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Ultrasound of the kidneys is normal in adults and children. What does a kidney ultrasound show?

Ultrasound of the kidneys is a common procedure for diagnosing diseases of the urinary system. Sometimes ultrasound carried out with preventive purpose for early diagnosis possible diseases. In order to be able to distinguish kidney diseases on the ultrasound image, it is necessary, first of all, to know the anatomy and normal image of the kidneys on ultrasound. Ultrasound of the kidneys has its own characteristics for different age periods, therefore, ultrasound images are evaluated differently for children and adults.

Anatomy of the urinary system and kidneys

Normal and topographic anatomy underpin any research. To compare the data of ultrasound of the kidneys and make a conclusion, it is necessary to know the anatomical data that are the norm. However, it is worth considering that the kidneys are the organ in the structure of which the largest number of anatomical variants is observed.

In case of violations of the renal circulation, ultrasound reveals the following signs of acute renal failure:

• the kidneys acquire a spherical shape;
• the boundary between the cortical and medulla is sharply emphasized;
• the kidney parenchyma is thickened;
• echogenicity of the cortex is increased;
• Doppler study reveals a decrease in blood flow velocity.

In acute renal colic, the kidney is also enlarged in size, but it is not the parenchyma that thickens, but the pelvicalyceal system. In addition, a stone in the form of a hyperechoic structure is detected in the kidney or ureters, which caused the cessation of urine outflow.

Kidney injury on ultrasound. Contusion ( injury), kidney hematoma on ultrasound

Injury to the kidneys occurs as a result of the application of an external force to the lower back or abdomen due to a strong blow or pressure. Kidney disease makes them even more susceptible to mechanical damage. Most often, kidney injuries are closed, which is why the patient may not be aware of internal bleeding when the kidneys rupture.

There are two types of kidney injury:

• bruise ( contusion). With a bruise, there are no ruptures of the capsule, parenchyma or pelvis of the kidney. This damage usually resolves without sequelae.
• Gap. When a kidney ruptures, the integrity of its tissues is violated. Ruptures of the parenchyma of the kidneys lead to the formation of hematomas inside the capsule. In this case, blood can enter the urinary system and be excreted along with urine. In another case, when the capsule breaks, the blood, together with the primary urine, is poured into the retroperitoneal space. This forms the pararenal ( pararenal) hematoma.

Ultrasound of the kidneys is the fastest and most affordable method for diagnosing kidney damage. In the acute phase, deformation of the contours of the kidneys, parenchymal defects and PCL are detected. When the kidney breaks, the integrity of the capsule is broken. Inside the capsule or near it, anechoic areas are found in places where blood or urine accumulates. If some time passes after the injury, then the hematoma acquires other characteristics on ultrasound. With the organization of blood clots and thrombi in the hematoma, hyperechoic areas are observed against a general dark background. Over time, the hematoma resolves and is replaced by connective tissue.

The best diagnostic possibilities for injuries and hematomas are offered by computed tomography and magnetic resonance imaging. Treatment of hematomas up to 300 ml is carried out conservatively. Sometimes, percutaneous puncture of hematomas under ultrasound guidance can be performed. Only in 10% of cases with abundant internal bleeding perform surgery.

Chronic renal failure ( CRF) on ultrasound

Chronic kidney failure- this is pathological decline kidney function as a result of nephron death ( functional renal units). Chronic renal failure is the outcome of most chronic kidney disease. Since chronic diseases are asymptomatic, the patient considers himself healthy until the onset of uremia. In this state, there is a severe intoxication of the body with those substances that are usually excreted in the urine ( creatinine, excess salts, urea).

The causes of chronic renal failure are the following diseases:

• chronic pyelonephritis;
• chronic glomerulonephritis;
• urolithiasis disease;
• arterial hypertension ;
• diabetes;
• polycystic kidney disease and other diseases.

In renal failure, the volume of blood filtered by the kidneys per minute decreases. Normal glomerular filtration rate is 70-130 ml of blood per minute. The patient's condition depends on the decrease in this indicator.

There are the following degrees of severity of chronic renal failure, depending on the glomerular filtration rate ( GFR):

• Light. GFR is 30 to 50 ml/min. The patient notices an increase in nocturnal urination, but nothing else worries him.
• Average. GFR is in the range from 10 to 30 ml/min. Increased daily urination and there is a constant thirst.
• Heavy. GFR less than 10 ml/min. Patients complain of constant fatigue, weakness, dizziness. Nausea and vomiting may occur.

If chronic renal failure is suspected, an ultrasound of the kidneys is always performed in order to establish the cause and treat the underlying disease. The initial sign on ultrasound, speaking of chronic renal failure, is a decrease in the size of the kidney and thinning of the parenchyma. It becomes hyperechoic, the cortex and medulla are difficult to distinguish from each other. In the late stage of chronic renal failure, nephrosclerosis is observed ( shriveled kidney). In this case, its dimensions are about 6 centimeters in length.

Signs of a shriveled kidney ( nephrosclerosis) on ultrasound. Retraction of the parenchyma of the kidneys

The term "shrunken kidney" ( nephrosclerosis) describes a condition in which kidney tissue is replaced by connective tissue. Many diseases cause destruction of the kidney parenchyma, and the body is not always able to replace the dead cells with identical ones. The human body does not tolerate emptiness, therefore, with massive cell death, regeneration occurs and they are replenished by connective tissue cells.

Connective tissue cells produce fibers that, being attracted to each other, cause a decrease in the size of the organ. In this case, the body shrinks and ceases to perform its function in full.

