UroRadiology Diagnostic

8/12/2019 UroRadiology Diagnostic

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Nephrology Annual Meeting

Banjarmasin, March, 26th, 2011Luthfy Mahatma Hadi

Radiology Dept. UGH , LM U School of Medicine


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Congenital Anomalies :

Renal Agenesis, Renal Dysplasia/Hypoplasia, Renal Ectopic,

Renal Malrotated, Renal Duplication, Renal Fusion.

Benign Lesions :

Polycystic Disease of the Adult ( autosomal dominant ) / Polycystic Kidney Disease

Simple Cyst ( 50% populasi, > 50 yr )

Multilocular Cyst

Medullary Sponge Kidney

Papillary Necrosis

Perinephric Cyst ( Urinoma )

Acquired Cystic Disease of Dyalisis

Von Hippel-Lindau Disease


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Renal Parenchyme Disease :

Acute Pyelonephritis, Renal Abscess, Acute Tubuler Necrosis,

Chronic Pyelonephrosis, Acute Glomerulonephritis,

Renal Tuberculosis, others infections.

Renal Vascular Disease :

Renovascular Hypertension, R

Renal Artery-Vein Thrombosis.

Renal Trauma

Renal Failure

Benign & Malignant Tumour


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Modalities :

X-ray with variant examinations ( with CR / Computed Radiography )

BOF IVU, Cystography ,

Urethro-Cystography (mono bipolar),Ante Retrograde Pyelography ( APG RPG )

Reflux Study, Lopoography, etc. ( mostly with conrast media )

Ultrasonography

CT Scanner , MRI, Angiography,

Nuclear Medicine / Radionuclide ( Renography )


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Polycystic Disease of the Adult

( abdominal mass, pain, hematuri, renal failure or hypertension )

Classification of cystic disease ( Elkin, 1975 )

1. Renal dysplasiaa. Multicystic kidney

b. Focal & segmental dysplasia

c. multiple cysts associated with lower urinary tract. Obstruction

d. Hereditary & familial cystic dysplasia


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Left Polycystic Kidney Disease

8Luthfy Mahatma Hadi - Nephrology Meeting

March, 2011


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2. Polycystic diseasea. Polycystic disease of the young ( newborn, childhood )

b. Polycystic disease of the adult

3. Cortical cyst

( Trisomy syndromes, Tuberous sclerosis, simple cyst, Multilocular cyst )

4. Medullary cysts( Medullary sponge kidney, Medullary cystic disease,

Papillary necrosis, Pyelogenic cyst )

5. Miscellaneous intrarenal cyst( Inflammatory, Neoplastic, Traumatic )

6. Extraparenchymal cyst


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Medullary cyst

Extraparenchymal cyst


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1st/2ndInfections Tumour B/M Obstructive UropathyRenal Vascular Disease Trauma

radiodiagnostic

Influence Vasa Vascular (A/E) & Nephrons

Filtration & Biochemis functions affection

Disturbances Renal Filtration ( with all consequences )

RENOGRAPHY ( 2011)

RENAL FAILURE


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Acute Tubular Necrosis (ATN)

Reversible from ARF associated with renal ischaemia episode.

Severe renal ischaemia episode = Acute Cortical Necrosis

Enlargement renal tissue

Chronic Pyelonephritis (ChPs)

Association with urinary tract. Infection ranging from renal scar orhypertension to severe renal damaged ensuing CRF.

Contracted / scarred renal tissue

Distorted calyces

Scarring with normal calyces indicating VASCULAR etiology.


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RVD common cause 2ndHypertension

Stenosis Renal Artery due to Atheroma or Fibromuscular Hyperplasia iscommonest cause.

Renal Artery or Vein Thrombosis or Aneurysm

Arteritis, Trauma

Renal Vein Thrombosis :

leucocytosis, haematuria, proteinuria, pain, fever,

common cause by pulmonary emboli (33%)

Others E/ : Nephrotic Syndrome, Cyanotic congenital heart disease,

extension renal tumour RCC/Wilms, hypovolemic shock.


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4 renal injury categories :

1. Contusion & corticomedullary lacerations that do not communicate

with the collecting system ( 75-85% ) [heal spontaneously]

2. Parenchymal lacerations that communicate with the collectingsystem

( 10 15% ) [ surgery esp. 3-4 category]

3. Shaterred kidney with injuries to the renal vascular pedicle ( 5% )

4. Pelviureteric junction avulsion & laceration of the renal pelvis


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Adenoma, Oncocytoma , Angiomyolipoma,

Hemangioma, Lipoma & Fibroma.

Angiomyolipoma :

Hamartoma that contain variable amounts of fat, smooth muscle,blood vessel.

singly middle age women as renal mass with haematuria, pain.

angiography : vascular tumour with aneurysmal dilatation of the abnormal

vessel &early venous filling.


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Renal Adenocarcinoma ( Hypernephroma / RCC )

86% of renal tumour ( 3% all human tumour ), M:F = 3:1

High mortality & increasing incidense

Thrombus in to renal vein & caval inferior vein

Lymphnodes retroperitoneal involvement

Liver tissue metastatic

All modalities

Transitional Cell Carcinoma (TCC)

WilmsTumour ( Nephroblastoma )


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Staging (T) : ( for RCC )

T1 : tumour confined to the renal capsule & causing minimal calyceal

displacement.

T2 : large tumour confined to the renal capsule & causing calyceal or

pelvic displacement.

T3A : tumour involving the perinephric or pelvic fat

T3B : tumour thrombus in the renal vein

T3C : tumour thrombus extending in to IVC

T4 : tumour involving contiguous structures & with distant metastase


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Documents

UroRadiology Diagnostic