CH 25 Renal Vasculature

• Which of the following is NOT a limitation of contrast angiography?

  a.detailed anatomic information

  b.lack of hemodynamic information

  c.no identification of functional significance of renal artery disease

  d.invasive with possible nephrotoxic contrast

  a.detailed anatomic information
• Which of the following is true regarding duplex ultrasound assessment of the renal vasculature?

  a.provides anatomic information

  b.provides hemodynamic information

  c.painless and noninvasive

  d.all of the above

  d.all of the above
• What is the normal length measurement of the kidney?

  a.4 to 5 cm

  b.9 to 13 cm

  c.10 to 15 cm

  d.5 to 7 cm

  b.9 to 13 cm
• What are kidneys that are joined at the lower poles by an isthmus of tissue that lies anterior to the aorta?

  a.ectopic kidneys

  b.cross-fused kidneys

  c.horseshoe kidneys

  d.junctional kidneys

  c.horseshoe kidneys
• Why is the renal sinus normally brightly echogenic on a sonographic image?

  a.lymphatic vessel location

  b.fat and fibrous tissue in the sinus

  c.increased blood flow in the area

  d.fluid from the collecting system

  b.fat and fibrous tissue in the sinus
• What are the triangular-shaped structures within the inner portion of the kidney that carry urine from the cortex to the renal pelvis?

  a.nephrons

  b.columns of Bertin

  c.renal pyramids

  d.renal calyces

  c.renal pyramids
• What is the most common congenital anomaly of the urinary tract?

  a.duplication of the renal collecting system

  b.absence of one or both kidneys

  c.junctional kidneys

  d.ureteropelvic junction malformation

  a.duplication of the renal collecting system
• The right renal artery initially courses __________ from the aorta, then passes __________ to the inferior vena cava.

  a.posterolateral, anterior

  b.posterior, superior

  c.anterolateral, lateral

  d.anterolateral, posterior

  d.anterolateral, posterior
• Which vessel courses anterior to the aorta but posterior to the superior mesenteric artery and anterior to both renal arteries?

  a.splenic vein

  b.right renal vein

  c.left renal vein

  d.inferior mesenteric vein

  c.left renal vein
• In which of the following renal artery segments does atherosclerotic disease in the renal artery typically occur?

  a.origin to proximal third

  b.distal renal artery just before entering the kidney

  c.mid-to-distal segment

  d.interlobar arteries within the renal parenchyma

  a.origin to proximal third
• Which of the following patients would be suspected of fibromuscular dysplasia in the renal artery?

  a.an 85-year-old diabetic male

  b.a 66-year-old female with a history of well-controlled hypertension and smoking

  c.a 25-year-old male with chronic asthma

  d.a 32-year-old female with poorly controlled hypertension

  d.a 32-year-old female with poorly controlled hypertension
• What is the most appropriate transducer for use in the evaluation of the renal arteries?

  a.7 to 10 MHz straight linear

  b.2 to 5 MHz curved linear

  c.1 to 2 MHz vector array

  d.5 to 8 MHz phased sector array

  b.2 to 5 MHz curved linear
• At which level is a spectral Doppler waveform with peak systolic velocity needed from the aorta for use in the renal–aortic ratio?

  a.proximal, at the level of the celiac and superior mesenteric arteries

  b.mid, at the level of the renal arteries

  c.distal, at the level of the inferior mesenteric artery

  d.distal, at the level of the common iliac bifurcation

  a.proximal, at the level of the celiac and superior mesenteric arteries
• To identify the renal artery ostia from a midline approach, an image is obtained from which location?

  a.transverse, at the level of the celiac artery

  b.sagittal, at the level of the celiac artery

  c.transverse, slightly inferior to the superior mesenteric artery

  d.sagittal, slightly superior to the left renal vein

  c.transverse, slightly inferior to the superior mesenteric artery
• Which of the following is an ultrasound modality that has a low-angle dependence that may be helpful in identifying duplicate renal arteries?

  a.color-flow Doppler

  b.power Doppler

  c.spectral Doppler

  d.pulse inversion Doppler

  b.power Doppler
• Using which angle of insonation are flow patterns within the kidney parenchyma typically obtained with a spectral Doppler?

  a.60 degrees

  b.90 degrees

  c.0 degrees

  d.45 degrees

  c.0 degrees
• When comparing renal length from side to side, how much of a difference suggests compromised flow in the smaller kidney?

  a.1 cm

  b.2 mm

  c.3 mm

  d.3 cm

  a.1 cm
• Which of the following describe normal spectral Doppler waveform characteristics in the renal artery?

  a.high-resistance, minimal diastolic flow with velocities in the range of 90 to 120 cm/s

  b.low-resistance, high-diastolic flow with velocities in the range of 90 to 120 cm/s

  c.low-resistance, minimal diastolic flow with velocities in the range of 10 to 120 cm/s

  d.high-resistance, high-diastolic flow with velocities in the range of 50 to 70 cm/s

  b.low-resistance, high-diastolic flow with velocities in the range of 90 to 120 cm/s
• A patient presents to the vascular laboratory for a renal artery duplex evaluation. During the examination, velocities in the right renal artery origin reach 175 cm/s with no evidence of poststenotic turbulence. Velocities on the left were 100 cm/s. What do these findings suggest?

  a.right renal artery stenosis less than 60%

  b.left renal artery stenosis less than 60%

  c.right renal artery stenosis more than 60%

  d.left renal artery stenosis more than 60%

  a.right renal artery stenosis less than 60%
• Which of the following spectral Doppler waveform changes will NOT occur distal to a hemodynamically significant stenosis of the renal artery?