In acute inflammation, the kidneys increase in size, and a hypoechoic swelling of the tissues around the organ is formed. Chronic infection gradually leads to a decrease in the size of the kidneys. The accumulations of pus look like hypoechoic areas. With inflammation in the kidney, blood flow can change. This is clearly seen on duplex ultrasound using Doppler mapping.

In addition to ultrasound, to visualize inflammatory processes in the kidneys, contrast x-ray examination, computed and magnetic resonance imaging are used ( CT and MRI). If some areas of the kidneys are not available for examination on x-rays, then tomography allows you to get a detailed image of the kidneys. However, there is not always time and appropriate conditions for performing CT and MRI.

Acute pyelonephritis on ultrasound of the kidneys

Pyelonephritis is an infectious and inflammatory disease of the kidneys. In pyelonephritis, the parenchyma of the kidneys and the collecting system of the tubules are affected. In this disease, the infection enters the kidney ascending through the ureters. Often acute pyelonephritis becomes a complication of cystitis - inflammation of the bladder. Pyelonephritis is caused mainly by opportunistic microflora ( coli) and staphylococci. Pyelonephritis according to the course options can be acute and chronic.

Symptoms acute pyelonephritis are:

• fever, fever, chills;
• pain in the lumbar region;
• urination disorders ( decrease in the amount of urine).

Diagnosis of acute pyelonephritis is based on a blood test, urinalysis, and ultrasound. The best method for diagnosing acute pyelonephritis is computed tomography.

Signs of acute pyelonephritis on ultrasound of the kidneys are:

• an increase in the size of the kidneys more than 12 cm in length;
• decreased mobility of the kidneys less than 1 cm);
• deformation of the medulla with the formation of accumulations of serous fluid or pus.

If on ultrasound of the kidneys, in addition to the above symptoms, an expansion of the pelvicalyceal system is observed, then this indicates an obstruction ( blocking) urinary tract. This condition requires urgent surgical intervention. Acute pyelonephritis with proper treatment passes quickly. This requires antibiotics. However, with the wrong treatment tactics or late access to a doctor, purulent abscesses or carbuncles form in the kidney tissue, the treatment of which requires surgery.

Kidney carbuncle on ultrasound. kidney abscess

Kidney carbuncle and abscess are severe manifestations of acute purulent pyelonephritis. They represent a limited infectious process in the renal parenchyma. During the formation of an abscess, microorganisms enter the kidney tissue through the blood or ascending the urinary tract. An abscess is a cavity surrounded by a capsule, inside which pus accumulates. On ultrasound, it looks like a hypoechoic area in the kidney parenchyma with a bright hyperechoic rim. Sometimes with an abscess, an expansion of the pyelocaliceal system is observed.

Kidney carbuncle is more severe than an abscess. Carbuncle is also caused by the multiplication of microorganisms in the tissue of the kidney. However, the vascular component plays the main role in the mechanism of carbuncle development. When entering the vessel, microorganisms block its lumen and stop the blood supply. In this case, the death of kidney cells occurs due to the lack of oxygen. After thrombosis and infarction ( vascular necrosis) of the renal wall follows its purulent fusion.

With a carbuncle of the kidney on ultrasound, the organ is enlarged, its structure is locally deformed. The carbuncle looks like a volumetric formation of high echogenicity with fuzzy contours in the kidney parenchyma. In the center of the carbuncle are hypoechoic areas corresponding to the accumulation of pus. At the same time, there are usually no changes in the pelvicalyceal structure. Carbuncle and kidney abscess are treated surgically with the mandatory use of antibiotics.

Chronic pyelonephritis on ultrasound of the kidneys

Chronic pyelonephritis differs from acute pyelonephritis in a long course and a tendency to exacerbate. This disease is characterized by the persistence of foci of infection in the kidney tissue. It occurs due to a violation of the outflow of urine. This is due to hereditary factors and acquired conditions ( e.g. urolithiasis). Chronic pyelonephritis with each exacerbation affects new and new areas of the parenchyma, due to which the entire kidney gradually becomes non-functional.

Chronic pyelonephritis has in its course several phases changing each other:

• active phase. This phase proceeds similarly to acute pyelonephritis, characterized by severe pain, malaise, difficult urination.
• latent phase. The patient is concerned about rare pain in the lower back, while bacteria are always present in the urine.
• remission phase. It is a condition in which the disease does not manifest itself in any way, however, with a decrease in immunity, it can suddenly worsen.

As with other destructive diseases, in chronic pyelonephritis, the destroyed parenchyma is replaced by scar tissue. Gradually, this leads to kidney failure. In this case, the kidney acquires a wrinkled appearance, since the fibers of the connective tissue are pulled together over time.

Signs of chronic pyelonephritis on ultrasound of the kidneys are:

• Expansion and deformation of the pyelocaliceal system. It becomes rounded, and the cups merge with the pelvis.
• Reducing the thickness of the parenchyma of the kidney. The ratio of the parenchyma of the kidneys to the pyelocaliceal system becomes less than 1.7.
• Reducing the size of the kidney, uneven contour of the edge of the kidney. Such a deformation indicates a long course of the process and wrinkling of the kidney.

Glomerulonephritis on ultrasound of the kidneys

Glomerulonephritis is an autoimmune lesion of the vascular glomeruli located in the renal cortex. The vascular glomeruli are part of the nephron, the functional unit of the kidneys. It is in the vascular glomeruli that blood is filtered and the initial stage of urine formation occurs. Glomerulonephritis is the main disease leading to chronic renal failure. With the death of 65% of nephrons, signs of renal failure appear.

