Renal Pathology Lecture Notes PDF

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 10 Renal Pathology (Part 3) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Readings 1. Rumack, CM Wilson, SR & Charboneau, JW 2011, Diagnostic Ultrasound, Vol...

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 10 Renal Pathology (Part 3) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Readings 1. Rumack, CM Wilson, SR & Charboneau, JW 2011, Diagnostic Ultrasound, Vol.1, 4th Ed. Mosby, St. Louis. 2. Bates J, 2011, Abdominal Ultrasound – How, Why and When, 3rd Ed. Elsevier, Edinburgh Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Learning Outcomes • Define terminology specific to urinary tract pathology • Explain some basic pathology of the urinary tract • Describe the ultrasound appearances of common renal and bladder pathology Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Pathology – Guide • Terminology • Cystic Disease • Renal obstruction • Renal infection • Parenchymal Disease • Renal tumours • Trauma Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Terminology • • • • • • • • • Haematuria Polyuria Oliguria Anuria Hesitancy/poor stream Dysuria Proteinuria Glomerular filtration rate (GRF) Creatinine Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae 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 Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Ultrasound Criteria: – Anechoic – Round or ovoid – Thin, smooth, well defined wall – Posterior enhancement Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Location may be: - Cortical: Within the cortex of the kidney - Exophytic: Extending from the surface of the kidney - Parapelvic: Located within the renal sinus (may mimic hydronephrosis or extra-renal pelvis) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Cortical Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Cortical Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Exophytic Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts •Parapelvic Cysts • - Located within the renal sinus • - Do not communicate with collecting system • - Likely result of dilated lymphatics • - Differentiate from hydronephrosis: • - Parapelvic cysts: Focal, non communicating, single or multiple • - Hydronephrosis: Communicating calyces • - CT may assist if ultrasound cannot differentiate Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Simple Renal Cysts Parapelvic Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Complex Renal Cysts - If simple cyst criteria not met – then it is complex May contain: a. - Internal echoes b. - Internal septations c. - Calcifications d. - Thickened, irregular walls e. - Mural nodules - CT to determine if benign or malignant Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Complex Renal Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Complex Renal Cystsysts\ Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Complex Renal Cysts Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Polycystic Disease - ADPKD Autosomal Dominant Polycystic Kidney Disease – Most common hereditary renal disorder – Usually develops approx. 30-40 years old Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Polycystic Disease - ADPKD • Diagnosis of ADPKD is made with positive family Hx • Cysts increase in size and number as the disease progresses • Increase in cyst volume correlates with decline in renal function Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Polycystic Disease - ADPKD Patients may present with: – – – – – – Pain Haematuria Hypertension UTI Renal failure (50% patients by the age of 60) Liver cysts (30-60%), pancreatic cysts(10%), splenic cysts (5%) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Polycystic Disease - ADPKD Ultrasound appearance – Grossly enlarged kidneys. – Innumerable, bilateral asymmetrical cysts. – Cysts of various sizes. – Disrupted parenchyma. – Cysts complicated by haemorrhage or infection will appear complex. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Polycystic Disease - ADPKD Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Hydronephrosis - Dilatation of renal collecting system (pelvis and calyces) as a result of obstruction to urine outflow. - Thinning of parenchyma with acute obstruction due to high intra renal pressure. - Atrophy of parenchyma with long standing severe obstruction. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Hydronephrosis Causes: – – – – – – – Calculi Urinary retention Masses Enlarged prostate Scarring/post infection Neurogenic bladder Vesicoureteric reflux Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Hydronephrosis Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Hydronephrosis - Mild Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Pelvicalyceal Dilatation Without Obstruction • Prominence of pelvicalyceal system is seen in some normal physiological states: – Secondary to an over-filled bladder – During pregnancy Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi • - Affects approx 12% 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 ‘calculus’ or Plural ‘calculi’. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi Three areas of narrowing in ureter when stone may become lodged: - PUJ (pelvic ureteric junction) - Ureter crosses iliac vessels - VUJ (most common) Bladder Calculi: - Caused by renal stone migration - Usually asymptomatic - Bladder pain, haematuria Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi Sonographic Appearances • • • • - Hyperechoic - Linear or Crescent shaped - Posterior shadowing (not always) - Twinkle artefact in Doppler Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Calculi Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Staghorn Calculus – Large calculus which occupies most of the collecting system Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Abscess • Collection of pus within the kidney • Intrarenal, subcapsular or perirenal • Ultrasound Appearances: o Solitary with variable appearance o Rounded, thick walled or poorly marginated o Hypoechoic complex mass o Posterior enhancement o Internal mobile debris o Gas with dirty shadowing Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Abscess Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Angiomylipoma – Benign Tumor - Common Benign mass consisting of: • Adipose tissue • Smooth muscle cells • Blood vessels - Usually solitary and asymptomatic (<4mm) - Symptoms include flank pain, haematuria, palpable mass Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Angiomylipoma Sonographic Appearance: • Well-defined, clear borders • Located within renal parenchyma or may be exophytic • Usually hyperechoic to surrounding parenchyma Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Angiomylipoma Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Angiomylipoma Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Cell Carcinoma – Malignant tumor • 86% of primary malignant renal tumours are RCC • Classic diagnostic triad only seen in 4-9% of pts: o Flank Pain o Haematuria o Palpable renal mass • Peak age 60-70yrs • Male predominance Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Cell Carcinoma •Sonographic Appearances: – - Usually solid – - Hypoechoic (10%) / Isoechoic (86%) / Hyperechoic (4%) – - Heterogeneous or homogenous – - Hypoechoic rim – - Intra-tumoural cystic spaces – - Calcifications Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Cell Carcinoma Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Tumour - Metastases • Primary: – Lung – Breast – RCC from contralateral kidney • Ultrasound appearance: – Solitary - DDx RCC – Multiple - small, poorly marginated, hypoechoic – Diffusely infiltrative - enlarged kidney, architecture distorted Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Renal Tumour - Metastases Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae QUESTIONS ?? Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Quiz The absence of urine is called? a) Polyuria b) Anuria c) Dysuria d) Oliguria Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Quiz The following is not a feature of renal calculi. a) Posterior shadowing b) Hypo-echoic c) Crescent shape d) Twinkle artefact Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Sample Exam Question Name the ultrasound features of a simple renal cyst. (2 marks) Where in the kidney are renal cysts typically found? (2 marks) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae Sample Exam Question List 4 possible causes of hydronephrosis (4 marks) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 5: Renal Pathology fchs.ac.ae