  a.delayed systolic upstroke

  b.loss of compliance peak

  c.decreased peak systolic velocity

  d.increased peak systolic velocity

  d.increased peak systolic velocity
• Which of the following findings within the kidney are consistent with renal artery occlusion?

  a.kidney length of greater than 10 cm, velocities less than 10 cm/s in the renal cortex

  b.kidney length of less than 9 cm, velocities less than 10 cm/s in the renal cortex

  c.kidney length greater than 13 cm with no detectable flow within the renal parenchyma

  d.kidney length less than 9 cm, velocities greater than 20 cm/s in the renal cortex

  b.kidney length of less than 9 cm, velocities less than 10 cm/s in the renal cortex
• A patient presents to the vascular lab with suspected acute tubular necrosis. Which of the following findings on the renal artery duplex examination would be consistent with this condition?

  a.renal artery velocities greater than 180 cm/s, EDR of 0.35

  b.renal artery velocities greater than 180 cm/s, RI of 0.6

  c.renal artery velocities of 70 cm/s, EDR of 0.19

  d.renal artery velocities of 70 cm/s, RI of 0.5

  c.renal artery velocities of 70 cm/s, EDR of 0.19
• What is measured to determine acceleration time?

  a.onset of systole to the early systolic peak

  b.onset of systole to the end of diastole

  c.onset of diastole to the early systolic peak

  d.end diastole to end systole

  a.onset of systole to the early systolic peak
• During a renal artery duplex examination, proximal aortic velocities of 100 cm/s, proximal right renal artery velocities of 200 cm/s, and proximal left renal artery velocities of 400 cm/s were found. Which of the following describes these findings?

  a.right RAR = 2.0, less than 60% stenosis, left RAR = 0.4, less than 60% stenosis

  b.right RAR = 0.2, more than 60% stenosis, left RAR = 0.4, more than 60% stenosis

  c.right RAR = 2.0, less than 60% stenosis, left RAR = 4.0, more than 60% stenosis

  c.right RAR = 2.0, less than 60% stenosis, left RAR = 4.0, more than 60% stenosis
• During the renal artery duplex examination, as in Question 24, for which renal artery would you expect to see poststenotic turbulence?

  a.right

  b.left

  c.both a and b

  d.neither a nor b

  b.left
• Which of the following may result in misinterpretation of the hilar acceleration time?

  a.elevated renovascular resistance

  b.systemic arterial stiffness

  c.renal artery stenosis in the 60% to 79% range

  d.all of the above

  d.all of the above
• Under which conditions is the renal-to-aortic ratio likely inaccurate?

  a.The abdominal aortic velocities are between 75 and 90 cm/s.

  b.The abdominal aortic velocities are over 100 cm/s or below 40 cm/s.

  c.The renal artery velocities exceed 300 cm/s.

  d.The renal artery velocities are below 100 cm/s.

  b.The abdominal aortic velocities are over 100 cm/s or below 40 cm/s.
• During renal duplex evaluation, the left renal vein near the hilum is noted to have continuous, nonphasic low-velocity flow. What do these findings suggest?

  a.renal artery stenosis

  b.normal renal vein findings

  c.proximal renal vein thrombosis

  d.distal renal vein thrombosis

  c.proximal renal vein thrombosis
• A patient presents to the vascular lab for follow-up after renal artery stent placement. Velocities within the distal segment of the stent reach 250 cm/s. At other follow-ups at 6 and 12 months, velocities in the distal stent remain 250 cm/s. What are these findings consistent with?

  a.increased velocity because of size mismatch from the stent to native vessel

  b.fixed stenosis at the distal end of the stent

  c.kinking of the stent, creating artificially elevated velocities

  d.stent collapse and failure

  a.increased velocity because of size mismatch from the stent to native vessel
• Which of the following represents renal duplex findings that demonstrate a high risk for renal atrophy and likely unsuccessful renal revascularization?

  a.renal artery PSV less than 400 cm/s and cortical EDV greater than 10 cm/s

  b.renal artery PSV greater than 400 cm/s and cortical EDV less than 5 cm/s

  c.renal artery PSV greater than 160 cm/s and cortical EDV less than 10 cm/s

  d.renal artery PSV greater than 200 cm/s and cortical EDV less than 5 cm/s

  b.renal artery PSV greater than 400 cm/s and cortical EDV less than 5 cm/s
• Patients with sudden onset of chronic hypertension, azotemia, unexplained renal insufficiency, or pulmonary edema should be evaluated for __________.

  renal artery stenosis
• In most patients, renal artery disease is correctable with treatment providing __________ for hypertension and stabilization of renal function in patients with chronic renal failure.

  control or cure
• Because of the __________ of the contrast agents, computed tomography angiography is often reserved for use as secondary confirmatory study.

  nephrotoxicity
• The kidneys are located __________ in the dorsal abdominal cavity between the 12th thoracic and third lumbar vertebrae.

  retroperitoneally
• For the purpose of sonographic examination of the kidney, it is divided into __________ main areas.

  4
• The renal arteries can be identified approximately __________ cm below the __________ plane, with the left renal artery slightly more cephalad than the right.

  2; transpyloric
• Duplicate main renal arteries that enter the kidney through the renal hilum or accessory polar arteries are present in __________ of patients.

  12% to 22%
• Owing to the location of the inferior vena cava, the right renal vein has a __________ course, and the left renal vein typically courses __________ to the aorta.

  short; anterior
• The second most common curable cause of renovascular disease is __________, which occurs most commonly in women aged 25 to 50 years.

  fibromuscular dysplasia
• Elevating the examination table, keeping the patient close to the sonographer's side, and not overextending the arm are all ways to maintain __________ positioning.

  ergonomic