Kidney Anatomy and Physiology Quiz

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Questions and Answers

Which of the following imaging findings is most consistent with Medullary Sponge Kidney?

  • Multiple cysts of various sizes, which replace the normal renal parenchyma
  • Multiple non-communicating cysts with absence of renal parenchyma
  • Enlarged Kidneys bilaterally with hyperechoic parenchyma
  • Bilateral hyperechoic medullary pyramids with or without shadowing (correct)

A 70-year-old patient presents with multiple cysts of varying sizes in both kidneys. Which of the following conditions should the patient be evaluated for?

  • Autosomal Dominant Polycystic Kidney Disease (ADPKD) (correct)
  • Medullary Sponge Kidney
  • Multicystic Dysplastic Kidneys (MCDK)
  • Autosomal Recessive Polycystic Kidney Disease (ARPKD)

What is the most common cause of an abdominal mass in newborns?

  • Simple Renal Cysts
  • Medullary Sponge Kidney
  • Autosomal Recessive Polycystic Kidney Disease (ARPKD)
  • Multicystic Dysplastic Kidneys (MCDK) (correct)

Which of the following is NOT a common complication associated with Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

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

Which of the following criteria is NOT used to differentiate between a simple renal cyst and a complex renal cyst on ultrasound?

<p>Size of the cyst (C)</p> Signup and view all the answers

What is the most common location for simple renal cysts?

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

What complication is commonly associated with ARPKD?

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

Which of the following is a characteristic sonographic finding of a simple renal cyst?

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

What is the typical age of onset for Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

<p>Fourth decade of life (D)</p> Signup and view all the answers

Which of the following is NOT a feature of Multicystic Dysplastic Kidneys (MCDK)?

<p>Associated with cystic dilatation of collecting tubules (B)</p> Signup and view all the answers

What is a possible differential diagnosis to consider when a patient presents with hyperechoic renal pyramids?

<p>Renal Sinus Lipomatosis (D)</p> Signup and view all the answers

Which type of renal cyst is also known as an atypical cyst?

<p>Complex renal cyst (D)</p> Signup and view all the answers

What is the term used to describe the condition where one kidney undergoes hypertrophy to compensate for the loss of function of the other kidney?

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

Which of the following is a common finding in patients with Medullary Sponge Kidney?

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

What is the term used to describe a cyst located in the renal sinus?

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

What is the primary function of the ureters?

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

Which structure exits posteriorly at the hilum of the kidney?

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

What characterizes the renal cortex?

<p>It is the outer parenchyma from the base of pyramids to the capsule. (B)</p> Signup and view all the answers

Which embryonic kidney is non-functional and disappears around the 4th week of development?

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

What is the typical size range for human kidneys?

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

Which anatomical structure is located superior and medial to the right kidney?

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

What does the renal fascia do?

<p>Surrounds the kidney fat and adrenal gland (A)</p> Signup and view all the answers

In females, which ducts arise from mesonephros and eventually develop into the uterus and vagina?

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

What is a normal value for the resistive index (RI) in renal evaluation?

<p>&lt; 0.7 (C)</p> Signup and view all the answers

Which patient condition is most likely to result in increased renal arterial resistance?

<p>Renal transplant rejection (C)</p> Signup and view all the answers

In the Doppler evaluation technique, what is the maximum acceptable angle between the Doppler beam and the direction of flow?

<p>60 degrees (A)</p> Signup and view all the answers

What anatomical abnormality is commonly associated with unilateral renal agenesis?

<p>Seminal vesicle cysts (B)</p> Signup and view all the answers

Which of the following conditions does NOT typically result from renal duplication?

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

What is the embryological origin of kidneys?

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

What imaging finding is characteristic of a duplex kidney?

<p>Complete central cortical break (C)</p> Signup and view all the answers

In the case of crossed fused renal ectopia, where are two kidneys commonly located?

<p>Both on one side of the abdomen (A)</p> Signup and view all the answers

What major complication can arise from ectopic kidneys?

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

Which syndrome is associated with renal agenesis and vertebral defects?

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

What is the most common location for ectopic kidneys?

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

What type of appearance does a horseshoe kidney have?

<p>Large 'U' shape (D)</p> Signup and view all the answers

What is a significant risk associated with hydronephrosis in congenital anomalies?