Symptoms of glomerulonephritis are:

• increased blood pressure;
• swelling;
• red staining of urine the presence of red blood cells);
• lower back pain.

Glomerulonephritis, like pyelonephritis, is inflammatory disease. However, in glomerulonephritis, microorganisms play a secondary role. Vascular glomeruli in glomerulonephritis are affected due to a malfunction in immune mechanisms. Glomerulonephritis is diagnosed using a biochemical analysis of blood and urine. It is mandatory to conduct an ultrasound of the kidneys with a Doppler study of the renal blood flow.

AT initial stage glomerulonephritis on ultrasound, the following signs are noted:

• increase in kidney volume by 10 - 20%;
• slight increase in echogenicity of the kidneys;
• increase in blood flow velocity in the renal arteries;
• clear visualization of blood flow in the parenchyma;
• symmetrical changes in both kidneys.

In the late stage of glomerulonephritis, the following changes in the kidneys on ultrasound are characteristic:

• a significant decrease in the size of the kidneys, up to 6 - 7 cm in length;
• hyperechogenicity of kidney tissue;
• the impossibility of distinguishing the cortical and medulla of the kidney;
• decrease in blood flow velocity in the renal artery;
• impoverishment of the bloodstream inside the kidney.

The outcome of chronic glomerulonephritis in the absence of treatment is nephrosclerosis - primary wrinkled kidney. Anti-inflammatory drugs and drugs that reduce immune responses are used to treat glomerulonephritis.

Tuberculosis of the kidneys on ultrasound

Tuberculosis is a specific disease caused by mycobacterium. Tuberculosis of the kidney is one of the most common secondary manifestations this disease. The primary focus of tuberculosis is the lungs, then with the bloodstream, Mycobacterium tuberculosis enters the kidneys. Mycobacteria multiply in the vascular glomeruli of the renal medulla.

With tuberculosis in the kidneys, the following processes are noted:

• Infiltration. This process means the accumulation of mycobacteria in the cortex and medulla with the formation of ulcers.
• Destruction of tissues. The development of tuberculosis leads to the formation of necrosis zones, which look like rounded cavities.
• Sclerosis ( connective tissue replacement). Vessels and functional cells of the kidneys are replaced by connective tissue. This defensive reaction leads to impaired renal function and to renal failure.
• Calcification ( calcification). Sometimes the foci of mycobacteria turn into stone. This protective reaction of the body is effective, but does not lead to a complete cure. Mycobacteria can regain activity again with a decrease in immunity.

A reliable sign of kidney tuberculosis is the detection of mycobacteria of the kidneys in the urine. With the help of ultrasound, you can determine the degree of destructive changes in the kidneys. In the form of anechoic inclusions, caverns in the kidney tissue are found. Stones and areas of calcification accompanying tuberculosis of the kidneys look like hyperechoic areas. Duplex ultrasound of the kidneys reveals narrowing of the renal arteries and a decrease in renal circulation. For a detailed study of the affected kidney, computed and magnetic resonance imaging are used.

Anomalies in the structure and position of the kidneys on ultrasound. Kidney disease with cyst formation

Kidney anomalies are abnormalities caused by impaired embryonic development. For one reason or another, anomalies of the genitourinary system are the most common. It is believed that about 10% of the population has various kidney anomalies.

Kidney anomalies are classified as follows:

• Anomalies of the renal vessels. They consist in changing the trajectory of the course, the number of renal arteries and veins.
• Anomalies in the number of kidneys. There are cases when a person had 1 or 3 kidneys. Separately, an anomaly of duplication of the kidneys is considered, in which one of the kidneys is divided into two almost autonomous parts.
• Anomalies in the size of the kidneys. The kidney may be reduced in size, but there are no cases of congenital enlargement of the kidneys.

• Anomalies in the position of the kidneys. The kidney can be located in the pelvis, at the iliac crest. There are also cases when both kidneys are located on the same side.
• Abnormalities in the structure of the kidneys. Such anomalies are the underdevelopment of the renal parenchyma or the formation of cysts in the renal tissue.

Diagnosis of anomalies of the kidneys for the first time becomes possible when performing an ultrasound scan of the kidneys of a newborn. Most often, kidney abnormalities are not a serious cause for concern, but a follow-up examination of the kidneys is recommended throughout life. For this, x-rays, computed tomography and magnetic resonance imaging can be used. It must be understood that kidney anomalies in themselves are not diseases, but they can provoke their appearance.

Doubling of the kidneys and pyelocaliceal system. Signs of duplication of the kidneys on ultrasound

Doubling of the kidneys is the most common anomaly of the kidneys. It occurs in women 2 times more often than in men. Doubling of the kidneys is explained by a congenital anomaly of the germ layers of the ureters. Doubled kidneys are conditionally divided into the upper part and the lower part, of which the upper kidney is usually less developed. Doubling differs from an additional kidney in that both parts are connected to each other and covered with one fibrous capsule. The accessory kidney is less common, but has its own circulatory system and capsule. Doubling of the kidneys can be complete and incomplete.

Doubling of the kidneys can be of two types:

• Full doubling. With this type of doubling, both parts have their own pelvicalyceal system, artery and ureter.
• incomplete doubling. Characterized by the fact that the ureters of both parts are combined before flowing into bladder. Depending on the degree of development of the upper part, it may have its own artery and pyelocaliceal system.

