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ULTRASOUND DIAGNOSIS

OF KIDNEY DISEASES
Christian Gh Klein, MD
University Hospital Clinic of
Nephrology Carol Davila
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Renal ultrasonography.
Indications
Urinary tract infections
Renal colic
Macroscopic haematuria
Congenital abnomalies
Obstructive uropathy
Urolithiasis
Nephrocalcinosis
Differential diagnosis of abdominal solid masses from cystic masses
Benign renal neoplasm
Malignant renal neoplasm
Renal parenchyma diseases
Cystic diseases of the kidney
Renal trauma
Vascular diseases
Renal transplants
Acute renal failure
Chronic renal failure
Sonographically guided renal biopsy
Sonographically guided percutaneous nephrostomy
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Size of normal adult kidney
Male Female
Longitudinal axis Right Kidney
11.30.8
(10.5-12.1)
10.80.8
(10-11.6)
Left Kidney
11.50.9
(10.6-12.4)
10.91
(9.9-11.9)
Cross sectional area 16-30 cm
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16-30 cm
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Volume (ml) Right Kidney
14738
(109-185)
11827
(91-145)
Left Kidney
15437
(117-191)
12526
(99-151)
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Characteristics of normal adult
kidney
Characteristic
Size
Echogenicity
Parenchyma
Renal sinus
Surface
Appearance
Average: 11cm (range, 9-13cm)
Right, liver, left < spleen
Homogeneous (except for
hypoechoic pyramids)
Hyperechoic
Smooth
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Features who are evaluate in
renal ultrasonography
Kidney position
Kidney size
Kidney surface
Kidney anatomy
Cortical renal parenchyma: Echogenicity, size
Medullar renal parenchyma: Echogenicity, size
Renal sinus: pelvis, calyces, arteries, veins
Visualization of other abdominal organs: liver, spleen,
abdominal aorta, vena cava inferior, ureteres, prostate,
bladder, urethra, pelvis and uterus.
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Renal Contour Abnormalities
Normal variants:
Fetal lobulation
Dromedary kidney
Hypertrophy of the renal column of Bertin
Prominence of the renal contour:
Cysts
Abscesses
Perinephretic hematoma
Neoplasm
Retraction of renal contour:
Renal infarction
Chronic pyelonephritis (obstruction, vesicoureteral reflux)
Kidney duplication
Segmental renal hypoplasia: Ask-Upmark kidney
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Renal Size Abnormalities
Bilateral Renal Enlargement (Nephromegaly)
Acute pyelonephritis
Acute glomerulonephritis
Nephrotic syndrome
Bilateral hydronephrosis
Autosomal dominant kidney polycystic disease
Acute renal failure
Amyloidosis, myeloma, lymphoma, leukemia
Bilateral Neoplasm
Renal bilateral venous thrombosis
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Renal Size Abnormalities
Unilateral Renal Enlargement (Nephromegaly)
Unilateral acute pyelonephritis
Unilateral hydronephrosis
Renal abscess
Neoplasm
Benign unilateral cysts (simple cysts, multiloculated
cysts, cystic dysplastic kidney)
Renal venous thrombosis
Renal congenital abnomalies: renal duplication,
renal ectopy with fusion of lower or upper pole
Compensatory hypertrophy (unilateral renal
agenesis, unilateral hypoplasia, nephrectomia)
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Renal Size Abnormalities
Bilateral Small Kidneys
Chronic glomerulonephritis (both kidney equal size,
renal symmetry)
Chronic pyelonephritis (kidney with unequal size,
one of them are atrophic, renal asymmetry)
Bilateral renal artery stenosis
Nephrosclerosis
Bilateral renal hypoplasia
End-stage inflammatory renal disease (end-stage
chronic renal failure)
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Renal Size Abnormalities
Unilateral Small Kidney
Chronic pyelonephritis
