Urinary System

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Urinary System

• Kidneys
• Ureters
• Bladder
• Urethra

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Physiology and Function

• The main function of the urinary system is to
  excrete urine.

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Special Procedures

• IVP
• Nephrography
• Hypertensive IVU
• Cystography
• Voiding cystography
• Retrograde urethrography
• Retrograde pyelography
• Percutaneous antegrade pyelography

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Special Procedures cont.

• Percutaneous Nephrostomy
• Renal angiography
• CT
• Ultrasound
• Nuclear medicine
• Extracorporeal shock wave lithotripsy (ESWL)

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Pathology definitions

• Oliguria a decrease in the amount of urine that
  is being passed.
• Polyuria too much urine is being excreted
• Anuria total suppression of urine formation and
  secretion
• Retetion the bladder does not release urine
• Hematuria blood in the urine
• Uremia toxic wastes in the blood
• Cystitis inflammation of bladder
• Pyelitis inflammation of the renal pelvis.
• Dysuria painful urination

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Renal agenesis (Solitary kidney)

• The total failure of a kidney to develop.
• Results from a failure of the embryonic renal bud
  or renal vascular system to form.

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Supernmerary kidney

• A third kidney that is usually small and
  rudimentary and possesses a separate pelvis,
  ureter, and blood supply

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Hypoplaisa (Hypoplastic kidney)

• A kidney that is less developed than normal.

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Compensatory hypertrophy

• An acquired condition that develops when one
  kidney is forced to perform the function normally
  carried out by two kidneys.

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Hyperplasia

• A kidney is over developed.
• It usually contains more that the usual number of
  cells so that the size of the kidney is larger
  than normal.

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Renal Ectopia

• A misplaced kidney that are usually found in the
  pelvis and associated with a short ureter.

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Anomalies of rotation, position and fusion

• Mal-rotation
• One or both kidneys may produce a bizarre
  appearance of the renal parenchyma, calyces, and
  pelvis that suggest a pathological condition when
  in reality the kidney is normal

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Anomalies of rotation, position and fusion

• Nephroptosis
• The kidney falls down into the pelvis when a
  person stands up due to the pull of gravity
• Also called floating kidney or ectopic kidney

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Crossed Ectopy

• One kidney lies either partially or completely
  across the midline and is fused with the other
  kidney at the lower pole.

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Horseshoe kidney

• Both kidneys are joined at their lower poles
  across the midline of the body.

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Complete Fusion

• Both of the kidneys are fused together in a
  single irregular mass which has no resemblance to
  a renal structure.

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Congenital Anomalies of the Urinary System

• Double System (bifid) may be a double renal
  pelvis or ureter or both
• It is possible to have a double kidney as well.

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Ureteroceles

• Cyst like dilations of a ureter near its opening
  into the bladder.
• Radiographically it has the classic cobra head
  appearance.

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Diverticula

• The bladder or ureters are common areas for
  diverticula (out pouching of the wall).
• Best seen on a retrograde ureogram

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Inflammatory Processes of the Urinary System

• Glomerulonephritis (bright disease) an
  inflammatory disease of the capillary loops of
  the renal glomeruli that filter blood through the
  kidneys.(secondary inflammation caused by
  immunologic factors)
• Ultrasound is the imaging modality of choice that
  demonstrates a small kidney which is a result
  from damage to the cortex.

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Pyelonephritis

• A suppurative (pus forming)inflammation of the
  kidney and renal pelvis.
• Radiographic findings reveal blunted calyces on
  and IVP

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Cystitis

• Inflammation of the urinary bladder that is
  caused by bacteria.
• It is most common in women due to their short
  urethra.

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Renal calculi

• Stones formed in the urinary tract, usually in
  the renal pelvis but may also be in the bladder.
• 80 of kidney stones contain enough calcium to
  be radiopaque and detectable on plain abdominal
  radiographs.

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Types of stones

• Staghorn a large stone that takes on the shape
  of the pelvicaliceal junction as it completely
  fills the renal pelvis.
• Nephrocalcinosis numerous irregular spots of
  calcium contained in the renal parenchyma

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Reflux

• Caused by an incompetent urethral valve that
  allows urine to flow back into the ureters and
  kidneys from the bladder.
• Radiographic findings if contrast material is
  seen in the ureter after filling the bladder
  there is reflux present.

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Hydronephrosis

• The result of some obstruction in the renal
  pelvis or ureter.
• It is characterized by dilation of the renal
  pelvis, calyces and ureter from back pressure of
  urine that can not flow past the obstruction.

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Radiographic findings of Hydronephrosis

• IVP shows enlargement above the obstruction site
  with no anatomy demonstrated below the
  obstruction.

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Hypertension

• The result of a narrowing of one or more renal
  arteries.

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Radiographic Findings of Hypertension

• The kidney that is the source of hypertension is
  usually smaller, shows delayed excretion, and
  over concentrates the contrast agent.

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Cysts and Tumors

• Renal cysts
• The most common unifocal masses of the kidney
• They are fluid filled and may vary in size
• They may be singular or multiple sites in one or
  both kidneys
• Ultrasound is the diagnostic method of choice.

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Polycystic renal disease

• An inherited renal cystic condition which is the
  most common cause of enlarged kidneys.

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Malignant tumors

• Hypoernephroma or Grawitz tumor (adenocarcinoma)
  arises from the renal tubule cells.
• Destroys the kidney and invades the blood vessels
  spreading the disease to the lungs and bones.

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Radiographic Findings ofGrawitz tumor

• A space occupying lesion that distorts and
  displaces the collecting system is demonstrated.

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Nephroblastoma (Wilms tumor)

• A malignant tumor composed of small spindle cells
  and various other types of tissue, including
  tubules and in some cases, structures resembling
  striated muscle and cartilage.
• Most commonly occurs in children under 5.
• It will metastasize if not caught early enough
  and treated with surgery that includes removal of
  the kidney.

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Bladder carcinoma

• The cancerous tumor usually projects into the
  bladder causing a filling defect on the ureogram
  bladder radiograph.

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Nephrosis (Acute Renal Failure)

• A tubular degeneration of the nephron of the
  kidney.
• Causes
• Ischemia (localized swelling)
• Toxic injury especially alcohol
• Decreased renal function due to an obstruction

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Radiographic Findings of Acute Renal Failure

• IVP reveals unusually large kidneys and a
  prolonged nephrocortical blush.

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Chronic renal failure

• The slow, insidious and irreversible progressive
  loss of renal function.

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Prostatic hypertrophy

• An enlarged prostate gland and subsequent
  obstruction of urinary output.
• Radiographically the bladder has a notched
  appearance from the prostate pushing up on the
  bladder.
• The bladder also has a lumpy appearance due to
  the trabecular cords of the inner surface of the
  bladder pulling on the wall.

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THE END