Evaluation and Further Testing

Kidney Function Restoration Program

Natural Solution to get rid of Kidney Damage

Get Instant Access

"O

al n Diffuse changes: e.g., renal failure, undetermined renal disease. Ultrasound is jj usually the primary imaging modality for evaluating these cases. Generally the -q process can immediately be classified as interstitial, glomerular, or atrophic on A

the basis of sonographic findings. nd n Circumscribed changes: These changes are often detected incidentally in routine O examinations. Table 50 reviews the various changes that may be found and the confidence with which they can be identified with ultrasound. dn

Table 50 ■ Circumscribed lesions that can be identified with ultrasound

Can be positively identified Can be classified, but further testing is recommended

Cysts Lipomatosis

Kidney stone Calcification

Renal cell carcinoma Abscess

Angiomyolipoma Tumor mass in the renal pelvis or renal sinus

n Indeterminate chronic renal disease: Besides routine medical and serologic tests, special nephrologic procedures are used that include ultrasound-guided percutaneous renal biopsy.

• The most common cause of renal failure in a general hospital setting is diabetic nephropathy.

! Caution: Renal pelvic abscesses are often mistaken for cysts. This diagnosis should be considered in patients with unexplained fever and diabetes, and if necessary the lesions should be evacuated by fine-needle aspiration or retrograde drainage.

n Indeterminate masses in the parenchyma or renal pelvis:

• CDS: Peripheral vascularity and multiple intratumoral vessels detected by contrast-enhanced duplex sonography are considered proof of a renal malignancy. The confirmation of RCC is an indication for surgery. CDS is a proven adjunct that can narrow the differential diagnosis in many other types of investigation (Fig. 420).

• Further tests: FNAB or CT (for the differentiation of tumor, parenchymal band, sinus lipomatosis, and hemorrhagic cyst)

Sinus Lipomatosis Kidney
Fig. 420a, b CDS of the kidney. a Normal-appearing segmental and interlobar arteries alongside the medullary pyramids (MP). b CDS: avascular area caused by a traumatic hematoma (H), causing the displacement of other vascular structures

n Parapelvic cysts, obstruction: excretory urography. Peripheral vascularity and multiple intratumoral vessels detected by contrast-enhanced duplex scanning establish the diagnosis of a malignant renal tumor. n Suspected ectopic kidney or atrophic kidney: excretory urography, isotope nephrography, or both n Small kidney and hypertension: Suspicion of renal artery stenosis should be investigated by CDS with the determination of Doppler indices (see also Table 30, p. 193).

• Renal artery (Fig. 421a, b): examine in the lateral decubitus position (more favorable angle). With stenosis: Vmax > 150cm/s, aliasing (see p. 8)

• Intrarenal parameters (Fig. 421c, d): RI < 0.5 is a significant decrease and indicates stenosis in > 75 % of cases with 95 % sensitivity and 97 % specificity. Accuracy is further increased by comparing the sides (ARI pathologic if > 0.05).

Renal Artery Stenosis Doppler Ultrasound

Fig. 421a-d Examination to confirm or exclude renal artery stenosis (CDS and spectral analysis). a Scan plane for defining the renal arteries (left oblique position, flank scan from right to left). The scan displays the right and left renal arteries (RRA, LRA) at a favorable angle for duplex sonography ("banana peel" view; AO = aorta). b Normal spectral analysis of the LRA. c Normal intrarenal vascular architecture. d RI determined from an interlobar artery = 0.63 (normal)

Fig. 421a-d Examination to confirm or exclude renal artery stenosis (CDS and spectral analysis). a Scan plane for defining the renal arteries (left oblique position, flank scan from right to left). The scan displays the right and left renal arteries (RRA, LRA) at a favorable angle for duplex sonography ("banana peel" view; AO = aorta). b Normal spectral analysis of the LRA. c Normal intrarenal vascular architecture. d RI determined from an interlobar artery = 0.63 (normal)

Was this article helpful?

0 0
Diabetes Sustenance

Diabetes Sustenance

Get All The Support And Guidance You Need To Be A Success At Dealing With Diabetes The Healthy Way. This Book Is One Of The Most Valuable Resources In The World When It Comes To Learning How Nutritional Supplements Can Control Sugar Levels.

Get My Free Ebook


Post a comment