On ultrasound, a double kidney is easily determined, since it has all the structural elements of a normal kidney, but in double the amount. Its constituent parts are located one above the other inside one hyperechoic capsule. When doubling the PCS in the area of ​​the gate, two characteristic hypoechoic formations are visible. Kidney doubling does not require treatment, but this anomaly increases the risk various diseases such as pyelonephritis, urolithiasis.

Underdevelopment ( hypoplasia, dysplasia) kidneys on ultrasound

Underdevelopment of the kidneys can be observed in two ways. One of these is hypoplasia, a condition in which the kidney is reduced in size but functions like a normal kidney. Another option is dysplasia. This term refers to a condition in which the kidney is not only reduced, but also structurally defective. With dysplasia, the parenchyma and PCL of the kidney are significantly deformed. In both cases, the kidney on the opposite side is enlarged to compensate for the functional insufficiency of the underdeveloped kidney.

With hypoplasia of the kidneys, an organ of a smaller size is determined by ultrasound. Its length on ultrasound is less than 10 centimeters. Ultrasound can also determine the function of an underdeveloped kidney. In a functioning kidney, the arteries are of normal width ( 5 mm at the gate), and the pelvicalyceal system is not expanded. However, with dysplasia, the opposite is observed.

Signs of kidney dysplasia on ultrasound are:

• expansion of CHLS more than 25 mm in the area of ​​the pelvis;
• reduction in the thickness of the parenchyma;
• narrowing of the renal arteries;
• narrowing of the ureters.

Kidney prolapse ( nephroptosis) on ultrasound. Wandering kidneys

Nephroptosis is a condition in which the kidney moves down from its bed when the position of the body changes. Normally, the movement of the kidneys during their transition from a vertical to a horizontal position does not exceed 2 cm. However, due to various factors ( injury, excessive exercise stress, muscle weakness) the kidney may acquire pathological mobility. Nephroptosis occurs in 1% of men and about 10% of women. In cases where the kidney can be displaced by hand, they are called the wandering kidney.

Nephroptosis has three degrees:

• First degree. When inhaling, the kidney partially shifts down from the hypochondrium and is palpated, and during exhalation it returns back.
• Second degree. In a vertical position, the kidney completely leaves the hypochondrium.
• Third degree. The kidney descends below the iliac crest into the small pelvis.

Nephroptosis is dangerous because when the position of the kidneys changes, vascular tension occurs, blood circulation is disturbed and swelling of the kidneys occurs. Stretching of the kidney capsule causes pain. When the ureters are deformed, the outflow of urine is disturbed, which threatens to expand the renal pelvis. A common complication of nephroptosis is infection ( pyelonephritis). These complications are almost inevitable in the second or third degree of nephroptosis.

On ultrasound, nephroptosis is detected in most cases. The kidney may not be found on a routine scan in the upper flanks of the abdomen. If a kidney prolapse is suspected, ultrasound is performed in three positions - lying, standing and on its side. The diagnosis of nephroptosis is made in the case of an abnormally low position of the kidneys, their great mobility when changing body position or when breathing. Ultrasound also helps to identify complications caused by a change in the position of the kidneys.

Kidney cyst on ultrasound

A cyst is a cavity in the kidney tissue. It has an epithelial wall and a fibrous base. Kidney cysts can be congenital or acquired. Congenital cysts develop from cells in the urinary tract that have lost contact with the ureters. Acquired cysts are formed at the site of pyelonephritis, kidney tuberculosis, tumors, infarction, as a residual formation.

Kidney cyst usually does not show up clinical symptoms and detected by chance during ultrasound examination. With a kidney size of up to 20 mm, the cyst does not cause compression of the parenchyma and functional disorders. A cyst larger than 30 mm is an indication for its puncture.

On ultrasound of the kidneys, the cyst looks like a round anechoic formation of black color. The cyst is surrounded by a hyperechoic rim of fibrous tissue. The cyst may show solid areas that are blood clots or fossils. The cyst may have septa, which are also visible on ultrasound. Multiple cysts are less common and must be differentiated from polycystic kidney disease, a disease in which the kidney parenchyma is almost completely replaced by cysts.

When performing ultrasound with a water or diuretic load, the size of the cyst does not change, in contrast to the pyelocaliceal system, which expands with this study. On color Doppler imaging, the cyst does not give color signals because there is no blood supply to its wall. If vessels are found around the cyst, this indicates its degeneration into a tumor.

Puncture of cysts with ultrasound guidance

Ultrasound examination is indispensable for the treatment of kidney cysts. With the help of ultrasound, the size and position of the cyst, its availability for puncture, are assessed. Under the control of the ultrasound image, a special needle is inserted through the skin, which is fixed on the puncture sensor. The location of the needle is checked by the image on the screen.

After the cyst wall is punctured, its contents are removed and examined in the laboratory. The cyst may contain serous fluid, urine, blood, or pus. Then a special fluid is injected into the cyst cavity. It destroys the epithelium of the cyst and resolves over time, causing the cyst cavity to be replaced by connective tissue. This method of treating cysts is called sclerotherapy.

For the treatment of cysts up to 6 cm in diameter, cyst sclerotherapy is effective. With certain positions of cysts or their large sizes, only surgical removal of cysts is possible.

Polycystic kidney disease on ultrasound

Polycystic is a congenital kidney disease. Depending on the type of inheritance, it can manifest itself in childhood or in the adult population. Polycystic is a genetic disease, so there is no cure. The only treatment for PCOS is kidney transplantation.