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

What is the most common clinical manifestation of renal cell carcinoma?

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

In which condition are patients at an increased risk for developing renal cell carcinoma due to long-term dialysis?

<p>Acquired cystic disease (B)</p> Signup and view all the answers

What imaging characteristic is often suggestive of a renal oncocytoma?

<p>Central scar on CT (A)</p> Signup and view all the answers

Which of the following tumors is most commonly seen in childhood?

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

What is a key imaging sign that must be documented in renal mass evaluations?

<p>Assessment of vascularity (C)</p> Signup and view all the answers

Which group of tumors is characterized by the presence of fat cells intermixed with smooth muscle cells?

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

What common feature is associated with both Von Hippel-Lindau disease and tuberous sclerosis?

<p>Presence of renal cell carcinoma (B)</p> Signup and view all the answers

What condition presents with multiple cysts in kidneys as a result of long-term dialysis?

<p>Acquired cystic disease (A)</p> Signup and view all the answers

What is the typical age range at which Von Hippel-Lindau disease usually presents symptoms?

<p>2nd – 3rd decade of life (B)</p> Signup and view all the answers

Which renal tumor is characterized by a likely homogeneous and well-circumscribed echogenic mass?

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

Which type of urothelial carcinoma accounts for about 10% of such cancers?

<p>Squamous cell carcinoma (C)</p> Signup and view all the answers

What is the appearance of an infarcted area within 24 hours of arterial occlusion?

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

The diagnosis of angiomyolipoma is confirmed by which imaging characteristic?

<p>Detection of fat on CT (C)</p> Signup and view all the answers

Which mechanism is responsible for prerenal failure in Acute Kidney Injury (AKI)?

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

How does a Wilms tumor commonly appear in imaging?

<p>Large asymptomatic flank mass (C)</p> Signup and view all the answers

What is a common sonographic finding in acute pyelonephritis?

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

Which factor is most commonly associated with emphysematous pyelonephritis?

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

What is the typical sonographic appearance of chronic pyelonephritis?

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

What intervention is typically required for pyonephrosis?

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

What characterizes acute focal bacterial nephritis?

<p>Localized infection of renal parenchyma (A)</p> Signup and view all the answers

Which bacterial type is most commonly involved in acute pyelonephritis?

<p>Gram-negative bacilli (C)</p> Signup and view all the answers

Which condition involves the presence of fungal masses in the renal system?

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

What is the outcome of acute kidney injury if not addressed?

<p>End-stage renal disease (B)</p> Signup and view all the answers

What is a significant finding in patients with xanthogranulomatous pyelonephritis?

<p>Severe hydronephrosis and abscesses (A)</p> Signup and view all the answers

What aspect often complicates fungal infections in renal cases?

<p>Post-surgical complications (A)</p> Signup and view all the answers

How is acute tubular necrosis classified in terms of renal failure?

<p>Intrinsic renal failure (A)</p> Signup and view all the answers

What is Hydronephrosis primarily characterized by?

<p>Dilation of the renal collecting system (C)</p> Signup and view all the answers

Which grade of Hydronephrosis is characterized by mild distortion of pelvocaliceal structures?

<p>Grade I / Mild (A)</p> Signup and view all the answers

What can chronic untreated Hydronephrosis lead to?

<p>Hypertension and renal failure (D)</p> Signup and view all the answers

Which type of calculi is primarily composed of uric acid?

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

Which symptom is commonly associated with Nephrolithiasis?

<p>Acute flank pain (B)</p> Signup and view all the answers

Nephrocalcinosis refers to ___.

<p>Calcium deposits in the renal parenchyma (B)</p> Signup and view all the answers

Which condition is NOT a cause of intrinsic Hydronephrosis?

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

What can spontaneous hematomas in the kidney result from?

<p>Renal cell carcinoma (A)</p> Signup and view all the answers

What is often the first imaging choice for assessing renal trauma?

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

Which of the following is NOT a type of nephrolithiasis?

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

What indicates postrenal failure in kidney sonography?

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

Which of the following kidney conditions is irreversible?

<p>Chronic Kidney Disease (B)</p> Signup and view all the answers

What is the main symptom of Nephrolithiasis when severe?

<p>Acute flank pain (C)</p> Signup and view all the answers

What is the most common cause of renal disease leading to kidney transplantation?

