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