In polycystic disease, a genetic mutation disrupts the fusion of the nephron tubules with the primary collecting ducts. Because of this, multiple cysts are formed in the cortical substance. Unlike simple cysts, with polycystosis, the entire cortical substance is gradually replaced by cysts, due to which the kidney becomes non-functional. In polycystic disease, both kidneys are equally affected.

On ultrasound, the polycystic kidney is enlarged in size, has a bumpy surface. In the parenchyma, multiple anechoic formations are found that do not connect to the pelvicalyceal system. Cavities on average have a size of 10 to 30 mm. In newborns with polycystic kidney disease, a narrowing of the PCS and an empty bladder are characteristic.

Medullary spongy kidney on renal ultrasound

This disease is also a congenital pathology, however, unlike polycystic cysts, cysts are formed not in the cortex, but in the medulla. Due to the deformation of the collecting ducts of the pyramids, the kidney becomes like a sponge. Cyst cavities in this pathology have a size of 1 to 5 mm, that is, much smaller than with polycystic disease.

The medullary spongy kidney functions normally for a long time. Unfortunately, this disease is a provoking factor for urolithiasis and infection ( pyelonephritis). In this case, unpleasant symptoms may appear in the form of pain, urination disorders.

On ultrasound, the medullary spongy kidney is usually not detected, since there are no ultrasound machines with a resolution of more than 2 - 3 mm. In medullary spongy kidney, the cysts are usually smaller. Suspicion may be a decrease in the echogenicity of the renal medulla.

Excretory urography is used to diagnose this disease. This method belongs to X-ray diagnostics. With excretory urography, the filling of the urinary tract with a radiopaque substance is observed. The medullary kidney is characterized by the formation of a "bouquet of flowers" in the medulla on excretory urography.

Before use, you should consult with a specialist.

Nephrologist - what kind of doctor is this? Children's specialist. Consultation

Ultrasound of the kidneys. Indications, contraindications for ultrasound of the kidneys. Methodology for conducting ultrasound. Preparation for the procedure

Ultrasound of the kidneys. Urolithiasis on ultrasound. Kidney tumors on ultrasound. Deciphering the conclusion. Combination with ultrasound examination of other organs

Ultrasound of the kidneys for pyelonephritis is considered a secondary research method. It is sent to him if there is a suspicion of a disease, due to the patient's complaints, the results general analysis serum and urine, indicating an inflammatory process occurring in the urinary system.

Most often, pregnant women and children suffer from pyelonephritis. Ultrasound examination does not give any radiation, therefore it can be used in the diagnosis of patients of any age and condition.

Inflammation of the kidneys can be confused with other diseases. Differentiation of the disease among others is a paramount task in making a diagnosis. Ultrasound for pyelonephritis is part of the necessary comprehensive examination.

It is assigned:

• if protein was found in the urine, and there are less or more leukocytes than 3-6 units;
• if the amount of protein and red blood cells in the blood serum has decreased, immunoglobulin, potassium have increased;
• when worried about stupid or sharp pain in the lower back, lower abdomen;
• when a patient at a doctor's appointment describes clinical manifestation diseases - high temperature, weakness, nausea, headache, acute or spastic pain in the lower back, lower abdomen.

3 days before the examination, it is necessary to introduce dietary restrictions. No spicy, fatty, fried foods. You can’t eat for the last 5-8 hours before the ultrasound. You need to drink 500 ml of pure water before the diagnosis.

The research method is non-invasive and painless. The patient lies down on the couch. Removes clothes to expose the lower back, lower abdomen and sides. A special gel-conductor for the sensor is applied to these areas. The device emits ultrasonic waves that are repelled from the tissues and cells of organs. The image on the monitor is formed based on the speed and strength of the wave. Later it is printed and deciphered by a specialist.

In addition to an ultrasound examination, a urologist may write a referral for CT or MRI.

Description of chronic pyelonephritis on ultrasound

This form of the disease develops as a complication of advanced acute inflammation of the kidneys. Signs of chronic pyelonephritis on ultrasound are nonspecific (during remission). Big role in staging final diagnosis play a biochemical analysis of blood and urine, the patient's history.

As a consequence of a severe form of chronic pyelonephritis, nephrosclerosis may appear.

Functional tissues and cells are gradually replaced by connective ones, which leads to a complete dysfunctional disorder of the urinary system.

Ultrasound signs of chronic pyelonephritis:

1. The density of the parenchyma decreases (less than 15 mm). The ultrasonic wave is repelled at a higher speed, which indicates an increase in echo density.
2. The surface of the kidney is not uniform. There are small bumps, indicating infiltration.
3. Edema of the kidney is visible due to the inflammatory process. In chronic pyelonephritis of the unilateral type, their asymmetry is noticeable, and in the bilateral size, both kidneys are on average 8-10 mm larger.

Based on these data, the doctor writes a conclusion. Also, during ultrasound, worms, tuberculosis can be detected if the area around the kidney is covered with pseudotumor nodes that do not manifest themselves clinically.

The diagnosis of acute inflammation of the kidneys is made quickly. There are diffuse form of acute pyelonephritis and focal. The second is easier and faster treated.

Acute pyelonephritis on ultrasound has the following visible signs:

1. The surface of the kidney changes. She becomes rough. This is caused by a change in the composition of cells and tissues - infiltration. This is typical for the focal form of the disease.
2. Puffiness. Bilateral or unilateral enlargement of the kidneys is noted. You can see such pathological changes more often with focal inflammation.
3. Another level of echo density. With focal pyelonephritis - increases, with diffuse - falls.
4. The cortical renal layer is not clearly visible.
5. The mobility of the kidney is impaired during the respiratory process.