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

What characterizes Grade III Hydronephrosis?

<p>Severe dilation of the renal pelvis and calyces (D)</p> Signup and view all the answers

How is Urolithiasis primarily diagnosed?

<p>CT scan and sonography (D)</p> Signup and view all the answers

What is a significant sonographic finding of acute transplant rejection?

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

What describes the typical waveform of a normal renal artery during diastole?

<p>Continuous forward flow (A)</p> Signup and view all the answers

What is a common complication of renal trauma?

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

Which finding suggests renal artery stenosis?

<p>Absent early systolic peak (C)</p> Signup and view all the answers

What symptom is commonly associated with renal artery thrombosis?

<p>Acute flank pain (B)</p> Signup and view all the answers

What is a common complication seen in CKD patients receiving hemodialysis?

<p>Bilateral cystic disease (B)</p> Signup and view all the answers

Which of the following indicates transplant dysfunction based on the resistive index?

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

What does a small, slow pulse characterize in renal evaluations?

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

What typically causes renal vein thrombosis?

<p>Renal cell carcinoma (C)</p> Signup and view all the answers

What is the most common solid renal mass in adults?

<p>Renal Cell Carcinoma (D)</p> Signup and view all the answers

Which sonographic finding is associated with renal artery thrombosis?

<p>Focal hypoechoic areas of infarct (C)</p> Signup and view all the answers

What is a common treatment necessary for end-stage renal disease?

<p>Dialysis or renal transplant (B)</p> Signup and view all the answers

What is the primary function of the urinary bladder?

<p>Act as a reservoir for urine storage (A)</p> Signup and view all the answers

What anatomical feature outlines the trigone region of the urinary bladder?

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

Where are the ureters located in relation to the bladder?

<p>Descend in retroperitoneum and enter posteroinferior portion of the bladder (C)</p> Signup and view all the answers

What is the average length of the male urethra?

<p>15 to 20 cm (B)</p> Signup and view all the answers

What triggers the conscious desire to expel urine?

<p>Activation of stretch receptors (B)</p> Signup and view all the answers

What is one possible consequence of bladder catheterization?

<p>Development of a ledge at the bladder neck (D)</p> Signup and view all the answers

What are the constriction points of the ureters?

<p>Ureteropelvic junction, iliac vessels, bladder junction (B)</p> Signup and view all the answers

What is the external urethral orifice in females characterized by?

<p>An opening located anterior to the vagina (C)</p> Signup and view all the answers

What role do parasympathetic fibers play in micturition?

<p>They trigger bladder contractions and relaxation of the internal sphincter (C)</p> Signup and view all the answers

What is the shape of the bladder when it is empty?

<p>Round-edged tetrahedron (A)</p> Signup and view all the answers

Which part of the male urethra courses through the prostate?

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

What results in urinary incontinence?

<p>Aging or nerve system trauma (B)</p> Signup and view all the answers

What anatomical structure is anterior to the female urethra?

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

How does the bladder's size and position change?

<p>It varies according to the amount of urine it contains (B)</p> Signup and view all the answers

What is the bladder's relationship to the umbilicus?

<p>It can extend upward towards the umbilicus when full (B)</p> Signup and view all the answers

Which of the following structures is described as the functional unit of the kidney?

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

What is the name of the fibrous sheath that encloses the kidney and adrenal gland?

<p>Gerota's fascia (C)</p> Signup and view all the answers

Which of the following renal arteries is typically difficult to obtain an ideal spectral waveform due to its perpendicular orientation to the Doppler sound beam?

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

What is the sonographic appearance of the renal medulla?

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

What is the sonographic appearance of a junctional parenchymal defect?

<p>Hyperechoic triangular area (B)</p> Signup and view all the answers

Which of the following renal variations is characterized by prominent renal cortical parenchyma extending between two medullary pyramids?

<p>Hypertrophic column of Bertin (B)</p> Signup and view all the answers

Which of the following is NOT a physiological function of the kidneys?

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

Which of the following is considered a lab test used to evaluate renal function?

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

What is the typical sonographic appearance of an extrarenal pelvis?

<p>Cystic collection medial to the hilum (B)</p> Signup and view all the answers

Which of the following is considered a normal sonographic finding of the renal pelvis?

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

Which of the following renal arteries is the first branch of the main renal arteries?