Hydronephrosis (end stage)
Reflux nephropathy
Renal artery stenosis
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Renal Anatomy (Structure)
Abnormalities
Abnormalities of Renal Sinus
Duplication
Incomplete
Renal pyramid hypertrophy
Bertin column hypertrophy
Pelvic duplication
Complete
Complete or incomplete ureteral duplication
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Renal Anatomy (Structure)
Abnormalities
Anechoic images in renal sinus
Hydronephrosis
Caliceal diverticula (caliceal cysts)
Peripelvic cysts
Hypoechoic images in renal sinus
Sinusal lipomatosis
Neoplasm
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Renal Anatomy (Structure)
Abnormalities
Hypoechoic images in renal sinus
Sinusal lipomatosis
Neoplasm
Hyperechoic images with acoustic shadow in the
renal sinus
Renal calculi: caliceal stones, pelvic stones
Arcuate calcifications (curved, ring shaped):
hydatic cysts, abscesses, aneurysms
Dystrophic calcifications: xantogranulomatous
pyelonephritis
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Renal Anatomy (Structure)
Abnormalities
Abnormalities of renal parenchyma
Calcifications
Diffuse
Cortical
Chronic glomerulonephritis
Acute cortical necrosis
Renal transplant rejection
Cortical nephrocalcinosis, rare: acute
cortical necrosis, hyperoxaluria
Medullar
Medullary nephrocalcinosis: distal tubular
acidosis, hyperparathyroidism, medullary
sponge kidney
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Renal Anatomy (Structure)
Abnormalities
Abnormalities of renal parenchyma
Calcifications
Localized
Cortical
Tuberculosis
Renal infarction
Medullary
Hyperechoic images calcifications:
angiomyolipoma
Ring calcifications: tuberculosis cavern,
echinococcal cyst, abscess
Anarchic: renal cell carcinoma
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Renal Anatomy (Structure)
Abnormalities
Abnormalities of renal parenchyma
Anechoic images in renal parenchyma
Hereditary cysts: autosomal dominant polycystic
disease, von Hippel- Lindau disease, tuberous
sclerosis Bourneville
Congenital non-hereditary cysts: cystic dysplastic
kidney, medullary sponge kidney
Acquired cysts
Solid localized images (hypoechoic, hyperechoic):
Abscess
Xantogranulomatous pyelonephritis
Benign renal neoplasms
Malignant renal neoplasms
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Renal Anatomy (Structure)
Abnormalities
Diffuse hyperechoic abnormalities of renal
parenchyma
With normal renal size
Glomerulonephritis: acute, chronic
Acute pyelonephritis: areas of both increased
and decreased echogenicity
Chronic pyelonephritis
Acute renal failure: acute tubulointerstitial
nephropathy
Chronic rejection of renal graft
Amyloidosis and glomerular diseases with
monoclonal immunoglobulin deposition
With small kidney
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Perirenal abnormalities
Hematoma
Abscess
Neoplasms
Urinoma
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Causes of hydronephrosis
COMMON
Obstruction
Previous obstruction
Extrarenal pelvis
Distended bladder
Pregnancy
UNCOMMON
Active diuresis
Diabetes insipidus
Reflux nephropathy
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Renal cystic diseases
Kidney
size
Kidney
tumors
Extrarenal
cysts
Extrarenal
lesions
APKD Large None Liver Cerebral aneurysms
VHL Normal/large RCC Pancreas
Pancreas cystic neoplasms
Pancreas islet cell tumors
Pheochromocytomas
SNC hemangioblastomas
Retinal angiomas
ACD Small RCC None None
TS Normal/large AML None
Cerebral hamartomas
Periventricularnodules
Subungual fibromas
Cardiac rhabdomyomas
Lung lymphangiomyomatosis
APKD, adult polycystic kidney disease; VHL, von Hippel-Lindau disease; RCC, renal cell
carcinoma; CNS, central nervous system; ACD, acquired cystic disease; TS, tuberous
sclerosis; AML, angiomyolipoma