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Presented By
Dr. Shamim Rima
MBBS,DMU.FCGP
M.PHIL
RADIOLOGY & IMAGING
BSMMU.

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 RENAL FAILURE

Renal failure refers to temporary or permanent damage to the

kidneys that results in loss of normal kidney function. .
There are two different types of renal failure - acute and chronic.

Acute renal failure

 Acute renal failure has an abrupt onset and is potentially reversible.

Chronic failure

Chronic failure progresses slowly over at least three months and can
lead to permanent renal failure

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 CAUSES OF RF
Acute Renal Failure Chronic Renal Failure
Decreased blood flow to the kidneys A prolonged urinary tract obstruction
for a period of time. This may occur or blockage.
from blood loss or shock.
An obstruction or blockage along the Alport syndrome - an inherited
urinary tract. disorder that causes deafness,
progressive kidney damage, and eye
defects. 
Hemolytic uremic syndrome - usually Nephrotic syndrome - a condition that
caused by an E. coli infection, kidney has several different causes.
failure develops as a result of Nephrotic syndrome is characterized
obstruction to the small functional by protein in the urine, low protein in
structures and vessels inside the the blood, high cholesterol levels, and
kidney. tissue swelling.

Ingestion of certain medications that Polycystic kidney disease - a genetic

may cause toxicity to the kidneys. disorder characterized by the growth
of numerous cysts filled with fluid in
the kidneys.
Glomerulonephritis - a type of kidney Cystinosis - an inherited disorder
disease that involves glomeruli. whereby the kidneys have excessive
During glomerulonephritis, the excretion of certain amino acids. This
glomeruli become inflamed and impair leads to severe kidney stones. 4
the kidney's ability to filter urine.
 ULTRASOUND FINDINGS:

POINTS AF CHR
Sizes Normal/ increased Decreased
Parenchymal Normal /increased Increased
echogenicity
Parenchymal Normal / increasded Decreased (<1cm)
thickness
Cortico-medullary Maintain or poor lost
differentiation
Dupllex Doppler RI increased RI increased

Color Doppler Decreased blood flow Decreased blood flow

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ARF

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Sonography of the kidneys revealed: 1) bilateral echogenic
(hyperechoic renal cortex) kidneys 2) both kidneys appear
small in size (atrophic) 3) reduced thickness (thinning) of
renal cortex (10mm.) 4) reduction in cortico-medullary
differentiation
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Left kidney showed parenchymal thinning, particularly at the
upper pole, with increased echogenicity and loss of cortico-
medullary differentiation. The right kidney had increased
echogenicity with loss of cortico-medullary differentiation.
No significant dilatation of the urinary tract was detectable 8
COLOR DOPPLER IMAGING OF THE KIDNEYS REVEALED
REDUCED FLOW IN KIDNEY

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RENAL TRANSPLANTATION

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SONOGRAPHY OF NORMAL RENAL TRANSPLANTS

Ultrasound is the principal imaging technique used in the

evaluation of the transplant and has the advantage of safely
imaging the structure of the graft and its perfusion without
the need for intravenous contrast or ionizing radiation..
High-resolution phased-array 3 to 5 MHz transducers with
colour Doppler imaging (CDI) and pulsed Doppler (PD)
capability are required

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 ASSESSMENT OF THE RENAL GRAFT INCLUDES

Evaluation of the parenchymal echogenicity,

Definition of the cortical/medullary junction, collecting system,

Surrounding soft tissues and estimation of graft volume
The normal renal transplant is easily visualized in the iliac fossa lying
anterior to the external iliac artery and vein 

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 Renal Transplant Complications
Immediate Early Late
(<1 week) (1-4 weeks) (>1 month)
Table 2: Renal
Parenchymal Acute Tubular Necrosis Acute Rejection Acute Rejection
Chronic Rejection
Rejection
·  Hyperacute Cyclosporine Toxicity
·  Accelerated Acute Disease Recurrence
·  Acute Infection

Vascular Renal Vein Thrombosis Renal Vein Thrombosis Renal Artery Stenosis
Renal Artery Thrombosis
Urologic Ureteral Oedema Urinary Fistulae Ureteral Strictures
Urinoma
Fluid Collections Haematoma Urinoma Lymphocoele
Abcess
Neoplastic     Skin Malignancies
Lymphomas
Iatrogenic Post Biopsy Haemorrhage    
Renal AV Fistula
Pseudoaneurysm
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 POSTOPERATIVE MONITORING

Ultrasound of the kidney with doppler colorflow to

evaluate renal perfusion is done during first 3 days 

The size of the kidney is

measured; a kidney undergoing
acute rejection may become
larged

Repeated USG 4 weeks after

surgery to check for
hydroureter and for renal
perfusion.

