thrombosis

A renal vein thrombosis is a blockage of the renal vein, often causing symptoms like nephrotic syndrome, hematuria, and kidney enlargement.

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Renal Cell Carcinoma

A renal cell carcinoma is the most common solid renal mass in adults.

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Wilm's Tumor

A Wilm's tumor is the most common childhood renal mass.

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Mesoblastic Nephroma

A mesoblastic nephroma is the most common neonatal solid renal tumor.

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Renal Infarction

A condition where the blood supply to the kidney is blocked, often by a clot or narrowed blood vessel. This can cause damage to the kidney tissue.

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Sonographic Findings of Renal Infection

An ultrasound finding where the kidney is enlarged and the tissue appears less reflective (hypoechoic). This can be a sign of kidney infection or inflammation.

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Acute Pyelonephritis (APN)

A severe form of kidney infection where bacteria invade the renal tissue. It's often caused by bacteria ascending from the bladder.

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Focal Bacterial Nephritis

A focal area of infection in the kidney where the affected area appears less reflective (hypoechoic) on ultrasound. This is similar to the appearance of a kidney infarction.

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Emphysematous Pyelonephritis (EPN)

A life-threatening complication of kidney infection where gas bubbles form in the kidney tissue. This is more common in people with diabetes.

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Reverberation or Comet-Tail Artifacts

Artifacts on ultrasound that appear as bright lines or streaks caused by the reflection of sound waves off gas bubbles within the kidney. This is a sign of Emphysematous Pyelonephritis.

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Gas Within Renal Parenchyma on Ultrasound

Ultrasound findings in Emphysematous Pyelonephritis showing gas bubbles within the renal parenchyma (kidney tissue).

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Nephrectomy for EPN

A treatment option for Emphysematous Pyelonephritis where the entire kidney is surgically removed.

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Xanthogranulomatous Pyelonephritis (XGP)

A type of chronic pyelonephritis caused by long-term obstruction and recurrent infections. It is characterized by renal enlargement, abscesses, and a staghorn calculus.

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Pyonephrosis

A serious complication of pyelonephritis where pus collects in the renal pelvis and calyces. It usually arises from blockage of the urinary tract.

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Fungal Ball

A mass of fungal material found in the urinary tract, often seen in patients with fungal infections. It appears as a hyperechoic, non-shadowing mass on ultrasound.

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Candida

The most common cause of fungal infections worldwide. It can cause urinary tract infections and form fungal balls in the urinary tract.

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Poorly Defined Low-Density Areas

A sonographic finding in XGP that includes multiple low-density areas within the renal parenchyma. It's often seen in combination with other features like abscesses and staghorn calculus.

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Hyperechoic Debris

A sonographic finding in pyonephrosis that shows hyperechoic debris within the dilated collecting system. It indicates the presence of pus in the collecting system.

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Cortical Thinning

The outer layer of the kidney is thinned in chronic pyelonephritis. This occurs due to repeated kidney infections and inflammation.

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Chronic Pyelonephritis

This is characterized by recurring renal infections due to conditions like anatomical abnormalities, obstructions, or ureteral reflux. It can lead to kidney failure.

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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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