ADPKD
�Usually later in life around 4th decade
�Bilateral renal enlargement due to development of numerous cysts of varying sizes
What kidney disease is associated with arterial aneurysms (especially cerebral arterial Berry aneurysms of the circle of Willis.)?
ADPKD
ARPKD is associated with:
Cysts in liver and congenital hepatic fibrosis
-pulmonary hypoplasia
-portal hypertension
ARPKD is present ....
at birth
there is Loss of cortico-medullary distinction with....
ARPKD
what is the most common cause of an abdominal mass in newborns?
multi cystic dysplastic kidneys (MCDK)
Multicystic Dysplastic Kidneys is associated with.....
many other syndromes
Multicystic Dysplastic Kidneys is usually
Unilateral and the other kidney will be enlarged.
Bilateral hyperechoic medullary pyramids with or with/out shadowing
sonographic findings of medullary sponge kidney:
Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia
medullary sponge kidney
cysts located in the periphery of kidney
Cortical or parenchymal cysts
cysts located in the center (renal sinus) of the kidney
Peripelvic cysts
�Multiple or thick septations�Thick calcifications�Mural nodule/or solid component
cysts that require further investigation and should be met with suspicion of malignancy
Development of multiple cysts in chronically failed kidneys during long-term dialysis
acquired cystic disease
Patients undergoing long-term renal dialysis are at an increased risk for ______ ____ ____ disease, which predisposes patients to renal cell carcinoma
acquired renal cystic
�Inherited disease which usually presents in 2nd - 3rd decade of life with serious visual impairment
Von Hippel-Lindau Disease
Renal Cell Carcinoma, Pheochromocytomas, Islet cell tumors, Renal and Pancreatic cysts are associated with.....
Von Hippel-Lindau Disease
�A multi-system genetic disease. Classic presentation include: Seizures, mental retardation, and facial angiofibromas
Tuberous Sclerosis
Patients with _____ _____ have an increased incidence of renal cysts and angiomyolipomas.
tuberous sclerosis
Angiomyolipomas are typically ______ in patients with tuberous sclerosis.
bilateral
1. Adenoma
2. Oncocytomas
3. Angiomyolipoma (AML)
Benign Solid Renal Masses
1. Renal Cell Carcinoma (RCC)
2. Wilms Tumor (Nephroblastoma)(Pedi)
3. Mesoblastic Nephroma (Pediatric)
4. Urothelial Carcinoma
a. Transitional Cell Carcinoma (TCC)
b. Squamous Cell Carcinoma (SCC)
Malignant Solid Renal Masses
Mets to liver is typically from primary......
lymphoma
A central scar on CT or MRIs and a spoke wheel pattern of vessels on angiograms are often suggestive of _______
oncocytoma
Renal Oncocytomas (benign) AKA
oxyphilic adenomas
Angiomyolipoma(AML) is AKA
Hamartoma
Hyperechoic benign renal tumor composed of fat cells intermixed with smooth muscle cells and aggregates of thick-blood vessels in varying proportions.
Angiomyolipoma (AML)
A propagation speed artifact may result in the posterior displacement of structures due to the slower acoustic velocity in the fatty mass with
Angiomyolipoma
�Lipoma
�Leiomyoma
�Juxtaglomerular tumor (reninoma)
�Hemangioma
�Fibroma
�Multilocular cystic nephroma
benign renal tumors
Most common solid renal mass in the adult is
Renal Cell Carcinoma
Renal Cell Carcinoma (RCC) AKA
Hypernephroma or adenocarcinoma
Most often Hypoechoic relative to the normal adjacent renal parenchyma although it may appear hyperechoic
sonographic findings of RCC
RCC is more common in ....
males
Hematuria is Most Common and significant finding with ____
RCC
Most common childhood renal tumor
Wilm's Tumor ( Nephroblastoma)
Wilm's tumors destroy the_____ _____
renal contour
Wilm's tumors must be differentiated from _______ ________
adrenal neuroblastomas
. If normal renal contour is maintained bilaterally, an abdominal mass is most likely an ______ _______
adrenal neuroblastoma
Associated with Beckwith-Weidemann Syndrome
Wilms tumor
Most common renal tumor in NEONATES and INFANTS and represents 3% of pediatric renal tumors.
Mesoblastic Nephroma(pediatric)
________ is reported in 71% of pregnancies associated with mesoblastic nephroma
Polyhydramnios
_____ ____ are malignant tumors of the lining of the renal pelvis, calyces, ureter, and bladder
Urothelial tumors
most common bladder neoplasm
transitional cell carcinoma
_____ ___ account for about 10% of urothelial carcinomas
Squamous Cell
urinary tract lined with transitional cells. ___ commonly in bladder-bladder mass
Hydronephrosis may be caused by ___
TCC
_______ is the most common clinical presentation of TCC
Hematuria
�Hypoechoic masses or
�Diffusely enlarged inhomogeneous kidney
Sonographic findings of Metastatic Renal Tumors- Lymphoma
dilation of calices
caliectasis
dilation of renal pelvis
pelciectasis
dilation of calices and renal pelvis
Pelvicaliectasis
calculi, UPJ obstruction, tumors
Intrinsic causes of hydronephrosis
Neoplasm, trauma, surgery, BPH, neurogenic bladder, GYN bladder outlet, Pregnancy, obstruction, Prostate CA
extrinsic causes of hydronephrosis
Grades 1-3 for
hydro
1.Ureterovesical junction (most common)
2.Uretopelvic junction
3.Pelvic brim
3 common areas of obstruction by a stone:
A resistive index RI of greater than .7 is suggestive of _____ _____
obstructive hydronephrosis
1.Vesicoureteral reflux
2.Non-obstructive Hydronephrosis
3.Ureteropelvic junction Obstruction (UPJ)
most common causes of newborn/ prenatal hydro
Calculi that can develop anywhere in the urinary system
urolithiasis
most urolithiasis develop in the .....
kidneys (nephrolithiasis)
Some form of calcium, uric acid, struvite or magnesium ammonium phosphate, crystine,
types of renal calculi
Renal parenchymal calcium deposits. Occurs in cortical or medullary or both regions. Calcium levels are increased and often this is detected through x-ray as incidental finding.
