unilateral small kidney
TRANSCRIPT
DISCUSS THE CAUSES OF UNILATERAL SMALL
KIDNEY AND THE ROLE OF IMAGING IN ESTABLISHING
A DIAGNOSIS
BY
DR.MAIMUNA A. HALLIRURADIOLOGY DEPARTMENT
AMINU KANO TEACHING HOSPITAL02-09-2013
SYNOPSIS
INTRODUCTION
CAUSES OF UNILATERAL SMALL KIDNEY
ROLE OF IMAGING IN ESTABLISHING A DIAGNOSIS
SUMMARY/CONCLUSION
INTRODUCTION
DEFINITION OF UNILATERAL SMALL KIDNEY
CAUSES OF UNILATERAL SMALL KIDNEY
PRE-RENAL/VASCULAR
INTRA-RENAL/PARENCHYMAL
POST-RENAL/COLLECTING SYSTEM
PRE-RENAL CAUSES
RENAL ARTERY STENOSIS
DOPPLER ULTRASONOGRAPHYNORMAL PATTERN: RAPID UPSTROKE & EARLY SYSTOLIC PEAK (ARROW)
TARDUS & PARVUS WAVEFORM: SLOWED UPSTROKE & LOW AMPLITUDE PEAK
COMPUTED TOMOGRAPHIC ANGIOGRAPHY
Delayed nephrogram on CT
COMPUTED TOMOGRAPHIC ANGIOGRAPHY
CT- arterial phase : Differential perfusion
MAGNETIC RESONANCE ANGIOGRAPHY
INTRAVENOUS UROGRAPHY
DENSE PERSISTENT NEPHROGRAM WITH POOR EXCRETION OF CONTRAST MEDIUM
ANGIOGRAPHY
BILATERAL RENAL ARTERY STENOSIS
ANGIOPLASTY + STENT PLACEMENT
ANGIOGRAPHY
BEADED, ANEURYSMAL APPEARANCE OF THE RIGHT RENAL ARTERY IN FIBROMUSCULAR DYSPLASIA
RENAL SCINTIGRAPHY
RENAL INFARCTION
INTRAVENOUS UROGRAPHY
(A) An initial nephrotomogram demonstrates a thin cortical rim surrounding the right kidney (arrows), reflecting viable renal cortex perfused by perforating collateral vessels from the renal capsule. (B) Four months later, a repeat nephrotomogram shows a marked decrease in the size of the atrophic right kidney (arrowheads).
COMPUTED TOMOGRAPHY
C+ portal venous phase CT demonstrates a wedge of poorly / non-enhancing renal parenchyma at the upper pole
COMPUTED TOMOGRAPHY
CT demonstrates a non-enhancing thrombus extending into the renal vein
COMPUTED TOMOGRAPHY
ULTRASONOGRAPHY
Heterogeneous mass at the upper pole of the kidney.
ANGIOGRAPHY
Angiography showing a renal infarction
RADIATION NEPHROPATHY
Comparison of static renal scintigraphy before (C) and 12 months after (D) chemoradiation shows a new activity defect (black arrows) in the cranial third of the right kidney consistent with the volume of kidney included
within the radiation field.
INTRA-RENAL CAUSES
CONGENITAL HYPOPLASIA
INTRAVENOUS UROGRAPHY
SMALL LEFT KIDNEY WITH PRESERVED ALBEIT REDUCED RENAL FUNCTION
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
RENAL DYSPLASIA
INTRAVENOUS UROGRAPHY
Renal dysplasia in Laurence-Moon-Biedlsyndrome showing poorly developed papillae and small communicating calyceal diverticula on IVU.
POST-INFECTIVE ATROPHY
RENAL SCINTIGRAPHY
Post infective scarring.99mTc-DMSA study showing normal left kidney; scarred right upper pole (arrows)
REFLUX NEPHROPATHY
INTRAVENOUS UROGRAPHY
Demonstrates bilateral diffuse calyceal clubbing (arrows) and deformity accompanied by thinning of the adjacent renal parenchyma (arrowheads)
ULTRASONOGRAPHY
Normal parenchymal thickness in the upper portion of the kidney and generalized marked parenchymal thinning in the lower portion. The latter reflects chronic pyelonephritic scarring secondary to urinary tract infection and vesicoureteral reflux that occurred in childhood.
COMPUTED TOMOGRAPHY
POST-OBSTRUCTIVE ATROPHY
COMPUTED TOMOGRAPHY
ROLE OF IMAGING IN ESTABLISHING A
DIAGNOSIS
CONVENTIONAL RADIOGRAPHY
ULTRASONOGRAPHY: B-MODE & DOPPLER
ULTRASONOGRAPHY
Normal parenchymal thickness in the upper portion of the kidney and generalized marked parenchymal thinning in the lower portion. The latter reflects chronic pyelonephritic scarring secondary to urinary tract infection and vesicoureteral reflux that occurred in childhood.
ULTRASONOGRAPHY
Heterogeneous mass at the upper pole of the kidney.
DOPPLER ULTRASONOGRAPHYNORMAL PATTERN: RAPID UPSTROKE & EARLY SYSTOLIC PEAK (ARROW)
TARDUS & PARVUS WAVEFORM: SLOWED UPSTROKE & LOW AMPLITUDE PEAK
INTRAVENOUS UROGRAPHY
INTRAVENOUS UROGRAPHY
DENSE PERSISTENT NEPHROGRAM WITH POOR EXCRETION OF CONTRAST MEDIUM
INTRAVENOUS UROGRAPHY
(A) An initial nephrotomogram demonstrates a thin cortical rim surrounding the right kidney (arrows), reflecting viable renal cortex perfused by perforating collateral vessels from the renal capsule. (B) Four months later, a repeat nephrotomogram shows a marked decrease in the size of the atrophic right kidney (arrowheads).
INTRAVENOUS UROGRAPHY
SMALL LEFT KIDNEY WITH PRESERVED ALBEIT REDUCED RENAL FUNCTION
COMPUTED TOMOGRAPHY/CTA
NARROWED SEGMENT OF LEFT MAIN RENAL ARTERY
COMPUTED TOMOGRAPHY
COMPUTED TOMOGRAPHY
CORTICAL DEFECTS ON CECT IN RENAL INFARCTION
COMPUTED TOMOGRAPHY
RENAL SCARRING IN REFLUX NEPHROPATHY
MAGNETIC RESONANCE IMAGING/ MRA
MAGNETIC RESONANCE ANGIOGRAPHY
RENAL ARTERY STENOSIS
MAGNETIC RESONANCE IMAGING
RENAL HYPOPLASIA
RENAL SCINTIGRAPHY
DIFFERENTIAL PERFUSION IN RAS
RENAL SCINTIGRAPHY
Post infective scarring.99mTc-DMSA study showing normal left kidney; scarred right upper pole (arrows)
Comparison of static renal scintigraphy before (C) and 12 months after (D) chemoradiation shows a new activity defect (black arrows) in the cranial third of the right kidney consistent with the volume of kidney included
within the radiation field.
DIGITAL SUBTRACTED ANGIOGRAPHY
ANGIOGRAPHY
BILATERAL RENAL ARTERY STENOSIS
ANGIOPLASTY + STENT PLACEMENT
ANGIOGRAPHY
Angiography showing a renal infarction
CONCLUSION/SUMMARY