The kidney is divided into what two regions? -Answer- The renal sinus and the renal parenchyma What is the renal sinus? -Answer- The collecting system What is the renal parenchyma? -Answer- The functional part of the kidney which includes the renal cortex and renal medulla What is the renal cortex? -Answer- The outer band of tissue in the kidney What is the renal medulla composed of? -Answer- Medulla/renal pyramids How does the renal cortex appear on ultrasound? -Answer- Homogeneous and slightly hypoechoic than a normal liver What are cortical extensions in between the medullary pyramids called? -AnswerColumns of Bertin True or False? The columns of Bertin project towards the renal sinus -Answer- True How do the medullary pyramids appear on ultrasound? -Answer- Relatively hypoechoic round or triangular areas between the cortex and the renal sinus. What are three junctions or sites of connection in the upper and lower urinary systems? -Answer- 1. UPJ - ureteropelvic junction 2. UVJ - ureterovesical junction 3. VUJ -vesicourethral junction What is the most common site of obstruction due to a stone in the urinary system? - Answer- UVJ- ureterovesical junction What are the ureters? -Answer- Thin muscular tubes that are 25-30 cm long, 4-7 mm in diameter Where do the ureters originate? -Answer- The ureteropelvic junction How do the ureters course? -Answer- -They course through the retroperitoneum until the ureterovesical junction -At this level, they pass obliquely through the muscular bladder wall, creating a valve mechanism that prevents urine reflux What is ureteral peristalsis? -Answer- It transports urine to the urinary bladder What is associated with the bladder? -Answer- -Large muscular bag -Has postero-lateral openings for the ureters -Has an anterior opening for the urethra Urine collects and contracts to expel urine through the ________, conveys urine from the Urinary Bladder to the outside -Answer- Urethra What is the urethra? -Answer- Membranous Hollow Canal, measure 4-6mm What is associated with the junctional parenchyma defect? -Answer- -Seen in upper to mid pole as an echogenic triangular, linear structure -Better seen in the longitudinal plane -May mimic an echogenic mass A simple ectopia is more often seen where? -Answer- The pelvis A horseshoe kidney is also called what? -Answer- Renal fusion What is a horseshoe kidney? -Answer- When two kidneys are fused or joined together What should be seen on ultrasound with a horseshoe kidney? -Answer- -Isthmus should be imaged with ultrasound to confirm the diagnosis -Isthmus is seen midline lower abdomen over the great vessels -In some cases, loss of normal renal outline or reniform, instead they look with some degree of rotation or malrotation What type of horseshoe kidney is the most common? -Answer- The one where the lower poles fuse together How does a complete duplication of a collecting system appear on ultrasound? - Answer- -Two echogenic regions separated by parenchymal tissue -2 separate collecting systems in one kidney The duplicated ureter commonly has a stenotic opening into the bladder and forms what? -Answer- A ureterocele How does a duplex collecting system appear on ultrasound in a transverse imaging plane? -Answer- No echogenic renal pelvis seen on a transverse view at the level of the mid pole What is associated with a parapelvic cyst? -Answer- -Originates from renal parenchyma and seen in the renal hilum -May present with hypertension What are the sonographic findings of a parapelvic cyst? -Answer- -Same criteria as for simple cyst but located within the renal pelvis -Solitary and large -Does not communicate with collecting system Where does a peripelvic cyst originate? -Answer- In the renal sinus from the lymphatic system What are the sonographic findings of a peripelvic cyst? -Answer- -Small, multiple, and irregular in shape -May appear as dilated pelvis -Does not communicate with collecting system What are posterior urethral valves (PUV)? -Answer- Obstructive membranes that develop in the urethra (the tube that drains urine from the bladder) and are most commonly seen in boys What valve can obstruct or block the outflow of urine through the urethra? -AnswerPosterior urethra valve (PUV) What is a copum? -Answer- Extra tissue in the distal urethra What are the sonographic findings for posterior urethra valve (PUV)? -Answer- -The bladder has a distinct "keyhole" appearance and massive bladder, hydroureters, and hydronephrosis -Bilateral hydronephrosis What are the procedures to fix the condition of a posterior urethra valve? -AnswerAblation and vesicostomy What are other names for adult polycystic kidney disease (APKD)? -Answer- Autosomal dominant polycystic kidney disease (ADPKD) or Potter type III What is adult polycystic kidney disease (APKD)? -Answer- -An autosomal dominant disease and the most common disorder. -The disease may be latent for many years and not manifest itself until the fourth decade. What are the clinical findings associated with adult polycystic kidney disease? -Answer- -Patients present with decreasing renal function, and hypertension -May have flank pain -Associated findings include cysts in the liver, pancreas, and spleen. What are the sonographic findings of adult polycystic kidney disease? -AnswerPresents as bilateral large kidneys with randomly distributed cortical cysts of various sizes, and in the advanced stages, the kidneys lose the reniform shape