Urinary System

Kidneys

Ureters
Bladder

Urethra

Physiology and Function

The main function of the urinary system is

to excrete urine.

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

Special Procedures cont.

Percutaneous Nephrostomy

Renal angiography
CT

Ultrasound
Nuclear medicine Extracorporeal shock wave lithotripsy

(ESWL)

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

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.

Supernmerary kidney
A third kidney that is usually small and

rudimentary and possesses a separate pelvis, ureter, and blood supply

Hypoplaisa (Hypoplastic kidney)

A kidney that is less developed than normal.

Compensatory hypertrophy
An acquired condition that develops when

one kidney is forced to perform the function normally carried out by two kidneys.

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.

Renal Ectopia
A misplaced kidney that are usually found

in the pelvis and associated with a short ureter.

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

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

Crossed Ectopy
One kidney lies either

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

Horseshoe kidney
Both kidneys are

joined at their lower poles across the midline of the body.

Complete Fusion
Both of the kidneys are fused together in a

single irregular mass which has no resemblance to a renal structure.

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.

Ureteroceles
Cyst like dilations of a ureter near its

opening into the bladder. Radiographically it has the classic cobra head appearance.

Diverticula
The bladder or ureters are common areas for

diverticula (out pouching of the wall). Best seen on a retrograde ureogram

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.

Pyelonephritis
A suppurative (pus forming)inflammation

of the kidney and renal pelvis. Radiographic findings reveal blunted calyces on and IVP

Cystitis
Inflammation of the urinary bladder that is

caused by bacteria. It is most common in women due to their short urethra.

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.

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

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.

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.

Radiographic findings of Hydronephrosis

IVP shows enlargement above the

obstruction site with no anatomy demonstrated below the obstruction.

Hypertension
The result of a narrowing of one or more

renal arteries.

Radiographic Findings of Hypertension

The kidney that is the source of

hypertension is usually smaller, shows delayed excretion, and over concentrates the contrast agent.

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.

Polycystic renal disease

An inherited renal cystic condition which is

the most common cause of enlarged kidneys.

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.

Radiographic Findings of Grawitz tumor

A space occupying lesion that distorts and

displaces the collecting system is demonstrated.

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.

Bladder carcinoma
The cancerous tumor usually projects into

the bladder causing a filling defect on the ureogram bladder radiograph.

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

Radiographic Findings of Acute Renal Failure

IVP reveals unusually large kidneys and a

prolonged nephrocortical blush.

Chronic renal failure

The slow, insidious and irreversible

progressive loss of renal function.

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.

THE END