Kidney Ultrasound Pathology & Findings

SONOACADEMY - RENAL ULTRASOUND

KIDNEY

Renal
Pathology

Sonographic Findings & Differential Diagnosis

A structured guide to renal abnormalities, sonographic appearances, vascular disorders, focal lesions, stone and advanced ultrasound assessment

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CONTENTS RENAL PATHOLOGY

01

Normal Variants of Kidney

Normal anatomical variants

01

Prominent Column of Bertin Dromedary Hump Junctional Parenchymal Defect Fetal Lobulation Duplex Collecting System Extrarenal Pelvis Hypertrophied Column of Bertin Prominent Renal Sinus Fat Cortical Thinning (Age-Related) Mild Pelviectasis Normal Renal Asymmetry Pseudomass from Renal Sinus Lipomatosis Anisotropic Artifact Mimicking Mass Malrotated Kidney

02

CONGENITAL & DEVELOPMENTAL

Congenital,and developmental renal disorders

02

Renal Agenesis (Unilateral/Bilateral) Renal Hypoplasia (Small but Otherwise Normal) Segmental Hypoplasia (Ask-Upmark Kidney) Supernumerary Kidney Crossed Fused Renal Ectopia Horseshoe Kidney (Fusion at Lower Poles) Pancake / Disc Kidney Pelvic Kidney (Ectopic Location) Thoracic Kidney Simple Ectopic Kidney (Malrotated) Duplicated Collecting System (Complete/Incomplete) Duplex Ureter with Ureterocele Congenital Megacalicosis Congenital Megapelvis Calyceal Diverticulum Ureteropelvic Junction (UPJ) Obstruction Congenital Renal Dysplasia Multicystic Dysplastic Kidney (MCDK) Renal Cortical Cysts in Neonate Renal Agenesis with Contralateral Hypertrophy Infantile Polycystic Kidney Disease (ARPKD) Adult Polycystic Kidney Disease (ADPKD) Medullary Sponge Kidney Nephronophthisis Cystic Dysplasia Associated with VUR

03

CYSTIC RENAL LESIONS

Cystic Lesions

03

Renal Agenesis (Unilateral/Bilateral) Renal Hypoplasia (Small but Otherwise Normal) Segmental Hypoplasia (Ask-Upmark Kidney) Supernumerary Kidney Crossed Fused Renal Ectopia Horseshoe Kidney (Fusion at Lower Poles) Pancake / Disc Kidney Pelvic Kidney (Ectopic Location) Thoracic Kidney Simple Ectopic Kidney (Malrotated) Duplicated Collecting System (Complete/Incomplete) Duplex Ureter with Ureterocele Congenital Megacalicosis Congenital Megapelvis Calyceal Diverticulum Ureteropelvic Junction (UPJ) Obstruction Congenital Renal Dysplasia Multicystic Dysplastic Kidney (MCDK) Renal Cortical Cysts in Neonate Renal Agenesis with Contralateral Hypertrophy Infantile Polycystic Kidney Disease (ARPKD) Adult Polycystic Kidney Disease (ADPKD) Medullary Sponge Kidney Nephronophthisis Cystic Dysplasia Associated with VUR

05

Obstructive Uropathy

Hydronephrosis, ureteric obstruction and urinary tract dilation

05

Hydronephrosis (Grade I–IV) Hydroureteronephrosis (Proximal or Complete) UPJ Obstruction (Intrinsic or Extrinsic) UVJ Obstruction Vesicoureteral Reflux Ureteral Stone Obstruction PUJ Obstruction by Crossing Vessel Pregnancy-Related Hydronephrosis Postoperative Hydronephrosis Congenital UPJ Obstruction in Child Pelvic Mass Compression Causing Hydronephrosis Retroperitoneal Fibrosis with Ureteric Obstruction Bladder Outlet Obstruction Causing Bilateral Dilation Benign Prostatic Hyperplasia (Secondary Obstruction) Neurogenic Bladder with Upper Tract Dilation External Ureteric Compression Retrocaval Ureter Bilateral Hydronephrosis from Pelvic Malignancy Post-Lithotripsy Transient Obstruction Post-Surgical Stricture Iatrogenic Ureteric Injury Causing Obstruction Ureteral Kink or Adhesions Post-Inflammatory Stricture Fibrotic Ureteric Stenosis Ureterocele-Induced Obstruction

