INTRA-VENOUS UROGRAPHY

Prepared by Dr Sahar Javed

5

Normal IVU

Congenital lesions and variants

Renal agenesis• Failure of ureteric bud to reach the

metanephros • Ipsilateral ureter and hemitrigone also fails to

develop

Renal agenesis (left sided)

Renal agenesis(right sided)

Renal ectopia•Failure of complete ascent of kidney from pelvis to the lumbar region •Kidney comes to lie anywhere from pelvis upwards •Over ascent is rare •Pelvic kidney •Pancake kidney•Intra-thoracic kidney

Pelvic kidney• Often small with increased risk of trauma ,

vesico-ureteric reflux and calculus formation(due to stasis).

Right sided pelvic kidney

Left sided pelvic kidney

14

Pancake kidney• When both kidneys remain in the pelvis ,they

may fuse together producing the small pancake kidney

• Very frequently associated with other congenital anomalies

Pancake kidney

Intra-thoracic kidney• Over ascent is almost always limited by the

diaphragm but there may be some superior herniation through a localized eventeration and very rarely a true thoracic kidney

Intra-thoracic kidney

HORSE SHOE KIDNEY• A midline connection ( isthmus) b/w the lower

poles • Associated malrotation and accessory renal

arteries• Increased incidence of renal calculi and injury

Horse shoe kidney

Horse shoe kidney

Crossed fused ectopia• A horse shoe kidney that has slipped

superolaterally so that both kidneys come to lie on one side

• The ureter draining the upper moiety inserts orthotopically on the ipsilateral side of the bladder

• The lower moiety ureter also inserts orthotopically but into the contralateral side of the bladder

Crossed fused ectopia

Crossed fused ectopia

Crossed fused ectopia

Crossed fused renal ectopia

Duplication abnormalities(duplex kidneys)

• Characterized by two (on rare occasions more than two ,up to 6 having been reported ) ureters and renal pelves.

• Duplication may be complete or incomplete

Duplex collecting system

Duplex collecting system(complete)

Duplex collecting system (incomplete)

Ureteral triplication with contralateral duplication and

ureterocoele

Ureterocoele• Submucosal dilatations of intramural distal

ureter• They often project into the bladder lumen

Ureterocoele

Polycystic kidneys

Polycystic kidneys

Medullary sponge kidney• Ectasia (fusiform or cystic) of the collecting

ducts within the renal pyramids.• Seen in 1 in 200 IVUs• Generally bilateral but may be unilateral or

segmental affecting as little as a single papilla• Usually a benign incidental finding but there is

a weak association with some tumors (Wilm`s and pheochromocytoma)

Medullary sponge kidney

Calyceal diverticulum• Common variant (1 in 250 IVUs)• An intra-parenchymal cavity lined with

transitional epithelium• Do not receive drainage from nephrons and

therefore opacify during IVU after the rest of the calyces

• Diverticula are usually a few millimeters in diameter & communicate with minor calyx

Calyceal diverticulum

Retrocaval ureter• Right ureter occasionally takes an aberrant

course, running sharply medially posterior to IVC and then dropping inferiorly towards the pelvis along a course medial to the pedicles

• Rarely associated with hydronephrosis

Retrocaval ureter

Primary megaureter• Due to congenitally abnormal musculature of

the distal ureter leading to focal failure of peristalsis

• Ureter above the abnormal segment becomes dilated sometimes massively

• In severe cases dilatation involves the entire ureter and renal pelvis

Primary mega ureter

Prune-belly syndrome

• Following bladder outflow obstruction in utero due to urethral valves with development of hydro ureters and hydronephrosis

• Obstruction is overcome but obstructive phase produces defective development of anterior abdominal wall and ureteric musculature with subsequent poor peristalsis and persistent non obstructive dilatation of collecting systems

Prune belly syndrome

Inflammatory diseases

Acute pyelonephritis• IVU may be normal• Kidney may be smoothly enlarged and calyces

compressed by the adjacent swollen parenchyma

• Kidney may show reduction in perfusion and function and a striated nephrogram

Acute pyelonephritis

Renal abscess(IVU usually shows a non specific mass)

Renal TB

Renal hydatid

Malignant masses

Renal cell carcinoma

Transitional cell carcinoma

TCC

TCC

TCC

Wilm`s tumor

Calculi

Renal calculi

kid sto.htmkid sto.htmkid sto.htm

Stag-horn calculus

calculi

Ureteric calculus

Ureteric calculus

Ureteric calculus

Vesical calculi

Vesical calculi

Renal trauma

Vesical diverticulum

Vesical diverticulum

Vesical diverticula