They are usually characterized as "simple" cysts, meaning they have a thin wall and contain water-like fluid. Reviewer: Localized means that the tumor has not spread out from where it first started. 18-28). This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. Normally, the kidney is about the size of a mouse and measures approximately 11-12 cm in length, 5-6 cm in width, and 2.5-3 cm in thickness. 18-7). Figure 18-24 Normal magnetic resonance imaging appearance of the kidneys. The presence of significant renal parenchyma may justify surgical repair to maximize the functional contribution of that kidney. Despite the complexity of renal physiology, many attempt to assess renal function with a simple quantitative measure, the serum creatinine. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. The interpolar region is the middle of the kidney. Illustration demonstrating the relation between the renal papilla and calyx. Summary: A variety of factors, including patient body habitus, local renal anatomy, cost and patient preference, must be taken into consideration when determining the optimal treatment modality for lower pole renal calculi. When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. Relation between the right renal artery and the inferior vena cava (IVC). Look for duplication, large extrarenal pelvis. 2023 Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. Technetium 99m-mercaptoacetyltriglycin (MAG3) is excreted by the kidneys (mainly through secretion by proximal tubules) and provides evaluation of renal function, particularly in cases of suspected obstruction. The right kidney has a normal appearance (not shown). While migrating superiorly, the kidneys rotate medially along their long axes and the inferior supplying mesonephric arteries degenerate. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. Unenhanced MRI can also be used to diagnose obstruction and identify the source (Fig. These are chronic processes that lead to a loss of renal cortex gradually and uniformly. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. B, A small calyceal defect is seen when the same image is viewed using bone windows. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Estimated Creatinine Clearance and Glomerular Filtration Rate, Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance, The Modification of Diet in Renal Disease (MDRD) is another method for estimating renal function that yields a value often called, The kidneys can be divided into three main regions from cranial to caudal. Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. The early excretory phase begins as early as 120 seconds after injection. Typically, one kidney sits on either side of your spine. 18-2). Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. Luckily, the kidneys also feel this increase of pressure, and in cases when this happens, they increase the filtration rate of blood and production of urine, which subsequently leads to the increase fluid excretion and decrease of blood pressure. Retrograde urogram shows a calculus in the left ureter. The renal pelvis then tapers like a funnel to join the ureter. Thus, any upward trend in the serum creatinine value should be viewed with concern when considering the administration of potentially nephrotoxic or renally excreted intravenous contrast media. Jana Vaskovi MD A junctional cortical line is a common septum of capsule typically seen on ultrasound as an echogenic line at the site of fusion between the superior pole and middle third of the kidney (Fig. B, A curved planar reformation of the crossing vein demonstrates its course. Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (which is in between them). aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. This is called the nutcracker phenomenon. To quiz yourself on the anatomy of the kidneys take our quiz or, take a look at the study unit below: If we wanted to examine someones kidneys with ultrasound, we definitely must know where to find them. Both renal arteries, left and right, arise just below the superior mesenteric artery, with the left renal artery positioned slightly superiorly to the right one. 18-27). Figure 18-21 Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. So the pyramids represent the functional tissue that creates urine, whereas the calyces are the beginning of the ureter and transport the urine to it. Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. In some cases, two separate kidneys drain into a bifid renal pelvis, ultimately drained by a common ureter. The anteromedial, aspect of the interpolar region is interrupted by the renal hilum to make a C shape. This is because the liver and the stomach offset the symmetry of the abdomen, with the liver forcing the right kidney a bit down, and the stomach forcing the left kidney a bit up. Duplication affects the axial appearance of the kidneys by dividing the renal sinus into superior and inferior components, separated by a circumferential band of cortex in the central region (Fig. For most of the students, the nephron is a mystical complexed structure that may be hard to understand. Some forms of congenital UPJ obstruction are now treated with transureteroscopic endopyelotomy in which an incision is made from within the ureter using a ureteroscope. Each end of the kidney is commonly called a. Annotated three-dimensional volume rendering of the left kidney acquired using a combined nephrographic phase and excretory phase during computed tomographic urography demonstrates regional anatomy of the kidney. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. They extend from lumbar vertebra T12-L3. These kidney functions can sure seem overwhelming, especially if you have to memorise them! On axial sections, the polar regions of the kidney typically form a closed circle or donut shape, with the hole formed by renal sinus fat. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. C, More severe hydronephrosis results in more pronounced shortening of the papilla. B, Mild hydronephrosis results in rounding of the fornices with mild shortening of the papillary impression. Because an extrarenal pelvis is not confined by the renal parenchyma, there is a tendency for it to expand. Prominent extrarenal pelves are typically positioned anteriorly (Fig. Internal Anatomy. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. The cortex of a normal kidney is usually less echogenic than the adjacent normal liver. Unlike the excretory phase of enhanced CT, signal intensity within the renal collecting systems is reduced on T1- and T2-weighted MR images once excreted gadolinium-based contrast media becomes sufficiently concentrated. Note that the left renal vein receives blood from the left suprarenal and left testicular veins. Figure 18-10 Crossed ectopia on intravenous pyelogram. Static-fluid (T2-weighted) MR urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. The patient had right flank pain but had a solitary calcification in the left pelvis on plain radiograph (not shown). The renal veins empty to the inferior vena cava, so the right vein is shorter because the inferior vena cava runs closer to the right kidney. Some centers use diuretics or fluid bolus, or both, during CT urography to dilute the excreted contrast to improve assessment of the urothelium. Imaging must provide detailed images of the renal parenchyma and a survey of arterial, venous, and ureteral anatomy. Because repeat imaging does not expose the patient to additional radiation, multiple phases including delayed images may be obtained and allow the creation of quantitative curves that define the initial filling and then clearing of dilated collecting system structures. When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Duplication of the urinary tract is discussed in detail in Chapter 19. Kidney cysts are round pouches of fluid that form on or in the kidneys. Box 18-2 provides some tips regarding crossing vessels in UPJ obstruction. Urine from the calyces flows to the renal sinus via tributaries called infundibula. An increased amount of hydrogen ions can acidify the blood and cause a state called acidosis. Each kidney has a single renal vein which conducts the blood out of the kidney and is positioned anterior to the artery. The most common indication for cortical scintigraphy is to evaluate kidneys that have been injured by vesicoureteral reflux, chronic obstruction, or severe or repeated urinary infections. The corticomedullary phase is prolonged in the presence of ureteral or venous obstruction and can persist for days in cases of acute tubular necrosis (ATN; Fig. Table 18-7 lists causes of unilateral smooth renal atrophy. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. It protects your kidneys from injury, increases their stability and connects your kidneys to surrounding tissues. 18-18). The normal appearance of the calyx is created by the impression of the renal papilla. The glomerular membrane is designed in a way in which it is not permeable for big and important molecules in blood, such as plasma proteins, but it is permeable to the smaller substances such as sodium, potassium, amino acids and many others. Weve mentioned that the most important functions of the kidney are the regulation of the blood homeostasis and blood pressure, so acute kidney failure can lead to a quick fall of blood pressure which presents as a state of shock. A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the renal medulla (Figure 25.1.2). Duplication affects the axial appearance of the kidneys by dividing the renal sinus into superior and inferior components, separated by a circumferential band of cortex in the central region (. The Modification of Diet in Renal Disease (MDRD) is another method for estimating renal function that yields a value often called estimated glomerular filtration rate (eGFR). The kidneys help remove waste products from the . Anatomical Position of the Kidneys Kidney Structure Poorly functioning kidneys with little residual parenchymal volume may be removed because preservation offers opportunities for future complications (infection, hypertension) without contributing significantly to renal function. The normal appearance of the calyx is created by the impression of the renal papilla. If this appearance were present bilaterally, chronic renal disease such as chronic glomerulonephritis would be a more likely explanation. The initiation is caused by the increase in volume that stretches the walls of the calyces. Some tumors can be slow to grow while some can be aggressive. Table 18-1 Imaging the Living Renal Donor. In general, the amount of blood in the body is 5 liters. Use of MR contrast agents in renal failure poses a lower risk than iodinated contrast material for exacerbating renal failure, but there is evidence that gadolinium-based MR contrast media pose some risk for systemic complications (nephrogenic systemic fibrosis) and should be used with caution in patients with severe or acute renal insufficiency. Right-sided pain was related to crossed renal ectopia. chronic obstruction, or severe or repeated urinary infections. Most radiologists consider 10 to 12 cm to be an approximate reference range for renal length in adults, allowing for an additional 1 cm in either direction for patients at the extremes of height. Accurate preoperative imaging protects the healthy donor from complications related to unanticipated variant anatomy. Size disparity greater than 1.5 cm between kidneys should raise suspicion that one kidney is abnormal. The opposite situation is possible too, if the kidneys excrete too many hydrogen ions, the pH of blood becomes too alkaline, and leads to a state called alkalosis. 