Renal Pathology Ultrasound Quiz

Renal Pathology

• Terminology related to urinary tract pathology includes: Haematuria, Polyuria, Oliguria, Anuria, Hesitancy/poor stream, Dysuria, Proteinuria, and Glomerular filtration rate (GFR)
• Renal obstruction, renal infection, parenchymal disease, renal tumors, and trauma are common renal pathologies

Simple Renal Cysts

• Most common renal mass, incidence increases with age (rare < 30 yrs, common > 60 yrs, 33% benign)
• Epithelial lined and fluid filled, solitary or multiple, usually asymptomatic
• Ultrasound criteria: Anechoic, Round or ovoid, Thin, smooth, well-defined wall, Posterior enhancement
• Location: Cortical (within the cortex of the kidney), Exophytic (extending from the surface of the kidney), Parapelvic (within the renal sinus, may mimic hydronephrosis or extra-renal pelvis)

Complex Renal Cysts

• Not meeting simple cyst criteria, may contain internal echoes, septations, calcifications, thickened/irregular walls, and mural nodules
• CT may be needed to determine if benign or malignant

Polycystic Disease (ADPKD)

• Autosomal dominant, most common hereditary renal disorder
• Develops around 30-40 years old, increasing cyst size and number, correlating with decline in renal function
• Diagnosis: Positive family history, increasing cyst volume and number
• May present with pain, haematuria, hypertension, UTI, renal failure (50% by 60), liver cysts (30-60%), pancreatic cysts (10%), and splenic cysts (5%)
• Ultrasound appearance: Grossly enlarged kidneys, innumerable, bilateral, asymmetrical cysts, disrupted parenchyma

Hydronephrosis

• Dilatation of the renal collecting system (pelvis and calyces) due to obstruction of urine outflow
• Causes: Calculi, urinary retention, masses, enlarged prostate, scarring/post-infection, neurogenic bladder, vesicoureteric reflux
• Ultrasound appearance: Dilatation of pelvicalyceal system, thinning of parenchyma with acute obstruction, atrophy with long-standing severe obstruction

Renal Calculi

• Affects approximately 12% of the population, increasing incidence with age
• Calcium oxalate most common (60-80%), may cause haematuria, flank pain or infection
• Usually located in the collecting system, single or multiple
• Common areas of narrowing in the ureter where stones may become lodged: PUJ, ureter crosses iliac vessels, VUJ
• Bladder Calculi: Caused by renal stone migration, usually asymptomatic, may cause bladder pain, haematuria