The following conclusions can signal complications:

1. Stones, neoplasms. The pelvicalyceal system near the upper urinary tract expands.
2. Isolation of pus outside the fibrous capsule of the organ. There is an echo-negative trend, the picture is fuzzy, the surface of the kidneys is distorted.
3. Severe course of the clinical picture, complications. Only diffuse changes in the urinary tract are detected - swelling of the kidneys, expansion of the CHLS.

Diagnosis of pyelonephritis can take place in several stages. Ultrasound helps to assess the performance, structure of the body.

A minimum of contraindications and an affordable price make this visual diagnostic method paramount.

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Caring and knowledgeable doctor who knows how to put me at ease. Everything went quickly and as painlessly as possible. The doctor did an examination and an ultrasound. I didn't need detailed advice.

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I myself turned to Dr. Volokhov and I came to him with a complaint. I liked, firstly, that the appointment started on time, and in general, time is given for half an hour, and the doctor took care of me for 45 minutes. Secondly, in my opinion, Evgeny Alexandrovich is very attentive, reasonable and calm, he has a high intellect. And, thirdly, literally right at the reception, in fact, some data on my condition were clarified. There is a microscope in the office, the specialist immediately looked at what was needed and sent me for the necessary tests, I think that nothing extra was prescribed to me. Treatment has not yet been prescribed, as further examinations are needed. Dr. Volokhov explained everything in an understandable language, since I am a doctor myself, it can be said that we communicated with him on the same wavelength, but I believe that everything was accessible. I plan to see a specialist again after the results of the tests. I think to come to the doctor again and this is the main thing. I can give a specialist a mark of "5" on a five-point scale!

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Pyelonephritis accounts for up to 70% of all cases of infectious and inflammatory diseases of the kidneys. To clarify the diagnosis, a whole range of studies is carried out: laboratory, instrumental. Ultrasound of the kidneys for pyelonephritis is performed at the first signs of renal pathology.

Benefits of an ultrasound examination

Ultrasound examination of the kidneys has advantages over other methods:

• no radiation exposure to the patient's body;
• accessibility and ease of execution of the procedure;
• painlessness;
• absence side effects and contraindications;
• safety of use in children and pregnant women;
• the possibility of repeated sessions without the threat of harm to the health of the patient.

Ultrasound of the kidneys will show inflammation of different parts of the urinary system, including the pelvis and calyces, where the pathological process in pyelonephritis is mainly localized.

Preparation for the ultrasound procedure

Since the kidneys are located in the retroperitoneal space, in order for inflammation or other pathological changes in the kidneys to be clearly visible on ultrasound, the intestines must be free from feces and contain as little gas as possible. Otherwise, with significant intestinal pneumatosis, the study will be uninformative, and the ultrasound will have to be repeated. Therefore, in the process of preparing for the ultrasound procedure, the patient fulfills a number of conditions:

2-3 days before the manipulation limits in the daily diet products that lead to increased gas formation in the intestines: sweets, yeast baked goods, dairy products, vegetables and fruits, rye bread, legumes, sparkling water, beer.

Water regime - up to 2 liters of water per day.

With a tendency to flatulence, he drinks one of the enterosorbents between meals for two days: Enterosgel, Smektu, Polysorb.

For constipation, make a cleansing enema or take a laxative.

On the evening before the procedure, a light dinner is allowed.

Simultaneously with the study of the kidneys, the condition of the bladder must be monitored. Only the bladder filled with liquid is available for review, therefore, 1-2 hours before the procedure, the patient drinks up to 1.5 liters of water without gas and refrains from urinating.

Carrying out ultrasound of the kidneys

Typically, a kidney scan is performed transabdominal way. The kidneys are examined in the position of the patient on the back, on the side and standing. The patient undresses to the waist, lies down on the couch. For better contact of the sensor with the skin, the intended area of ​​examination is lubricated with a special gel. An algorithm for ultrasound examination of the kidneys has been developed.

First, the right kidney is examined, the sensor scans the upper abdomen on the right, then the patient lies on the right side and the sensor moves along the back to the border of the lower ribs. The left kidney is seen in the same sequence. During the procedure, the doctor asks the patient to take a deep breath and hold his breath. In a standing position, the level of the lower pole of the kidneys is determined, the mobility of the kidneys during breathing is assessed, as well as the symmetry of movement.

Women may have an ultrasound transvaginal method when the transducer is inserted into the vagina, with this method, the bladder and pelvic organs are well visualized.

Ultrasound of the kidneys for pyelonephritis in a child is technically performed in the same way as in an adult. The advantage of this method is that the procedure can be repeated, for example, after treatment to evaluate the effectiveness of therapy. The peculiarity of the echogram in children is that in addition to involvement in the inflammatory process of the pelvicalyceal system during pyelonephritis, part of the renal medulla, the pyramids, is also damaged.

Ultrasound picture in acute pyelonephritis

On ultrasound of the kidneys in acute pyelonephritis, a change in the size of the organ, its mobility, signals of various echogenicity from the inflamed renal parenchyma appear.

The renal structure changes - it becomes fine-grained.

In acute pyelonephritis due to inflammation, swelling of tissues is expressed,

The mobility of the affected kidney decreases during breathing.

The parenchyma zone is distinguished by echo signals of different density, which indicates the presence of small abscesses.