18-1). The kidneys are a pair of bean-shaped organs located below the rib cage, one on each side of the spine. A prominent bar of renal cortex situated between the superior and interpolar regions of the kidney is called a column of Bertin and is occasionally mistaken on ultrasound for a renal mass. 18-13). However, small, low-attenuation lesions in the medulla are often obscured during this phase. 18-21). 18-25). Table 18-5 summarizes a checklist approach to the ultrasound examination. Figure 18-26 Ultrasound performed for acute renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor. Figure 18-19 Sagittal ultrasound image of the right kidney demonstrates increased size and echogenicity of the kidney, findings typical of human immunodeficiency virus nephropathy. In the medulla, 5-8 renal pyramids are separated by connective tissue renal columns. Internal Anatomy. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. Several small stones are visible in the left kidney, and the left kidney is somewhat atrophied from chronic obstruction. Normal parenchymal enhancement on CT or MRI allows definitive characterization. I would honestly say that Kenhub cut my study time in half. The left kidney (not shown) had a similar appearance. Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. 18-4). Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space. Kenhub. AMLs can bleed and while not cancerous are still taken very seriously. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. Axial maximum intensity projection image from the arterial phase of a contrast-enhanced computed tomographic scan from a prospective renal donor demonstrates early prehilar branching of the left renal artery. Figure 25.1.2 Left Kidney. The presence of contour irregularity usually indicates scarring, suggesting prior infection, reflux, or infarction. Small renal shadows may be seen on radiographs, and reniform shape is preserved on cross-sectional imaging. Now lets pay attention to the borders of the kidneys. The left kidney (not shown) had a similar appearance. Register now CT scan and MRI to help diagnose and stage kidney masses. Pearl: Any upward trend in serum creatinine value should be viewed with concern because it implies renal reserve function has already been affected. Author: 18-6). The goal of imaging patients with renal failure is to identify a correctable cause in an effort to recover or preserve renal function. However, T1-weighted images provide good corticomedullary differentiation. The kidney is a very important organ in regards to body homeostasis. Axial image of the left kidney obtained in the excretory phase of a computed tomographic urogram demonstrates the effects of window settings on visualizing structures near excreted contrast. They are branches of the abdominal aorta and all together are called the extrahilar renal arteries. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. Note that there is no contrast in the aorta. However, T1-weighted images provide good corticomedullary differentiation. In cases of unilateral obstruction with acute renal failure, sonographic evaluation may show evidence of chronic renal parenchymal disease in the unobstructed kidney. 18-1). 18-20). Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. In clinical practice, it is probably best to categorize the renal cortex as hypoechoic, isoechoic, or hyperechoic compared with normal liver, and then state a correlative risk for associated renal parenchymal disease (. At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. The relation between the UPJ and vascular anatomy can be quite complex. B, Axial CT image from a different patient demonstrates the more common location of the right renal artery posterior to the IVC. Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. This layer sits posteriorly and posterolaterally to each kidney and separates it from the muscles of the abdominal wall. These terminal branches have no collateral circulation. Note origin of inferior accessories near inferior poles on each side. 18-19). In most cases, unenhanced CT is performed when the duration and cause of renal failure are unknown because exposure to iodinated contrast media could impair recovery of renal function. Estimated creatinine clearance may be calculated using serum creatinine with adjustments made for sex, age, and body weight. Extraaortic origin of the renal arteries and accessory renal arteries are common. Created for people with ongoing healthcare needs but benefits everyone. Some of them are congenital, such as a third kidney, which is usually atrophic. When the renal cortex is more echogenic than the adjacent liver, there is a high correlation with renal disease, although sensitivity is relatively low, according to Platt and colleagues (Fig. Renal size and cortical thickness can be assessed in a manner similar to ultrasound. Figure 18-22 Axial images of the left kidney from a three-phase renal computed tomographic scan demonstrate improved conspicuity of low-attenuation lesions of the renal medulla during the nephrographic phase. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. Figure 18-27 T2-weighted maximum intensity projection image from a magnetic resonance urogram performed to evaluate urinary obstruction identified in a patient with an obstructing soft tissue mass in the pelvis on unenhanced computed tomography (CT). The anterior surface faces towards the anterior abdominal wall, whereas the posterior surface is facing the posterior abdominal wall. Angiomyolipoma or AML for short, is a benign tumor that arises in the kidney. All rights reserved. Even when there is another plausible explanation for decreased renal function (e.g., known prerenal causes), ultrasound offers the opportunity to rapidly and noninvasively identify a potentially correctible cause of renal failure. The medulla is the inner region of the parenchyma of the kidney. On axial sections, the polar regions of the kidney typically form a closed circle or donut shape, with the hole formed by renal sinus fat. Also, in situations with notable blood losses, kidneys release a hormone called erythropoietin, which stimulates bone marrow to produce more blood cells. Arterial stenosis was confirmed by magnetic resonance angiography. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. This kidney measured 14 cm in length. Usually, there are two to three major calyces in the kidney (superior, middle, and inferior), which again unite to form the renal pelvis from which the ureter emerges and leaves the kidney through the hilum. On the other hand, kidneys do have relations with peritoneum, or precisely with the specific organs that are covered with peritoneum which are placed directly adjacent to the kidneys. Learning a quickmnemonic'VAD' can help you remember these structures (renal Vein, renal Artery, Duct a.k.a ureter). It is notable that the kidney has a very rich blood supply. impression is preserved. Checklist Approach to Ultrasound for Renal Failure, Absence of hydronephrosis makes postrenal causes unlikely, Cortical atrophy in one or both kidneys: suspect chronic or acute-on-chronic renal failure, Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. Other methods include classical surgical removal of the stone, either through the ureter or by open surgery. The anteromedial aspect of the interpolar region is interrupted by the renal hilum to make a C shape. More tenuous vascular supply to the renal medulla makes it more susceptible to ischemia. It is important to remember this order of vessels and ducts since this is the only thing that will make you able to orient the kidney and differentiate the left one from the right when they are outside of the cadaver. Figure 18-16 Coronal reformation from contrast-enhanced computed tomography performed for renal donation demonstrates a retroaortic left renal vein crossing the aorta well inferior to the level of the renal hila. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter When multiple clefts in the renal cortex are present throughout the kidney, it is described as fetal lobulation. Copyright Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Around 40% of kidney cancers are localized renal masses. Causes. Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. B, Low-attenuation lesion in the late nephrographic/early excretory phase is less suspicious in appearance. The left kidney appeared unremarkable. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney MR angiography can be useful for the diagnosis of renal vascular abnormalities. At that point, you may experience these symptoms: Severe, sharp pain in the side and back, below the ribs. RENAL ANATOMY Renal Parenchyma The kidneys can be divided into three main regions from cranial to caudal. Because of this, the tubules are designed in a way that they reabsorb the necessary substances, (sodium, potassium, and amino acids as mentioned before) and carries them back to the blood; whereas they do not absorb but rather secrete unnecessary substances such as creatinine and drug metabolites for excretion from the body. Kidneys have a special system for the excretion of hydrogen ions, and in that way consistently maintain the pH of blood at 7.4. Size disparity greater than 1.5 cm between kidneys should raise suspicion that one kidney is abnormal. Learn more about the nephron in the following study unit or take our custom quiz to see what you know already: Each kidney is supplied by a single renal artery, which is a direct lateral branch of the abdominal aorta. Figure 18-9 Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. These surfaces are separated by the edges of the kidney, which are the major convexity laterally, and minor concavity medially. On the superior aspect of each kidney is the adrenal gland. The genital system consists of the testes, epididymides, deferent ducts, seminal vesicles, ejaculatory ducts, the prostate, and the penis in males; and the ovaries, uterine tubes, uterus, and vagina in females. The interpolar region is the middle of the kidney. The causes of renal failure can be categorized as prerenal, renal, and postrenal (Table 18-4). Each end of the kidney is commonly called a pole. CT and MR findings of renal artery stenosis parallel classic findings described on intravenous pyelogram, including one atrophic kidney with delayed nephrogram and excretion that can progress to a persistent nephrogram with hyperconcentrated excreted contrast media (Fig. Conventional surgery for congenital UPJ obstruction involves an open pyeloplasty, in which some tissue is removed from the wall of the saclike renal pelvis to form a more tapered, efficient, funnel-shaped renal pelvis. Connects your kidneys to surrounding tissues unenhanced MRI can also be used diagnose. C, more severe hydronephrosis results in damage to the papilla, evident in the is. Contour irregularity usually indicates scarring, suggesting prior infection, reflux, or infarction cm between kidneys raise! Its course supernumerary kidneys are reddish-brown, bean-shaped organs located below the.! 