ULTRASOUND DIAGNOSIS

OF KIDNEY DISEASES
Christian Gh Klein, MD
University Hospital Clinic of
Nephrology Carol Davila

Renal ultrasonography.
Indications

Urinary tract infections

Renal colic
Macroscopic haematuria
Congenital anomalies
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

Size of normal adult kidney

Male
Longitudinal axis

Female

Right Kidney

10.80.8
11.30.8
(10.5-12.1) (10-11.6)

Left Kidney

10.91
11.50.9
(10.6-12.4) (9.9-11.9)

Cross sectional area

16-30 cm2

16-30 cm2

Volume (ml)

Right Kidney

14738
(109-185)

11827
(91-145)

Left Kidney

15437
(117-191)

12526
(99-151)4

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

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.

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
7
Segmental renal hypoplasia: Ask-Upmark kidney

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
8

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 anomalies: renal duplication, renal
ectopy with fusion of lower or upper pole
Compensatory hypertrophy (unilateral renal
agenesis, unilateral hypoplasia, nephrectomia)

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)
10

Renal Size Abnormalities

Unilateral Small Kidney
Chronic pyelonephritis
Hydronephrosis (end stage)
Reflux nephropathy
Renal artery stenosis

11

Renal Anatomy (Structure)

Abnormalities
Abnormalities of Renal Sinus
Duplication
Incomplete
Renal pyramid hypertrophy
Bertin column hypertrophy
Pelvic duplication
Complete
Complete or incomplete ureteral duplication
12

Renal Anatomy (Structure)

Abnormalities
Anechoic images in renal sinus
Hydronephrosis
Caliceal diverticula (caliceal cysts)
Peripelvic cysts
Hypoechoic images in renal sinus
Sinusal lipomatosis
Neoplasm

13

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

14

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

15

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

16

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
17

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

18

Perirenal abnormalities
Hematoma
Abscess
Neoplasms
Urinoma

19

Causes of hydronephrosis
COMMON
Obstruction
Previous obstruction
Extrarenal pelvis
Distended bladder
Pregnancy

UNCOMMON
Active diuresis
Diabetes insipidus
Reflux nephropathy

20

Renal cystic diseases

Kidney
size
APKD

Large

Kidney Extrarenal
tumors
cysts
None

Liver

Extrarenal
lesions
Cerebral aneurysms
Pancreas cystic neoplasms
Pancreas islet cell tumors

VHL

Normal/large RCC

Pancreas

Pheochromocytomas
SNC hemangioblastomas
Retinal angiomas

ACD

Small

RCC

None

None
Cerebral hamartomas
Periventricularnodules

TS

Normal/large AML

None

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, tuberous21
sclerosis; AML, angiomyolipoma