Kidneys:

ANATOMY:
• Paired organs, retroperitoneal, on the
posterior abdominal wall.
• Right kidney is slightly lower than left.
• With contraction of diaphragm both kidneys
move by as much as 2.5cm downwards.
• Medial border has Hilum, which extends into a
large cavity Renal sinus.
• Hilum transmits renal artery, vein, nerves and
renal pelvis.
Renal Structures:
• Outer Cortex, inner Medulla.
• Cortex extends into medulla between
pyramids as renal columns.

• Medulla is composed of 12 pyramids.

• Apex of pyramid is Renal papilla.
Renal Structures
Renal papilla

Minor calyx

Major calyx

Renal pelvis

Ureter

U Bladder

Urethra
Sonographic appearance:
• Renal sinus include Calyces, Renal vessels and
intermittent fibro fatty tissue.
• Fibro fatty tissue appear echogenic.
• Renal vessels and collecting system containing
fluid appear anechoic within echogenic tissues.
• Pyramids are cone shaped hypo echoic structures.
• Cortex is slightly more echogenic than Pyramids.
using the liver as a window and from a posterolateral approach shows a central echogenic
renal sinus (S) and a peripheral hypoechoic renal cortex that is slightly less echogenic than the
adjacent liver. Between the sinus and the cortex are several hypoechoic pyramids (asterisks)
 Characteristics of Normal Kidney
Charecteristics Appearance

Size L=9-13cm,AP=3-4cm,
W=4-5cm
Echogenicity Less than Liver and Spleen

Parenchyma Homogenous

Renal sinus Hyper echoic

Pyramids Hypo echoic

Surface Smooth

Contours Smooth

Volume L*T*W/2
Normal variants:
The external contour of the kidney is generally
smooth. A common normal variant, called the
junctional parenchymal defect, produces a
wedge-shaped hyper echoic defect in the anterior
aspect of the kidney near the junction of the upper
and middle thirds. can be distinguished from a scar
or mass by its typical triangle-shape and location. In
addition, the junctional parenchymal defect
communicates with the renal sinus medially at the
level where the renal vessels exit the hilum.
Longitudinal view shows a triangular echogenic defect (arrow) in the anterior aspect of the
kidney near the junction of the upper and middle thirds typical of a junctional parenchymal
defect
Congenital anomalies & variations
• 1. Dromedry Hump :
– it is localized cortical bulge On lateral side of left
kidney.
– Dromedary hump of the left kidney that should not
be mistaken for a tumor.

• 2.Persistent fetal lobulation :

– Normal kidney formed by the fusion of multiple renal
masses during embryological.
– The site of fusion of these masses may persist till
adult life and is manifested as lobular outer contour of
kidneys.
Fetal lobation. Longitudinal view shows slight indentations on the external surface of
the kidney
 Congenital anomalies & variations
• 3. Renal agenesis :
– Bilateral is not compatible with life.
– Unilateral kidney is an incidental finding with
hypertrophy of other kidney.

• 4.Duplex collecting system :

– May have duplication of calyceal system only or
with ureters as well.
– Duplicated ureter opens at ectopic site.
Longitudinal view of the left upper quadrant shows an empty renal fossa inferior to
the spleen
 Congenital anomalies &
variations
• 5. Renal ectopia :
– A number of congenital variations in the location
of kidney may occur.
– Pelvic kidney is most common.

• 6.Crossed ectopia:
– Kidney lying on the opposite side and may be
found in the pelbvis or high up.
⚫ These are some images of a 25-year-woman that presented with a severe abdominal pain
and fever at 9 weeks. An ultrasound examination revealed a pelvic kidney and a normal
fetus.
Congenital anomalies & variations

7. Horseshoe kidney :

– It is a variant of fused renal ectopia.

– Upper or lower pole of kidney fused during fetal
life.
RENAL CALCULI:
Urolithiasis is an extremely common problem,
affecting 12% of the population by the age of 70.
It affects men up to three times more often than
women and is more common in whites than in
other racial groups. Risk factors include low fluid
intake and diets high in animal protein.
Sonography:
Stones of sufficient size produce an echogenic
focus in the renal sinus with an associated
acoustic shadow. Stones that are 3 mm or
smaller are a diagnostic problem because they
are hard to separate from the echogenic renal
sinus itself. Efforts should therefore be made to
identify a shadow using a high-frequency
transducer that is focused at the appropriate
depth and by viewing the stone from a variety of
approaches.
Hydronephrosis:
• There is accumulation of fluid in Renal calyces , pelvis
and renal sinus.
• It appears as anechoic area instead of being echogenic.
• Finger sign , the dilated pelvicalyceal system in
hydronephrosis connects like fingers.
• Always check for post void changes.
Hydronephrosis
Hydronephrosis
Mild:
Moderate:
Severe :
Renal cysts:
Renal cysts are the most common renal mass.
Their frequency increases with age and they are
present in half of the population above the age
of 50. The etiology of renal cysts is not known.
Sonography:
Sonography is the most accurate way to
evaluate cystic lesions in the kidney To qualify as
a simple cyst, the lesion should have the
following characteristics:
• 1. Anechoic lumen
• 2. Well-defined back wall
• 3. Acoustic enhancement deep to the lesion
• 4. No measurable wall thickness
Renal cysts
Renal cysts:
These can be :
• Simple cyst

• Hemorrhagic cysts.
• Multicystic kidneys.
Hemorrhagic cyst:
Hemorrhage may cause diffuse low-level
internal echoes, fibrinous membranes, internal
echogenic clots, or a fluid-debris level. These
appearances can overlap with those of cystic
renal cell cancer.
Hemorrhagic cyst
Renal Cell Carcinoma:
RCC constitutes approximately 90% of the
primary renal malignancies and is the most
common solid renal mass in adults.
Sonogrphy:
Fifty percent of RCCs are hyper echoic compared
with the normal adjacent renal parenchyma.
Forty percent are only slightly more echogenic
than the renal parenchyma, but 10% are
markedly hyper echoic, to the point that they
are similar to the echogenicity of the renal sinus.
Thirty percent of renal cell cancers are isoechoic
to the renal parenchyma and 10% are hypo
echoic.
Hyper echoic renal cell cancer
Isoechoic renal cell cancer
Hypo echoic renal cell cancer
RENAL PARENCHYMAL DISEASE:
A large number of diseases affect the renal
parenchyma and produce renal failure. The term
medical renal disease is often used but is not
truly appropriate because some of these
patients will benefit from a surgical procedure.
Sonography:
Increased parenchymal echogenicity is often
seen in the setting of renal parenchymal disease.
Echogenicity is considered increased when the
right kidney is more echogenic than the liver or
when the echogenicity of the left kidney is equal
to or greater than that of the spleen. Small
amounts of perinephric fluid may be seen with
acute renal failure.
Longitudinal view of the right kidney (K) shows that it is slightly more echogenic than the liver