Sectional Anatomy

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Sectional Anatomy

• Renal

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Ultrasound Techniques

• Supine or decubitus
• LLD - Rt kidney
• RLD - Lt kidney
• Kidney is scanned in sagittal, transverse,
  coronal
• Sagittal coronal - renal capsule is smooth bean
  shaped

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Ultrasound Techniques

• Transverse - shape varies at different levels
• Upper lower poles are round or oral shaped
• Midportion slightly indented in the hilium region
• Kidney develops from lobes that fuse together
• They develop in the pelvis embryonicly and
  ascends to abdomen by birth

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Renal Upper Pole
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Renal Mid-portion
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Renal Lower Pole
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Kidney Anatomy

• Retroperitoneal organ
• Kidney surrounded by fibrous capsule
• Surrounding the encapsulated kidney is
  perinephric fat
• Enclosing kidneys, perinephric fat and adrenals
  is a fibrous sheath, called Gerotas Fascia

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Renal Long
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Renal Long
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Renal Long
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Renals
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Kidney Anatomy

• Retroperitoneal organ
• Renal Parenchyma can be divided into
• Renal Cortex (outer portion)
• Consists of glomerula complex
• Occupies outer 1/3 of parenchyma
• Moderately hypoechoic outer zone
• Slightly less echogenic than liver
• Medulla (inner portion)
• Pyramids contain collecting tubles and loops of
  Hnle
• Column of bertin is cortical tissue that extends
  inward toward the renal sinus between the
  pyramids
• Appears echogenic, when it is enlarged they
  appear as pseudotumers

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Column of Bertin
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Kidney Anatomy

• Renal Sinus (Center of the kidney)
• Sinus is centrally located, oblong, and highly
  echogenic
• Contains vessels, fat, normally collapsed
  calyces, arteries and veins, lymphatics,
  peripelvic fat, fibrous tissues and part of the
  renal pelvis
• Vaculature of the Kidney
• Vessels that can be identified include the main
  renal artery and vein, interlobar artery vein,
  and arcuate artery vein

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Renal Sinus
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Renal Sinus
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Renal Sinus
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Renal Anatomy

• Collecting System
• Minor caylces - 7-13 per kidney, they are found
  adjacent tot the renal pyramids and connect to
  the major calyces
• Major caylces - 2-3 per kidney, they connect to
  the renal pelvis

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Renal Anatomy
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Renal
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Left Kidney
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Renal Sinus Cortex
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Renal Sinus Cortex
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Sonographic Appearance
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Renal
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Renal
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Kidney Anatomy

• Renal Medulla (pyramids)
• Occupies inner 2/3 of parenchyma
• Triangular inner portion of kidneys that
  surrounds the renal sinus
• Represents loops of Henley and the collecting
  tubules
• Pyramids are separated from each other by bands
  of cortical tissue called columns of Bertin

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Renal Anatomy

• Apex of the pyramid is directed toward the sinus
  and base forms a junction with cortex - called
  corticomedullary junction.
• Arcuate arteries seen at the corticomedullary
  junction the interlobar arteries seen between
  each pyramid
• Infants pyramids appear larger and are hypoechoic

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Renal Anatomy
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Renals
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Renals
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Normal Renal Anatomy

• Normal adult kidney measures 8-13 cm in length
  and has smooth contour
• Adult 11.5 X 6 X 3.5 (ap)
• Renal Blood Supply
• Renal artery enters the hilium, it branches into
  4-5 segmental arteries
• Interlobar arteries found between pyramids, they
  go up and over the pyramids to form arcuate
  arteries
• Arcuate arteries branch to form interlobular
  arteries

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Normal Renal Anatomy

• Interlobular arteries enter the glomeruli and
  empty into the capillaries
• From the capillaries the blood travels through
  the interlobular, arcuate, interlobar, to the
  renal vein

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Renal hilus
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Power Doppler
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Power Doppler
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Power Doppler
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Renal system
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Color Doppler
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Renal Functions

• Renal Function
• 1. Water regulation
• Under influence of (ADH) anti-diuretic hormone,
  water absorption is controlled by blood osmosis
• 2. Salt Balance
• Essential to maintain fluid and maintain blood
  pressure

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Renal Functions

• 3. PH maintenance
• Controlled by excretion of hydrogen
• 4. Excretion of urea, creatinine, and other end
  products of metabolism

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Lab Values

• Serum Creatine
• Measures renal function
• Elevation means a disturbance in renal function
  which is due to a large number of nephrons being
  destroyed
• More sensitive than BUN in determining renal
  dysfunction

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Lab Values

• BUN - (blood urea nitrogen)
• Urea is an end product of protein metabolism and
  it is excreted by kidney's so blood urea
  concentrations is normally low
• Rises when kidney's ability to excrete urea is
  impaired
• Elevated levels may lead to mental confusion,
  disorientation coma
• Other diseases that may cause BUN to elevate GI
  bleeding - Congestive heart failure - Shock

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Normal Anatomic Variants

• Dromedary Hump
• Bulging of the lateral aspect of the left kidney
  probably due to developmental relationship
  between the kidney spleen
• Ultrasound Findings
• Coronal -lateral contour bulge of the kidney
  without evidence of parenchymal disruption

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Normal Anatomic Variants
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Normal Anatomic Variants

• Hypertrophied Column of Bertin
• Isoechoic contiguous with the renal cortex
• Located between renal pyramids
• Triangular or blunted shape

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Normal Anatomic Variants

• Renal Sinus Lipomatosis
• Isoechoic and continuous with the perirenal
  sinus fat
• An increase in the renal sinus fat
• No clinical significance

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Congenital Anomalies

• Solitary kidney
• One normal functioning kidney with the other
  undeveloped and not seen, it is atrophied
• Unilateral renal agenesis
• Absence of one side of the collecting system
• No kidney or ureter developed
• Associated with uterine or testicular variants

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Congenital Anomalies

• Bilateral Renal Agenesis
• Fatal - not compatible with life
• Infant dies shortly after birth
• Associated with Potter's syndrome

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Congenital Anomalies

• Supranumerary Kidney
• Duplication of the ureters and pelvis with a
  single kidney
• Double collecting system
• Sonographicly demonstrates two separate central
  sinus echoes separated by cortical tissue

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Supranumerary Kidney
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Congenital Anomalies

• Megacalyces/Megaureter
• Congenital condition consists of nonobstructive
  enlargement of the calyces
• There are usually less calyces with this
  condition
• The appearance on ultrasound is identical to
  obstructive hydronephrosis or dilatation
  secondary to vesicoureteral reflux

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Megacalyces/Megaureter
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Congenital Anomalies

• Pelvic Kidney
• In the embryo the kidneys develop in the pelvis
  and migrate upward, they ascend and rotate to the
  adult position
• Right kidney lower than left kidney
• Ascend by 5-6 years
• Incomplete ascension leads to ectopic kidneys

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Pelvic Kidney
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Congenital Anomalies

• Horseshoe Kidney
• Form of renal fusion
• Fused at the lower pole with the connecting
  bridge located just anterior to the aorta
• Isthmus (connection) is seen at about the level
  of the aortic bifurcation
• Cross-fused Renal Ectopia
• Kidneys are positional in the same quadrant and
  are fused together

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Horseshoe Kidney
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MRI of the Kidneys
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MRI of the Kidneys