Nephrology Annual Meeting

Banjarmasin, March, 26
th
, 2011
Luthfy Mahatma Hadi
Radiology Dept. UGH , LM U School of Medicine

Congenital Anomalies :


Renal Agenesis, Renal Dysplasia/Hypoplasia, Renal Ectopic,
Renal Malrotated, Renal Duplication, Renal Fusion.





Benign Lesions :

Polycystic Disease of the Adult ( autosomal dominant ) / Polycystic Kidney Disease
Simple Cyst ( 50% populasi, > 50 yr )
Multilocular Cyst
Medullary Sponge Kidney
Papillary Necrosis
Perinephric Cyst ( Urinoma )
Acquired Cystic Disease of Dyalisis
Von Hippel-Lindau Disease





Renal Parenchyme Disease :

Acute Pyelonephritis, Renal Abscess, Acute Tubuler Necrosis,
Chronic Pyelonephrosis, Acute Glomerulonephritis,
Renal Tuberculosis, others infections.

Renal Vascular Disease :
Renovascular Hypertension, R
Renal Artery-Vein Thrombosis.

Renal Trauma
Renal Failure
Benign & Malignant Tumour
Modalities :

X-ray with variant examinations ( with CR / Computed Radiography )
BOF IVU, Cystography ,
Urethro-Cystography (mono bipolar),
Ante Retrograde Pyelography ( APG RPG )
Reflux Study, Lopoography, etc. ( mostly with conrast media )

Ultrasonography
CT Scanner , MRI, Angiography,
Nuclear Medicine / Radionuclide ( Renography )
Polycystic Disease of the Adult
( abdominal mass, pain, hematuri, renal failure or hypertension )

Classification of cystic disease ( Elkin, 1975 )
1. Renal dysplasia
a. Multicystic kidney
b. Focal & segmental dysplasia
c. multiple cysts associated with lower urinary tract. Obstruction
d. Hereditary & familial cystic dysplasia
Left Polycystic Kidney Disease
8
Luthfy Mahatma Hadi - Nephrology Meeting
March, 2011
2. Polycystic disease
a. Polycystic disease of the young ( newborn, childhood )
b. Polycystic disease of the adult

3. Cortical cyst
( Trisomy syndromes, Tuberous sclerosis, simple cyst, Multilocular cyst )

4. Medullary cysts
( Medullary sponge kidney, Medullary cystic disease,
Papillary necrosis, Pyelogenic cyst )

5. Miscellaneous intrarenal cyst
( Inflammatory, Neoplastic, Traumatic )

6. Extraparenchymal cyst
Medullary cyst
Extraparenchymal cyst
1
st
/2
nd
Infections Tumour B/M Obstructive Uropathy
Renal Vascular Disease Trauma
radiodiagnostic


Influence Vasa Vascular (A/E) & Nephrons
Filtration & Biochemis functions affection
Disturbances Renal Filtration ( with all consequences )

RENOGRAPHY ( 2011)

RENAL FAILURE
Acute Tubular Necrosis (ATN)
Reversible from ARF associated with renal ischaemia episode.
Severe renal ischaemia episode = Acute Cortical Necrosis
Enlargement renal tissue

Chronic Pyelonephritis (ChPs)
Association with urinary tract. Infection ranging from renal scar or
hypertension to severe renal damaged ensuing CRF.
Contracted / scarred renal tissue
Distorted calyces
Scarring with normal calyces indicating VASCULAR etiology.

RVD common cause 2
nd
Hypertension
Stenosis Renal Artery due to Atheroma or Fibromuscular Hyperplasia is
commonest cause.
Renal Artery or Vein Thrombosis or Aneurysm
Arteritis, Trauma

Renal Vein Thrombosis :
leucocytosis, haematuria, proteinuria, pain, fever,
common cause by pulmonary emboli (33%)
Others E/ : Nephrotic Syndrome, Cyanotic congenital heart disease,
extension renal tumour RCC/Wilms, hypovolemic shock.

4 renal injury categories :
1. Contusion & corticomedullary lacerations that do not communicate
with the collecting system ( 75-85% ) [heal spontaneously]

2. Parenchymal lacerations that communicate with the collecting
system
( 10 15% ) [ surgery esp. 3-4 category]

3. Shaterred kidney with injuries to the renal vascular pedicle ( 5% )

4. Pelviureteric junction avulsion & laceration of the renal pelvis

Adenoma, Oncocytoma , Angiomyolipoma,
Hemangioma, Lipoma & Fibroma.



Angiomyolipoma :
Hamartoma that contain variable amounts of fat, smooth muscle,
blood vessel.
singly middle age women as renal mass with haematuria, pain.
angiography : vascular tumour with aneurysmal dilatation of the abnormal
vessel &early venous filling.




Renal Adenocarcinoma ( Hypernephroma / RCC )
86% of renal tumour ( 3% all human tumour ), M:F = 3:1
High mortality & increasing incidense
Thrombus in to renal vein & caval inferior vein
Lymphnodes retroperitoneal involvement
Liver tissue metastatic
All modalities

Transitional Cell Carcinoma (TCC)
Wilms Tumour ( Nephroblastoma )
Staging (T) : ( for RCC )
T1 : tumour confined to the renal capsule & causing minimal calyceal
displacement.

T2 : large tumour confined to the renal capsule & causing calyceal or
pelvic displacement.

T3A : tumour involving the perinephric or pelvic fat
T3B : tumour thrombus in the renal vein
T3C : tumour thrombus extending in to IVC

T4 : tumour involving contiguous structures & with distant metastase