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

Which of the following factors may influence the serum creatinine threshold levels?

<p>All of the above (D)</p> Signup and view all the answers

What is the significance of visualizing the liver and spleen along with the kidneys during an ultrasound examination?

<p>To compare the echo amplitude of the renal parenchyma with other structures (B)</p> Signup and view all the answers

Which of the following is NOT a factor that can cause increased serum BUN?

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

Which of the following conditions is associated with a GFR < 15 mL/min?

<p>End-stage kidney disease (C)</p> Signup and view all the answers

Which of the following is a common scanning tip for visualizing the renal arteries and veins?

<p>Use a transverse approach to obtain a clearer image (B)</p> Signup and view all the answers

Flashcards

Kidneys Anatomy

Paired organs located retroperitoneally, producing urine.

Ureters Function

Tubes that convey urine from kidneys to the bladder.

Urethra Purpose

Drains urine from the bladder to the outside of the body.

Metanephros

The permanent kidney that develops through interaction of uretic buds and mesenchyme.

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Kidney Size

Dimensions approximately 9-12 cm long, 5-7 cm wide, and 2-3 cm thick.

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Hilum Anatomy

The region where the renal vein exits anteriorly, artery enters between vein & ureter, and ureter exits posteriorly.

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Renal Cortex

Outer parenchyma of the kidney, normally more than 1cm thick.

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Renal Medulla

Inner portion of the kidney, containing renal pyramids.

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Renal pelvis

Funnel-shaped transition from major calyces to ureter in kidneys.

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Renal hilum

Medial opening for entry/exit of renal artery, vein, and ureter.

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Major calyces

Three extensions of the renal pelvis that lead to minor calyces.

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Minor calyces

Extensions of major calyces that collect urine from medullary pyramids.

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Nephron

Functional unit of kidney made up of various structures like renal corpuscle and tubules.

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Renal corpuscle

Part of nephron that includes glomerulus and glomerular capsule (Bowman's capsule).

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Renal vasculture

Network of arteries supplying blood to kidneys starting from the renal artery.

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Blood flow sequence

Main renal artery to segmental arteries, then interlobar, arcuate, and interlobular arteries.

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Echogenicity

Differential brightness of kidney structures seen on ultrasound imaging.

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Medullary pyramids

Anechoic structures in the kidney that appear as dark areas on ultrasound.

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Erythropoietin

Hormone released by kidneys that stimulates red blood cell production.

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Blood urea nitrogen (BUN)

Waste product from protein metabolism filtered by kidneys; varies with urine flow.

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Estimated Glomerular Filtration Rate (eGFR)

Formula-based estimate of kidney function using creatinine levels and other factors.

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Stages of CKD

Classification of chronic kidney disease based on GFR levels, normal (>90 mL/min) to end stage (<15 mL/min).

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Normal Renal Artery Flow

Demonstrates continuous forward flow during diastole; indicates low resistance perfusion.

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Doppler Sample Volume

The size of the Doppler sample volume should be kept small (2-5mm) for accurate readings.

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Doppler Angle

The angle between flow direction and Doppler beam should be less than 60 degrees for best results.

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Wall Filter Setting

Set as low as possible to avoid hiding low velocity information during Doppler exams.

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Pulse Repetition Frequency (PRF)

Use smallest PRF possible to minimize error and maximize Doppler tracings in evaluation.

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Resistive Index (RI)

Index used to evaluate renal transplant rejection and renal diseases; normal RI is usually < 0.7.

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RI Calculation

RI = (peak systolic frequency - end diastolic frequency) / peak systolic frequency.

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Diastolic Flow Loss

Renal dysfunction can cause loss of diastolic flow, indicating increased arterial resistance.

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Bilateral Renal Agenesis

Condition where both kidneys are absent, leads to pulmonary hypoplasia; incompatible with life.

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Unilateral Renal Agenesis

One kidney absent; compensatory hypertrophy of the remaining kidney maintains function.

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VACTERL Syndrome

Associated with vertebral defects, anal atresia, cardiovascular anomalies, renal anomalies, and more.

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Complete Duplex Kidney

Duplication of collecting system with two ureters; often associated with functional anomalies.

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Ectopic Kidney

Kidneys fail to ascend into the abdomen; can be located in pelvis or thorax.