There is an increased density of the mucous pelvis.

Often inflammation affects the perirenal tissue.

On ultrasound of the kidneys, the doctor can see manifestations of acute pyelonephritis due to the appearance on the echogram of signs of inflammation characteristic of this type of disease.

Useful video

By what signs can the disease be recognized, the specialist tells in this video.

Echogram in chronic pyelonephritis

The size of the kidneys, as a rule, is not changed. If nephrosclerosis has developed, the organ decreases in volume.

If the pathological process is unilateral, there is an asymmetry in the size of the right and left kidneys.

Roughness of the outer contour is evidence of infiltration of the parenchyma.

The zone of normal renal tissue is reduced, the parenchyma contains small and large scars and areas of calcifications, from which echo signals of various sizes depart.

The pelvis is enlarged, the tone is increased, the walls of the calyx are thickened.

Deformation of the pyelocaliceal architectonics indicates the secondary nature of pyelonephritis, which was formed against the background of hydronephrosis or congenital anomaly.

Sometimes secondary cysts are found in the parenchyma zone or on the surface - small liquid formations up to 2 cm in diameter. On the echogram they look like anechoic areas.

If ultrasound of the kidneys shows pyelonephritis, which coincides with the characteristic clinical picture and laboratory data, the diagnosis is confirmed.

The conclusion of ultrasound of the kidneys for pyelonephritis is drawn up by a special protocol, which indicates:

• number of organs;
• dimensions;
• location;
• shape and contour;
• parenchyma;
• inclusions;
• bulk formations.

Comparison of the data obtained with the average values ​​of the norm allows the doctor to determine the presence or absence of pathology of the organ under study.

The sensitivity and resolution of ultrasound devices allows you to see inflammation of the kidneys on ultrasound, which helps to make the correct diagnosis and start treatment on time.

Ultrasound diagnostics - modern method detection of diseases of internal organs, including kidneys. This type of research has a number of significant advantages for both the doctor and the patient. Evaluating the results, the specialist will be able to correctly determine the stage and type of the disease, as well as prescribe adequate treatment. The method is as safe as possible for the patient, does not require hospitalization. Ultrasound examination of the kidneys in pyelonephritis is a mandatory step in making the correct diagnosis.

Features of pyelonephritis

Pyelonephritis is the most common kidney disease. The pathology is based on the inflammatory process that occurs in the upper urinary tract. Most common cause- penetration into the tissues of the kidneys of pathogenic bacteria.

Pyelonephritis can occur in two different ways: in acute form with pronounced symptoms and in chronic with a series of exacerbations and subsidence pathological process. Inflammation of the kidneys is quite often combined with anomalies of their anatomical structure, occurs during pregnancy and urolithiasis.

In pyelonephritis, the focus of inflammation is in the calyces and pelvis of the kidneys.

Diagnostic ultrasound: the principle of the method

The human body is a collection of organs and tissues with different densities. The kidneys contain a cortex, fluid-filled pelvises, and a large amount blood vessels. The state of all these anatomical components of the organ can be assessed only by the only method - to do an ultrasound.

The method is based on high frequency mechanical waves produced by an ultrasonic sensor. They propagate at different speeds in the structures of the human body, after which they return back to the sensor. The received signals are converted into an inverted visual picture on the device screen.

Ultrasound - sound vibrations with a frequency of more than 20,000 Hertz

Depending on their density (echogenicity), tissues look different during the study. Liquid is reflected on the screen in the form of dark areas, dense structures have a lighter shade. White indicates stones located inside the urinary tract.

A separate type of ultrasound is a Doppler study of blood flow in the vascular bed of the kidneys. The device's sensor sends a signal that reflects off moving blood cells and returns back. In this case, on the screen of the device, the specialist sees a picture of blue and red areas. The first denotes blood flow moving away from the sensor. In the second case, the blood in the vessels flows towards the source of ultrasound.

Doppler study allows you to assess blood flow in the vessels

Indications for the study

With pyelonephritis, the study can be performed several times. The doctor will prescribe an ultrasound in the following cases:

Kidney ultrasound - video

Advantages and disadvantages of the method

Ultrasound diagnosis of various forms of pyelonephritis has many advantages:

• simple preparation for the study;
• carrying out on an outpatient basis without hospitalization in a hospital;
• absence of pain during the study;
• the possibility of ultrasound at any age, including newborns;

  Ultrasound can be performed on children of any age

• availability of kidney examination in a patient in any condition, including after surgery;
• lack of punctures and cuts;
• information content in the diagnosis of inflammation of the kidneys, anomalies in their structure, urolithiasis;
• no need for anesthesia;
• information content in the diagnosis of complications of pyelonephritis;
• the possibility of conducting research repeatedly during the treatment of the disease;
• lack of side effects and harmful effects;
• the possibility of conducting research during pregnancy.

  Ultrasound examination during pregnancy is a diagnostic method that is safe for mother and fetus

Ultrasound does not have any harmful effect on body tissues, so this research method has virtually no contraindications. However, there are a number of diagnostic features:

Preparation and conduct of the study

When examining the kidneys using ultrasound, the doctor gets a good picture even without special preparatory measures. However, for a more accurate result, a number of requirements must be met:

If simultaneous examination of organs is planned abdominal cavity and kidneys, then the procedure is performed on an empty stomach.

The study of the kidneys is carried out in several positions: lying, on the side, standing. To improve the contact of the device sensor with the skin, a special gel is used, which can then be removed with a regular napkin.