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 ACUTE REJECTION

Decreased cortical echogenicity and swelling of the

medullary pyramids resulting in loss of cortical/medullary
differentiation
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Oedema within the renal sinus fat which may
efface or obliterate the sinus echo complex. 

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Oedema of the collecting system wall

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Focal
Focal echo-poor
echo-poor areas
areas of
of parenchymal
parenchymal
infarction
infarction and
and perigraft
perigraft fluid
fluid due
due to
to
necrosis
necrosisand
andhaemorrhage
haemorrhage

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Reversed Diastolic Flow In Severe Acute Rejection.

PD characteristically shows reduced, absent or

reversed diastolic flow with elevation of the RI
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 CHRONIC REJECTION. 

small graft with thinned echogenic cortex and

relative sparing of the medullary pyramids
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 VASCULAR COMPLICATIONS

Renal Vein Thrombosis or Occlusion (RVT)

Prolonged, plateau-like reversal of diastolic flow

in a patient with renal vein obstruction
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 RENAL ARTERY STENOSIS (RAS)

CD image of the same stenosis shows colour aliasing

at the site of the jet

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The
TheReduction
ReductionInInPulse
PulseAmplitude
AmplitudeAnd
AndDelayed
Delayed
Systolic
SystolicUpstroke
UpstrokeOfOfRenal
RenalArtery
ArteryStenosis. 
Stenosis. 

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UROLOGIC COMPLICATIONS

URINOMA 

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URETERAL OBSTRUCTION AND HYDRONEPHROSIS

Dilatation confined to the renal pelvis in

the early post operative period.

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Pelvic And Calyceal Dilatation Is Associated With
Obstruction In Over Two-thirds Of Cases

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28
 Hydronephrosis
HydronephrosisSecondary
SecondaryTo ToAAUreteral
UreteralStone
Stone
(Arrow).
(Arrow).Dilated
DilatedRenal
RenalPelvis
Pelvis(P)
(P)And
AndLower
LowerPole
PolePf
Pf
The
TheTransplant
TransplantKidney
Kidney(K)
(K)Are
AreVisible
Visible

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Longitudinal
Longitudinalsonogram
sonogramdemonstrates
demonstrates
transplant
transplanthydronephrosis
hydronephrosisand
andaalower
lowerpole
pole
stone. 
stone. 

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 LYMPHOCELE

A large septated lymphocoele is situated between the 31

lower pole of the transplant and the bladder

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 PROCEDURE RELATED COMPLICATIONS

Haemorrhage Subcapsular Haematoma

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Longitudinal US Image Shows An Echogenic Mass
(Arrowheads) Surrounding The Renal Transplant

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 ABSCESS 

Longitudinal US image shows a complex fluid collection

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(arrows) superficial to the renal transplant.
 ACUTE TUBULAR NECROSIS

Longitudinal US image shows large, hypoechoic pyramids.

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 CORTICAL INFARCT

US image, the region of cortical infarct is hypoechoic (arrowhead

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ULTRASOUND FINDINGS

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URETERIC STONE

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 URETERIC STONE

Distal Uretral
mild dilatation of the renal collecting 40
Stone
system
PROXIMAL URETERIC STONE

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DISTAL URETERIC STONE

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MID URETERIC STONE

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URINARY BLADDER

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 PATHOLOGY OF UB

CONGENITAL LESION MECHANICAL PROBLEMS OF

THE UB WALL
Aagenesis
Trabeculation
Bladder duplication
Trabeculation
Bladder extrophy
Cystocele
Urechal anomeliesvesicourachal fistula
fistulas
Urechal cyst
diverticula UB NEOPLASIA
INFLAMATORY LESION
UB CALCULI
Acute bacterial cystitis
TRAUMA
Chronic bacterial cystitis
Emphysematous cystitis
Interstiial cystitis
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Focal cystitis
CYSTITIS

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CHRONIC CYSTITIS

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UB MASS

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Bladder mass: hyperechoic or mixed, irregular
shaped mass within the bladder

Fungating bladder mass

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LARGE URINARY BLADDER CALCULUS

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PSEUDO-TUMOURS OF THE URINARY TRACT 

The echogenic mass was seen to move position to the

right side of the urinary bladder on real time scanning
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IUCD IN UB

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 TRABECULATION

Longitudinal ultrasound scan with bladder wall thickening

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and trabeculation.
Any Question ?

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Thank You
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