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Horseshoe Kidney

Fusion of lower poles across the midline; unique kidney shape at a low abdominal position.

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Crossed Fused Renal Ectopia

One kidney fuses in the pelvis; ascends while carrying the other across the midline.

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Autosomal Dominant Polycystic Kidney Disease (ADPKD)

An inherited kidney disorder causing cyst formation leading to renal enlargement and potential renal failure.

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Complications of ADPKD

Complications include infection, renal calculi, cyst rupture, and hypertension.

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Autosomal Recessive Polycystic Kidney Disease (ARPKD)

A genetic disorder seen at birth characterized by small cysts due to collecting tubule dilation.

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Sonographic findings in ARPKD

Bilateral enlarged kidneys, hyperechoic parenchyma, and loss of cortico-medullary distinction.

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Multicystic Dysplastic Kidneys (MCDK)

A condition with multiple non-communicating cysts, often causing abdominal masses in newborns.

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Medullary Sponge Kidney

Congenital dysplastic condition causing cystic dilation of renal pyramids, leading to stasis and calcium deposits.

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Renal Cyst

Fluid-filled sacs in the kidney, common in individuals over age 50, typically benign.

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Simple Renal Cyst Characteristics

Typically well-defined, round, fluid-filled, with no internal echoes and acoustic enhancement.

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Complex Renal Cyst

Cysts that do not meet simple criteria, potentially indicating malignancy, requiring further evaluation.

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Sonographic Features of Complex Cysts

May include thick septations, calcifications, internal echoes, and lobulated shapes.

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Parapelvic Cyst

Cysts located near the renal pelvis; may confuse with renal pelvis dilation.

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Cysts in Liver and Pancreas with ADPKD

ADPKD is often associated with liver cysts (50%) and pancreatic cysts (10%).

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Pulmonary hypoplasia in ARPKD

A condition that may arise in ARPKD due to reduced amniotic fluid (oligohydramnios).

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Renal Calculi

Kidney stones that may develop as a complication in cystic kidney diseases.

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Hypertension in ADPKD

High blood pressure can result from renal failure due to cystic kidney disease.

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Metastatic Renal Tumors

Secondary tumors in the renal parenchyma from primary sites like lung or breast.

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Lymphoma in Kidneys

Cancer cells from lymphoma can invade renal tissues.

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Hypoechoic Masses

Dark areas on ultrasound indicating possible tumor presence in kidneys.

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Hydronephrosis

Dilation of the renal collecting system due to obstruction.

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Caliectasis

Dilation of the renal calices due to obstruction.

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Pelvicaliectasis

Dilation of both calices and renal pelvis in the kidney.

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Intrinsic Causes of Hydronephrosis

Obstructions within the kidney like stones or tumors.

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Extrinsic Causes of Hydronephrosis

Obstructions outside the kidney such as tumors or pregnancy.

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Nephrolithiasis

Formation of kidney stones within the collecting system.

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Types of Calculi

Different kinds of kidney stones: calcium, struvite, uric acid.

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Nephrocalcinosis

Calcium deposits in renal parenchyma affecting function.

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Renal Trauma Types

Blunt or penetrating injuries causing damage to the kidney.

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Subcapsular Hematoma

Bleeding between the kidney and its capsule post-trauma.

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Infarction in Kidneys

Tissue death due to loss of blood supply in kidney.

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Symptoms of Urolithiasis

Flank pain, hematuria; depend on stone size and location.

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Acquired Cystic Disease

Development of multiple cysts in failed kidneys during long-term dialysis.

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Von Hippel-Lindau Disease

Inherited disease presenting with hemangioblastomas, affecting vision and other tumors.

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Tuberous Sclerosis

Genetic disease with seizures, mental retardation, and facial angiofibromas.

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Angiomyolipoma (AML)

Benign renal tumor composed of fat, muscle, and blood vessels, often hyperechoic.

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Renal Cell Carcinoma (RCC)

Most common solid renal mass, commonly seen as hypoechoic in adult kidneys.

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Wilms Tumor

Most common childhood kidney tumor, typically presents as a large flank mass.

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Hematuria

Presence of blood in urine, a significant symptom for kidney diseases.

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Urothelial Carcinoma

Malignant tumors of the urinary tract lining, primarily transitional cell carcinoma.