Ultrasound picture for various types of pyelonephritis

The image obtained using ultrasound on the screen of the device may differ depending on the type, stage of the disease and the presence of complications.

Acute pyelonephritis

In case of an acute inflammatory process in the kidneys, the doctor, during the study, will first of all note an increase in the size of the affected organ. However, it must be remembered that normal performance are determined according to special tables based on the gender and age of the patient. In addition, in some cases, pyelonephritis occurs without changing the size of the kidneys.

Normal sizes of kidneys in adults depending on height - table

Growth	Length, mm		Width, mm		Parenchyma thickness, mm
	Left	Right	Left	Right	Left	Right
150	85	82	33	29	13	13
160	92	90	35	33	14	13
180	105	100	38	37	17	15
200	110	105	43	41	18	17

Normal sizes of kidneys in children depending on age - table

Age	Right			Left
	thickness, mm	length, mm	width, mm	thickness, mm	length, mm	width, mm
1-2 months	18,0-29,5	39,0-68,9	15,9-31,5	13,6-30,2	40,0-71,0	15,9-31,0
3-6 months	19,1-30,3	45,6-70,0	18,2-31,8	19,0-30,6	47,0-72,0	17,2-31,0
1-3 years	20,4-31,6	54,7-82,3	20,9-35,3	21,2-34,0	55,6-84,8	19,2-36,4
up to 7 years	23,7-38,5	66,3-95,5	26,2-41,0	21,4-42,6	67,0-99,4	23,5-40,7

Normally, when moving from a horizontal to a vertical position, the body can move up to one and a half centimeters. Kidney mobility in pyelonephritis is significantly limited.

The ultrasound picture of the elements of the inflamed kidney differs from the normal one. Usually in the cortical layer, pyramids turning into cups stand out in a darker color. An acute inflammatory process erases these differences. As they recover, they reappear.

In acute pyelonephritis, there is no difference between the cortical layer and the pyramids

When examining the vessels of the kidney by the Doppler method, the absence of a blue or red cortical layer in the peripheral areas is noted. Such changes indicate a pronounced decrease in blood flow in the kidney against the background of an acute inflammatory process.

The blood supply to the kidney in pyelonephritis is significantly impaired.

Local inflammation in the kidney

Apostematous (pustular) nephritis on ultrasound looks very peculiar. The size of the kidneys in this disease can be increased or normal. In the cortical substance of the organ, multiple dark areas are noted in which an inflammatory purulent process occurs. Pyramids in apostematous nephritis are not clearly defined. The contour of the kidney is blurred, tuberosity is noted.

With apostematous nephritis, ultrasound reveals many dark areas - abscesses

Kidney carbuncle is another type of acute pyelonephritis, which is characterized by a special ultrasound picture. In the cortical substance, an area of ​​increased density of a lighter shade is distinguished - a carbuncle. As it develops, it acquires a darker color compared to the surrounding tissues. When examining the site of the carbuncle by the Doppler method, it is detected complete absence blood flow in this area.

Kidney carbuncle looks like a dark area on the ultrasound picture

Chronic pyelonephritis

The chronic inflammatory process leads to many significant changes. With this type of pyelonephritis, the size of the organ tends to decrease, there is a gradual wrinkling of the kidney (nephrosclerosis). This situation is characterized by the expansion of the pelvis. The thickness of the cortical layer of the kidney decreases. The extreme degree of expansion of the pelvis, in which the latter has a gigantic size, is called hydronephrosis.

Hydronephrosis - an extreme degree of expansion of the renal pelvis

Kidney pyramids also change against the background of long-term inflammation. Their echogenicity gradually increases, and therefore they acquire a lighter shade on the screen of the apparatus. A peculiar white rim appears around the pyramids - calcium deposition (nephrocalcinosis).

Doppler studies show a pronounced decrease in blood flow in the affected organ. Especially this process concerns the cortical substance of the kidney.

Anomalies in the structure of the kidneys

Quite often, pyelonephritis occurs against the background of congenital anatomical anomalies in the structure of the kidneys. Ultrasound diagnostics will provide information about the presence of predisposing factors for the development of the disease.

Quite often there is a situation when there are two kidneys in the body, but their placement differs significantly from the norm. An organ that is usually located in the lumbar region can be localized by a specialist at a much lower level - in the region of the sacral spine.

Pyelonephritis can occur against the background of a doubling of the kidney. In this case, the specialist sees a picture of the presence of two pelvicalyceal systems, supplied by independent vessels. One of the varieties of structural anomalies is a horseshoe kidney. Such an organ is more prone to pyelonephritis, hydronephrosis and urolithiasis.

Horseshoe kidney - a congenital anomaly consisting in the fusion of the lower or upper poles of both kidneys with each other with the formation of an isthmus

Cysts in the kidneys are another common anomaly in the structure of an organ, implying the appearance of cavities in it containing fluid. The ultrasound picture in this case is characterized by the presence of dark areas against the background of a lighter cortical substance. Such formations can fill the entire kidney. This disease is hereditary and is called polycystic.

Cysts in the kidneys on the ultrasound picture look like dark areas

Pyelonephritis with urolithiasis

Stones (calculi) in the kidneys are a frequent companion of the inflammatory process. They have a high density, so on the screen of the ultrasound machine they look like areas of a light shade. In the kidney, a specialist can detect one or more stones. In rare cases, the calculus occupies the entire pelvis and is called coral. Using a modern ultrasound machine, a specialist can identify stones larger than three millimeters.

Coral stone occupies the entire space of the renal pelvis