Usually bilateral and diffuse
Nephrocalcinosis
Arise in the collecting system
Main symptom is acute back or flank pain often radiating down to ipsilateral groin. When severe- can have fever, chills, dysuria, cloudy urine and hematuria
Nephrolithiasis- Renal Stones
__________ is usually related to abnormal metabolic states leading to hypercalcemia.
Nephrocalcinosis
70% of renal trauma is ....
blunt force trauma
Depending on age of ________ have varying echo patterns. May go from anechoic, complex, echogenic, then reverted back to anechoic.
hematomas
________ ________ lies between the renal cortex and the capsule
Subcapsular hematoma
Caused by blood supply obstruction of the artery (By embolism coming from heart or aorta) or by occlusion or stenosis of the vein drainage.
renal infarction
______ is difficult to characterize with sonography.
infarction
_____ will look hypo echoic within 24 hours but with time it will look echogenic
infarction
A. Acute Pyelonephritis (APN)
B. Emphysematous Pyelonephritis (EPN)
C. Chronic Atrophic Pyelonephritis (CPN)
1. Xanthogranulomatous Pyelonephritis (XGP)
D. Renal and Perinephric Abscess
E. Pyonephrosis
F. Fungal Infections
G. Schistosomiasis
H. Tuberculos
Renal Infection & Inflammatory Disease
Results from bacterial invasion of renal parenchyma
acute pyelonephritis
Imaging studies are not necessary with ___ _____ because diagnosis van be made clinically.
acute pyelonephritis
Renal enlargement
Hypoechoic parenchyma
Absence of sinus echoes
sonographic findings of acute pyelonephritis
If infection is focal it is called .....
acute focal bacterial nephritis or lobar nephronia.
Ultrasound shows a focal wedge-shaped area or hypoechoic renal lobe with ____ ______ Similar to ischemia or infarction
acute pyelonephritis
A bacterial infection associated with renal ischemia. More commonly occurring :
Diabetics (87 - 97% of patients)
Immunosuppressed patients and patients with urinary tract obstructions.
Emphysematous Pyelonephritis
Anerobic bacteria produce intrarenal gas causing reverberation or comet-tail artifacts with .....
Emphysematous Pyelonephritis
Nephrectomy is usually required to treat _____ ______
Emphysematous Pyelonephritis
Leading to end-stage renal disease- appears small and hyperechoic with cortical thinning.
sonographic findings of Chronic Pyelonephritis (XanthogranulomatousPyelonephritis (XGP)
Renal injury induced by recurrent renal infection due to:
Anatomic anomalies, obstructive lesions, ureteral reflux
Chronic Pyelonephritis
type of chronic pyelonephritis results from chronic infections due to long term obstruction.
XanthogranulomatousPyelonephritis (XGP)
XanthogranulomatousPyelonephritis (XGP) is ___
rare
renal enlargement, parenchymal abscesses, staghorn calculus, papillary necrosis, hydronephrosis, pyonephrosis, loss of cortical-medullary boundary, cortical thinning
sonographic findings of XGP
purulent material in collecting system
Percutaneous or surgical drainage required to treat.
Shown as hyperechoic debris in dilated collecting system
pyonephritis
_____ is most common cause of fungal infections worldwide
candida
If ____ _____ obstructive- fungal ball appears as hyperechoic nonshadowing mass
fungal infection
malakoplakia is from ...........
chronic E. coli infection
Rapid decrease in renal function
Suspected when urine output falls or BUN and creatinine levels rise.
Acute Kidney Injury (AKI)
Most common cause of AKI is .....
Acute Tubular Necrosis
1.Prerenal Failure (inadequate perfusion)
2.Intrinsic Renal Failure: Acute tubular necrosis, acute glomerulonephritis, nephrotoxins
3.Postrenal Failure (obstructive nephropathy)
3 Main Mechanisms of AKI
Hypotension, volume decreased cardiac output
AKI-.Prerenal Failure (inadequate perfusion)
Acute tubular necrosis, acute glomerulonephritis, nephrotoxins
AKI Intrinsic Renal Failure
obstructive tubules with precipitates, bilateral ureteral obstruction, bladder outlet obstruction, bilateral renal vein thrombosis
AKI-Postrenal Failure (obstructive nephropathy)
urine output, urinalysis, BUN, serum creatinine
labs for AKI
�Hydronephrosis- Indicates postrenal failure
�Abnormal RI- suggests intrinsic
Sonography's Role in AKI
Irreversible condition
Diminished function of nephrons- decreased GF, renal blood flow, tubular function, and resorptive capability
Chronic Kidney Disease End-Stage Kidney Disease
Small, echogenic, shrunken kidney
sonographic findings of Chronic Kidney Disease
a complication of dialysis patients with acquired cystic disease
renal tumors
_____ ____ is a common complication with CKD patients receiving hemodialysis.
Acquired Cysts
Develop bilateral cystic disease
Cysts located throughout kidney and involve cortex, corticomedullary junction and medulla. Kidneys often appear small and echogenic
Acquired Cysts related to Dialysis