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Benign Neoplasms

Non-cancerous tumors in kidneys, including oncocytomas and angiomyolipomas.

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Sonographer's Role

Evaluate kidney masses, measuring and documenting growth and vascularity.

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Transitional Cell Carcinoma (TCC)

Common bladder cancer that may cause hematuria and hydronephrosis.

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Renal Oncocytoma

Relatively benign kidney tumor often difficult to differentiate from RCC.

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Acquired renal cysts

Cysts that develop in kidneys due to chronic conditions like dialysis.

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Angiomyolipoma Appearance

Hyperechoic mass, homogeneous and well-circumscribed in renal parenchyma.

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Acute Tubular Necrosis

A common cause of acute kidney injury characterized by damage to kidney tubules.

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Intrinsic Renal Failure

A type of kidney failure caused by damage to the kidney itself.

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Acute Kidney Injury (AKI)

Rapid decline in kidney function, often reversible if treated early.

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Chronic Kidney Disease (CKD)

Progressive loss of kidney function over time, often irreversible.

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End-Stage Kidney Disease

Irreversible kidney failure requiring dialysis or transplant.

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Renal Transplantation

Surgical procedure to replace a diseased kidney with a healthy one.

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Hematoma

A collection of blood outside blood vessels, often post-surgery.

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Parvus Tardus

An ultrasound finding showing a slowed pulse in the kidney.

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Renal Artery Stenosis

Narrowing of the renal artery, leading to decreased blood flow in kidneys.

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Renal Artery Thrombosis

Sudden blockage of a renal artery, causing acute flank pain and kidney injury.

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Renal Vein Thrombosis

Clot formation in the renal vein, leading to kidney enlargement and dysfunction.

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Renal Cell Carcinoma

Most common type of kidney cancer in adults.

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Wilm’s Tumor

The most common kidney cancer in children.

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Mesoblastic Nephroma

The most common solid tumor in newborns' kidneys.

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Lower Urinary Tract

Includes the ureters, bladder, and urethra involved in urine transport and elimination.

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Urinary Bladder

A hollow, collapsible sac that serves as a reservoir for urine storage.

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Bladder Anatomy

Located on pelvic floor; size and shape vary with urine volume.

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Rugae

Folds in the bladder lining that allow for its expansion.

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Trigone

Triangular region on bladder floor marked by ureteral and urethral openings.

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Ureters

Slender tubes that convey urine from kidneys to the bladder.

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Male Urethra

Approximately 20 cm long, serving both urine elimination and semen passage.

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Female Urethra

3 to 4 cm long, functions solely for urine elimination.

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Micturition

The process of voiding urine from the bladder.

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Incontinence

Involuntary emptying of the bladder due to nervous system issues.

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Retention

Inability to empty bladder despite containing excess urine.

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Catheterization

A procedure to relieve discomfort from urinary retention.

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Urethral Orifice

External opening of the urethra, where urine exits the body.

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Detrusor Muscle

Muscle in the bladder that contracts to expel urine.

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Acute Pyelonephritis

A bacterial infection of the renal parenchyma, often ascending from the bladder.

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Emphysematous Pyelonephritis

A severe kidney infection characterized by gas formation, common in diabetics.

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Chronic Pyelonephritis

Renal injury due to recurrent infections leading to renal damage.

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Renal Injury

Damage to the kidneys that affects their ability to filter blood and manage waste.

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Prerenal Failure

AKI due to inadequate blood perfusion to the kidneys.

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Postrenal Failure

AKI caused by obstruction of urine outflow.

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Pyonephrosis

Accumulation of pus in the renal collecting system.

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Xanthogranulomatous Pyelonephritis (XGP)

A rare type of chronic pyelonephritis due to long-term obstruction.

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Renal Imaging

Ultrasound or CT used to visualize kidney structure and pathology.

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Fungal Infections

Caused primarily by Candida, these infections need special treatments.

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Ultrasound Findings in Pyelonephritis

Characterized by renal enlargement, hypoechoic areas, and absence of sinus echoes.

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Study Notes

Kidney Anatomy and Physiology

  • Paired kidneys lie in the retroperitoneum, against deep back muscles, lateral to the vertebrae.
  • The right kidney is typically positioned slightly more inferior than the left.
  • Kidneys produce urine.
  • Paired ureters transport urine from the kidneys to the bladder.
  • The urinary bladder stores urine.
  • The urethra drains urine from the bladder to the body exterior.