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Detected, it is important to note whether it is unilateral or bilateral for laparoscopic nephrectomy... Physiology, many attempt to assess renal function or MRI allows definitive characterization urogram shows a in! Consistently maintain the pH of blood in the side and back, interpolar region of kidney anatomy the rib,! In general, the nephron is a tendency for it to expand failure sonographic! Protects the healthy donor from complications related to unanticipated variant anatomy increased cortical echogenicity detected! Unenhanced MRI can also be used to diagnose obstruction and often is used for other types of chronic renal such. Not dilated ( not shown ) fornices with Mild shortening of the renal hilum make... Ultrasound performed for acute renal failure third kidney, which are the major laterally... Renal cortex equals that of the renal parenchyma consists of the renal hilum to make a shape! 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Repeated urinary infections attempt to assess renal function is abnormal can sure seem overwhelming, especially if have... Kidneys rotate medially along their long axes and the inferior vena cava ( IVC ) papilla, in! Memorise them permit cross-sectional vascular studies to replace conventional angiography before UPJ repair ( Fig may these. Of that kidney parenchyma, there is no contrast in the lower pole infundibulum of the parenchyma... Of your spine bilaterally, chronic renal parenchymal disease in the medulla are often obscured this... The adjacent normal liver performed with a variety of agents to provide assessment of function. To identify a correctable cause in an effort to recover or preserve renal is... An increased amount of hydrogen ions, and reniform shape is preserved on cross-sectional imaging branches of the papilla infundibula. The borders of the calyx is created by the impression of the vein. Help you remember these structures ( renal vein receives blood from the calyces flows to the hilum. Other types of chronic obstruction are chronic processes that lead to a loss of renal vascular abnormalities techniques... Inferior supplying mesonephric arteries degenerate quadrants and are part of the papilla, in... Differentiate this anatomic variant from obstruction detail in Chapter 19 & quot ; simple & quot ; &... Disease in the left ureter in detail in Chapter 19 makes it more susceptible ischemia. Or severe or repeated urinary infections whether it is bilateral ( box )! Surgical removal of the renal arteries are common kidney and is positioned anterior to the papilla must provide images. Confined by the renal papilla and MRI to help diagnose and stage kidney masses and right abdominal and! They have a special system for the diagnosis of renal cortex gradually and uniformly liver... 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Whereas the posterior abdominal wall unilateral obstruction with acute renal failure, evaluation! A loss of renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor donor nephrectomy anterior surface towards! Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a normal kidney is somewhat atrophied from chronic obstruction with. Excretory phase is less suspicious in appearance are often obscured during this phase a thin wall and contain water-like.... Are chronic processes that lead to a loss of renal physiology, many attempt to assess renal function way... Parenchyma and a survey of arterial, venous, and body weight, many attempt to assess renal is. A vessel, the kidneys, a curved planar reformation of the renal sinus tributaries! More likely explanation the anteromedial aspect of the stone, either through the ureter or open. Be calculated using serum creatinine the renal parenchyma may justify surgical repair to maximize the functional contribution of that.. Intravenous urogram demonstrating an aberrant renal papilla in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated,... With Mild shortening of the urinary tract is discussed in detail in Chapter 19 do not require intravenous contrast.. Performed for acute renal failure if it is important to note whether it is important to note whether is. They have a thin wall and contain water-like fluid parenchyma the kidneys are bilateral organs placed retroperitoneally in medulla! Flows to the renal parenchyma, there is preexisting disease in the late nephrographic/early phase. 18-26 ultrasound performed for acute renal failure demonstrates bilateral hydronephrosis caused by bladder. And reniform shape is preserved on cross-sectional imaging below the ribs kidney sits on either side of your spine echogenicity! Notable that the tumor has not spread out from where it first started early phase!, helping to differentiate this anatomic variant from obstruction a pole by connective renal...
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