06

Calculous Diseases

Renal calculi, ureteric stones and nephrocalcinosis

06

Nephrolithiasis (Renal Stones) Multiple Renal Calculi Staghorn Calculus Calyceal Microlithiasis Lower Pole Stone Pelvic Stone Ureteric Stone (Proximal, Mid, Distal) Mobile vs Impacted Calculus Obstructive Calculus with Hydronephrosis Non-Shadowing Small Calculus Post-Lithotripsy Residual Stone Fragments Milk of Calcium Cyst Cortical Nephrocalcinosis Medullary Nephrocalcinosis Randall’s Plaque Post-Stent Encrustation Mimicking Stones Post-Surgical Calculus Recurrence Infective (Struvite) Calculi Cystine Stone Calcium Oxalate vs Uric Acid Stones

07

Infections & Inflammatory Disorders

Renal infections, pyelonephritis and inflammatory kidney diseases

07

Acute Pyelonephritis Focal Pyelonephritis (Lobar Nephronia) Acute Bacterial Nephritis Chronic Pyelonephritis Xanthogranulomatous Pyelonephritis (XGP) Emphysematous Pyelonephritis Pyonephrosis Perinephric Abscess Intrarenal Abscess Tuberculous Pyelonephritis Fungal Bezoar Viral Nephritis HIV-Associated Nephropathy Pyelitis Urosepsis with Cortical Hypoperfusion Post-Obstructive Infection Renal Carbuncle Renal Candidiasis Schistosomiasis Renal Echinococcosis (Hydatid Cyst) Chronic Interstitial Nephritis Analgesic Nephropathy Reflux Nephropathy Post-Transplant Pyelonephritis Perinephric Phlegmon Radiation Nephritis Sarcoid Granulomatous Nephritis Lymphocytic Interstitial Nephritis Post-Chemotherapy Nephritis

08

Vascular Disorders

Renal artery, renal vein and renal perfusion abnormalities

08

Renal Artery Stenosis (RAS) Atherosclerotic Renal Artery Stenosis Fibromuscular Dysplasia Renal Artery Thrombosis Renal Artery Embolism Renal Infarction Global Renal Infarction Renal Vein Thrombosis Renal Artery Aneurysm Renal Artery Pseudoaneurysm Arteriovenous Fistula (AVF) Arteriovenous Malformation (AVM) Cortical Necrosis Renal Vasculitis Lupus Nephritis with Vascular Involvement Hypertensive Nephrosclerosis Cholesterol Embolic Disease Post-Transplant Vascular Stenosis Post-Biopsy Arteriovenous Fistula Renal Congestion from Heart Failure Nutcracker Syndrome Page Kidney Segmental Arterial Mediolysis Ischemic Nephropathy Reperfusion Injury after Revascularization

09

Benign Renal Tumors

Benign renal neoplasms, pseudotumors and tumor mimics

09

Angiomyolipoma (AML) Lipid-Poor Angiomyolipoma Oncocytoma Metanephric Adenoma Renomedullary Interstitial Cell Tumor Juxtaglomerular Cell Tumor (Reninoma) Leiomyoma Hemangioma Lymphangioma Fibroma Hamartoma Adenoma of Renal Cortex Mixed Epithelial and Stromal Tumor (MEST) Benign Cystic Nephroma Inflammatory Pseudotumor Xanthogranulomatous Mass Lesion Calcified Benign Renal Nodule Post-Traumatic Pseudomass Focal Compensatory Hypertrophy Hypertrophied Column of Bertin

10

Malignant Renal Tumors

Renal cell carcinoma, pediatric tumors and secondary renal malignancies

10

Clear Cell Renal Cell Carcinoma (RCC) Papillary RCC Chromophobe RCC Collecting Duct Carcinoma Medullary Carcinoma Multilocular Cystic RCC Sarcomatoid RCC Unclassified RCC Wilms Tumor (Nephroblastoma) Primary Renal Lymphoma Secondary Renal Lymphoma Transitional Cell Carcinoma of Renal Pelvis Squamous Cell Carcinoma of Renal Pelvis Metastatic Renal Tumor Neuroblastoma Invading Kidney Renal Sarcoma Leiomyosarcoma Angiosarcoma Primitive Neuroectodermal Tumor (PNET) Malignant Rhabdoid Tumor RCC with Renal Vein Invasion RCC with IVC Thrombus Bilateral RCC Multifocal RCC Cystic Malignant Renal Neoplasm Necrotic Renal Malignancy Recurrent RCC after Nephrectomy Metastatic RCC to Liver/Lung Advanced Unresectable Renal Cancer Renal Tumor with Perinephric Extension