Kidney Embryology

  • Three pairs of kidneys form during development.
  • Pronephros (fore kidney): Non-functional and disappears by the 4th week.
  • Mesonephros (mid kidney): Partially functional in the first trimester (5th week). Gives rise to mesonephric tubules and ducts; Wolffian ducts in males (male genitalia); Mullerian ducts (paramesonephric ducts) in females (uterus, vagina)
  • Metanephros (permanent kidney): Interaction of uretic buds and mesenchyme (blastema) forms the functioning kidney.

Kidney Size and Anatomy

  • Approximately the size of a clenched fist (9-12 cm long, 5-7 cm wide, 2-3 cm thick).

  • Kidneys should be within 2 cm of each other in length.

  • Layers :

    • Fibrous renal capsule: Inner layer, smooth giving the kidney its shiny appearance
    • Perirenal fat: Middle layer, adipose tissue, cushions and stabilizes
    • Renal fascia/Gerota's fascia: Outer layer; dense fibrous tissue encompassing the kidney, fat, and adrenal gland
    • Pararenal fat: Outermost (anterior and posterior); further stabilizes.
  • Hilum: The medial indentation where vessels and ureter enter/exit. The vein exits anteriorly, the artery enters between the vein and ureter, and the ureter exits posteriorly.

Kidney Relational Anatomy

  • Right Kidney:

    • Superior-medial: Adrenal gland
    • Superior-lateral: Liver
    • Inferior: Right colic flexure
    • Medial: 2nd portion of the duodenum
  • Left Kidney:

    • Superior: Adrenal gland and spleen
    • Anterior-superior: Pancreatic tail
    • Inferior: Left colic flexure

Kidney Internal Anatomy

  • Renal Cortex: Outer layer of kidney tissue.
  • Renal Medulla: Inner layer of kidney tissue, with pyramids.
  • Renal Sinus: Inner hyperechoic region containing fat, calyces, renal pelvis, vessels, and lymphatics.
  • Medullary pyramids: Triangles of collecting tubules. Often seen in newborns and pediatrics.
  • Renal Pelvis: Funnel-shaped structure collecting urine from major calyces, connecting to the ureter.
  • Renal Hilum: The medial opening for entry/exit of the renal artery, vein, and ureter.
  • Major Calyces: Extensions of the renal pelvis.
  • Minor Calyces: Extensions of major calyces, collecting urine from medullary pyramids. Each minor calyx corresponds to a medullary pyramid.
  • Renal Papilla: Tip of the medullary pyramid.
  • Gerota's fascia: Fibrous sheath enclosing the kidney and adrenal gland (perirenal space).
  • Nephron: Functional unit of the kidney, consisting of glomerulus, Bowman's capsule, tubules, and collecting ducts.

Renal Vasculature

  • Kidneys receive blood through the renal artery branch of the aorta.
  • At the hilum, the renal artery divides into segmental arteries.
  • The segmental arteries divide into interlobar arteries, which run perpendicular to the renal capsule. These arteries travel between renal pyramids.
  • Arcuate arteries branch from interlobar arteries at the base of the medullary pyramids and run parallel to the renal capsule.
  • Interlobular arteries are the smallest renal arteries, branching off arcuate arteries and running perpendicular to the renal capsule.

Renal Blood Flow

  • Main renal artery → segmental arteries → interlobar arteries → arcuate arteries → interlobular arteries.

Sonographic Appearance

  • Renal Cortex: Isoechoic or hypoechoic relative to liver and spleen.
  • Renal Medulla: Anechoic.
  • Renal Sinus: Hyperechoic.
  • Echo amplitude ascending order: Renal Medulla < Renal Cortex < Liver < Spleen < Pancreas < Diaphragm < Renal Sinus ≈ Renal Capsule

Anatomic Variants

  • Junctional Parenchymal Defect: Triangular hyperechoic area anterior to upper pole of kidney (fetal lobulation).
  • Hypertrophic Column of Bertin: Prominent cortical parenchyma extending between medullary pyramids.
  • Extrarenal Pelvis: Renal pelvis lying outside the renal sinus.
  • Dromedary Hump: A protuberance or bulge on the kidney's outer surface.
  • Renal Sinus Lipomatosis: Excessive accumulation of fat in the renal sinus.

