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Sectional Anatomy. Renal. Ultrasound Techniques. Supine or decubitus LLD - Rt kidney RLD - Lt kidney Kidney is scanned in sagittal, transverse, & coronal Sagittal & coronal - renal capsule is smooth bean shaped. Ultrasound Techniques. Transverse - shape varies at different levels

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Sectional Anatomy

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Sectional anatomy l.jpg

Sectional Anatomy

Renal

CS-Renal-L.Zanin


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Ultrasound Techniques

  • Supine or decubitus

  • LLD - Rt kidney

  • RLD - Lt kidney

  • Kidney is scanned in sagittal, transverse, & coronal

  • Sagittal & coronal - renal capsule is smooth bean shaped

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Ultrasound Techniques

  • Transverse - shape varies at different levels

  • Upper & lower poles are round or oral shaped

  • Midportion slightly indented in the hilium region

  • Kidney develops from lobes that fuse together

  • They develop in the pelvis embryonicly and ascends to abdomen by birth

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Renal Upper Pole

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Renal Mid-portion

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Renal Lower Pole

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Kidney Anatomy

  • Retroperitoneal organ

  • Kidney surrounded by fibrous capsule

  • Surrounding the encapsulated kidney is perinephric fat

  • Enclosing kidney’s, perinephric fat and adrenals is a fibrous sheath, called Gerotas Fascia

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Renal Long

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Renal Long

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Renal Long

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Renals

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Kidney Anatomy

  • Retroperitoneal organ

    Renal Parenchyma can be divided into:

    Renal Cortex (outer portion)

  • Consists of glomerula complex

  • Occupies outer 1/3 of parenchyma

  • Moderately hypoechoic outer zone

  • Slightly less echogenic than liver

    Medulla (inner portion)

  • Pyramids – contain collecting tubles and loops of Hnle

  • Column of bertin is cortical tissue that extends inward toward the renal sinus between the pyramids

  • Appears echogenic, when it is enlarged they appear as pseudotumers

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Column of Bertin

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Kidney Anatomy

Renal Sinus (Center of the kidney)

  • Sinus is centrally located, oblong, and highly echogenic

  • Contains vessels, fat, normally collapsed calyces, arteries and veins, lymphatics, peripelvic fat, fibrous tissues and part of the renal pelvis

    Vaculature of the Kidney

  • Vessels that can be identified include the main renal artery and vein, interlobar artery & vein, and arcuate artery & vein

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Renal Sinus

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Renal Sinus

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Renal Sinus

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Renal Anatomy

Collecting System

  • Minor caylces - 7-13 per kidney, they are found adjacent tot the renal pyramids and connect to the major calyces

  • Major caylces - 2-3 per kidney, they connect to the renal pelvis

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Renal Anatomy

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Renal

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Left Kidney

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Renal Sinus & Cortex

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Renal Sinus & Cortex

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Sonographic Appearance

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Renal

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Renal

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Kidney Anatomy

Renal Medulla (pyramids)

  • Occupies inner 2/3 of parenchyma

  • Triangular inner portion of kidneys that surrounds the renal sinus

  • Represents loops of Henley and the collecting tubules

  • Pyramids are separated from each other by bands of cortical tissue called columns of Bertin

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Renal Anatomy

  • Apex of the pyramid is directed toward the sinus and base forms a junction with cortex - called corticomedullary junction.

  • Arcuate arteries seen at the corticomedullary junction & the interlobar arteries seen between each pyramid

  • Infants pyramids appear larger and are hypoechoic

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Renal Anatomy

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Renals

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Renals

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Normal Renal Anatomy

Normal adult kidney measures 8-13 cm in length and has smooth contour

  • Adult:11.5 X 6 X 3.5 (ap)

  • Renal Blood Supply

  • Renal artery enters the hilium, it branches into 4-5 segmental arteries

  • Interlobar arteries found between pyramids, they go up and over the pyramids to form arcuate arteries

  • Arcuate arteries branch to form interlobular arteries

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Normal Renal Anatomy

  • Interlobular arteries enter the glomeruli and empty into the capillaries

  • From the capillaries the blood travels through the interlobular, arcuate, interlobar, to the renal vein

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Renal hilus

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Power Doppler

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Power Doppler

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Power Doppler

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Renal system

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Color Doppler

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Renal Functions

Renal Function

1. Water regulation

  • Under influence of (ADH) anti-diuretic hormone, water absorption is controlled by blood osmosis

    2. Salt Balance

  • Essential to maintain fluid and maintain blood pressure

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Renal Functions

3. PH maintenance

  • Controlled by excretion of hydrogen

    4. Excretion of urea, creatinine, and other end products of metabolism

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Lab Values

Serum Creatine

  • Measures renal function

  • Elevation means a disturbance in renal function which is due to a large number of nephrons being destroyed

  • More sensitive than BUN in determining renal dysfunction

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Lab Values

BUN - (blood urea nitrogen)

  • Urea is an end product of protein metabolism and it is excreted by kidney's so blood urea concentrations is normally low

  • Rises when kidney's ability to excrete urea is impaired

  • Elevated levels may lead to mental confusion, disorientation & coma

  • Other diseases that may cause BUN to elevate: GI bleeding - Congestive heart failure - Shock

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Normal Anatomic Variants

Dromedary Hump

  • Bulging of the lateral aspect of the left kidney probably due to developmental relationship between the kidney & spleen

    Ultrasound Findings:

  • Coronal -lateral contour bulge of the kidney without evidence of parenchymal disruption

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Normal Anatomic Variants

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Normal Anatomic Variants

Hypertrophied Column of Bertin

  • Isoechoic & contiguous with the renal cortex

  • Located between renal pyramids

  • Triangular or blunted shape

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Normal Anatomic Variants

Renal Sinus Lipomatosis

  • Isoechoic and continuous with the perirenal & sinus fat

  • An increase in the renal sinus fat

  • No clinical significance

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Congenital Anomalies

Solitary kidney

  • One normal functioning kidney with the other undeveloped and not seen, it is atrophied

    Unilateral renal agenesis

  • Absence of one side of the collecting system

  • No kidney or ureter developed

  • Associated with uterine or testicular variants

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Congenital Anomalies

Bilateral Renal Agenesis

  • Fatal - not compatible with life

  • Infant dies shortly after birth

  • Associated with Potter's syndrome

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Congenital Anomalies

Supranumerary Kidney

  • Duplication of the ureters and pelvis with a single kidney

  • Double collecting system

  • Sonographicly demonstrates two separate central sinus echoes separated by cortical tissue

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Supranumerary Kidney

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Congenital Anomalies

Megacalyces/Megaureter

  • Congenital condition consists of nonobstructive enlargement of the calyces

  • There are usually less calyces with this condition

  • The appearance on ultrasound is identical to obstructive hydronephrosis or dilatation secondary to vesicoureteral reflux

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Megacalyces/Megaureter

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Congenital Anomalies

Pelvic Kidney

  • In the embryo the kidneys develop in the pelvis and migrate upward, they ascend and rotate to the adult position

  • Right kidney lower than left kidney

  • Ascend by 5-6 years

  • Incomplete ascension leads to ectopic kidneys

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Pelvic Kidney

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Congenital Anomalies

Horseshoe Kidney

  • Form of renal fusion

  • Fused at the lower pole with the connecting bridge located just anterior to the aorta

  • Isthmus (connection) is seen at about the level of the aortic bifurcation

    Cross-fused Renal Ectopia

  • Kidneys are positional in the same quadrant and are fused together

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Horseshoe Kidney

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MRI of the Kidneys

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MRI of the Kidneys

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