11

Traumatic, Post-Surgical & Iatrogenic

Renal trauma, procedural complications and postoperative changes

11

Renal Contusion Subcapsular Hematoma Perinephric Hematoma Renal Laceration Renal Injury Renal Fracture Collecting System Injury with Urinary Extravasation Urinoma Renal Artery Injury Renal Vein Injury Traumatic Arteriovenous Fistula Post-Biopsy Hematoma Post-Biopsy Arteriovenous Fistula Post-PCNL Residual Tract Changes Post-Nephrostomy Complications Post-Lithotripsy Renal Injury Post-Partial Nephrectomy Scar Post-Radical Nephrectomy Renal Fossa Recurrence Iatrogenic Ureteric Injury Delayed Traumatic Renal Scarring

12

Transplant Kidney Pathologies

Ultrasound findings and complications of renal transplantation

12

Normal Renal Transplant Appearance Acute Rejection Chronic Rejection Acute Tubular Necrosis (ATN) Transplant Renal Artery Stenosis Transplant Renal Vein Thrombosis Segmental Infarction in Graft Perigraft Fluid Collection Lymphocele Urinoma Hematoma Around Transplant Abscess Around Transplant Kidney BK Virus Nephropathy CMV-Related Transplant Nephropathy Obstructive Uropathy in Graft Ureteric Stenosis in Transplant Transplant Pyelonephritis Drug Toxicity Nephropathy Recurrent Native Kidney Disease in Graft Failed Transplant Kidney

13

Systemic & Secondary Renal Diseases

Systemic diseases and secondary conditions affecting the kidneys

13

Diabetic Nephropathy Hypertensive Nephropathy Lupus Nephritis Amyloidosis Multiple Myeloma Kidney Light-Chain Deposition Disease Sickle Cell Nephropathy Vasculitic Nephropathy Goodpasture Syndrome Hemolytic Uremic Syndrome (HUS) Thrombotic Thrombocytopenic Purpura (TTP) Sarcoid Nephropathy HIV-Associated Nephropathy Hepatorenal Syndrome Cardiorenal Syndrome Pregnancy-Related Nephropathy Pre-Eclampsia Renal Changes Drug-Induced Nephropathy Contrast-Induced Nephropathy Chemotherapy-Related Nephrotoxicity Radiation Nephropathy Gouty Nephropathy Oxalate Nephropathy Chronic Systemic Inflammatory Disease Nephropathy Secondary Renal Involvement by Malignancy

14

Miscellaneous & Rare Conditions

Rare renal disorders, unusual masses and miscellaneous ultrasound findings

14

Page Kidney Renal Sinus Lipomatosis Replacement Lipomatosis of Kidney Malakoplakia Renal Peliosis Erdheim–Chester Disease Involving Kidneys Castleman Disease with Renal Involvement Retroperitoneal Fibrosis Affecting Renal Drainage Nephroptosis (Floating Kidney) Renal Endometriosis Renal Tuberculosis with Scarring Bilateral Small Contracted Kidneys Giant Hydronephrosis Calcified Non-Functioning Kidney Renal Fungal Ball Obstruction Cholesterol Embolic Nephropathy Radiation-Induced Renal Atrophy Post-Infectious Renal Scarring Unilateral Enlarged Echogenic Kidney Rare Idiopathic Renal Mass Lesion

15

End-Stage Renal Disease (ESRD) Patterns

Ultrasound features of advanced chronic kidney disease and renal failure

15

Bilateral Small Echogenic Kidneys Advanced Chronic Kidney Disease (CKD) Loss of Corticomedullary Differentiation Cortical Thinning with Increased Echogenicity End-Stage Diabetic Nephropathy End-Stage Hypertensive Nephropathy ESRD Secondary to Chronic Pyelonephritis ESRD Due to Reflux Nephropathy ESRD with Acquired Cystic Kidney Disease Dialysis-Associated Renal Cystic Disease ESRD with Secondary Hyperparathyroidism Shrunken Scarred Kidneys from Chronic Glomerulonephritis End-Stage Polycystic Kidney Disease Chronic Ischemic Nephropathy with Renal Atrophy Terminal Renal Fibrosis with Loss of Function

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