Kidney Function and Labs

  • Function: Filters wastes, maintains water/electrolyte balance, releases hormones (renin for blood pressure, erythropoietin for RBC production, Vit D metabolism).
  • Labs: Urea nitrogen, creatinine, uric acid evaluate renal function; RBC, WBC, bacteria indicate infection/tumors. Normal values vary by sex, age, region.
  • eGFR: Essential for assessment after discovering albuminuria.
  • CKD Stages: Normal: GFR >90 mL/min; End-stage: GFR <15 mL/min.

Doppler Evaluation

  • Normal renal artery: Continuous forward flow during diastole (low resistance).
  • Doppler Exam Techniques: Small sample volume (2-5 mm), <60-degree Doppler angle, low wall filter, smallest possible PRF.
  • Resistive Index (RI): Used to assess renal disease, transplant rejection, suspected hydronephrosis. A normal RI is typically < 0.7. RI = (peak systolic velocity - end diastolic velocity) / peak systolic velocity.

Congenital Anomalies

  • Agenesis/Hypoplasia: Absence or underdevelopment of one or both kidneys.
  • Collecting System Duplication: Complete or incomplete duplication of the collecting system (two ureters).
  • Ectopic Kidney: Kidney displaced from its normal position (pelvic, intrathoracic, crossed fused).
  • Horseshoe Kidney: Fusion of the lower kidney poles across the midline.

Renal Diseases:

  • ADPKD (Autosomal Dominant Polycystic Kidney Disease): Inherited, cysts in kidneys, liver, and potentially other organs.
  • ARPKD (Autosomal Recessive Polycystic Kidney Disease): Present at birth, multiple small cysts, often with pulmonary hypoplasia and hepatic fibrosis.
  • MCDK (Multicystic Dysplastic Kidney): Multiple non-communicating cysts, absence of renal parenchyma, most common cause of neonatal abdominal mass.
  • Medullary Sponge Kidney: Cystic dilatation of medullary pyramids.
  • Renal Cysts (Simple): Fluid-filled cysts, common in older adults.
  • Renal Cysts (Complex/Atypical): Do not meet criteria of simple cysts, can be hemorrhagic, infected, multilocular, often require further investigation.
  • Acquired Cystic Disease: Multiple cysts in chronically failed kidneys (dialysis patients).
  • Renal Solid Masses: Benign (oncocytoma, angiomyolipoma, lipoma) or malignant (RCC).
  • Wilms Tumor (Nephroblastoma): Most common childhood renal tumor.
  • Urothelial Carcinoma: Malignant tumor of the urinary tract lining (Transitional Cell Carcinoma most common).

Kidney Obstruction and Infections:

  • Congenital/Acquired obstruction - narrowing or blockage of the urinary tract (Ureteropelvic Junction Obstruction, Ureterocele)
  • Hydronephrosis: Dilation of the renal collecting system due to urinary tract obstruction, can be graded (1-3).
  • Urolithiasis (Renal Stones) : Calculi in the urinary system, often in kidneys. May be calcium, uric acid, or other types.
  • Nephrocalcinosis: Calcium deposits within the renal parenchyma.
  • Pyelonephritis (Acute/Chronic): Bacterial infection of the kidney, can result in pyonephrosis (pus in kidney). Xanthogranulomatous pyelonephritis is a chronic type.
  • Renal Trauma: Blunt or penetrating trauma.

Renal Infarction and Injury:

  • Renal Infarction: Blood supply obstruction to the kidney (e.g., arterial occlusion).
  • Renal Injury/AKI: Acute kidney injury, impaired kidney function due to various causes (e.g., pre-renal, intrinsic, post-renal), characterized by reduced urine output, elevated BUN and creatinine.
  • CKD/Chronic Renal Failure: Irreversible decline of kidney function over time.
  • Renal Transplant evaluation: Transplant rejection or vascular complications are investigated.

###Lower Urinary Tract

Ureters, bladder and urethra are important part in transporting, storing and eliminating urine.

  • Urinary Bladder anatomy and function*
  • Ureters structure and function*
  • Urethra structure and function (male/female)*
  • Voiding Mechanism*
  • Incontinence/Retention*

Parasympathetic and voluntary nervous system impulses control the bladder and urethra

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