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RENAL EMERGENCIES ULTRASOUND SCANNING
Category: Diagnostic Radiology
Abstract : RENAL TRACT EMERGENCIES Ultrasound is usually the firstline investigation
in the assessment of acute loin pain, which in the absence of trauma is commonly
due to acute urinary tract obstruction and/or renal infection. Less common acute
presentations include renal vein thrombosis or spontaneous haemorrhage, usually
from a renal tumour or cyst. Until recently, ultrasound and/or
i
RENAL TRACT EMERGENCIES
Ultrasound is usually the firstline investigation
in the assessment of acute loin pain, which in the absence of trauma is commonly
due to acute urinary tract obstruction and/or renal infection. Less common acute
presentations include renal vein thrombosis or spontaneous haemorrhage, usually
from a renal tumour or cyst.
Until recently, ultrasound and/or
intravenous urography (IVU) have been the investigations of choice in acute
renal colic due to suspected ureteric calculus, and in most UK centres the IVU
is currently the method of choice for demonstrating ureteric obstruction.
Low-dose unenhanced multislice CT is increasingly being recommended as a
replacement for these two modalities,14 but even with this technique diagnostic
pitfalls exist. Abdominal ultrasound with or without plain radiography may still
provide comparable accuracy where CT resources are limited.
The main
limitation of ultrasound in acute ureteric obstruction is that obstruction may
be present in the early stages without collecting system dilatation. But the
minimally dilated renal pelvis, which would normally be dismissed as
unremarkable in a patient with a full bladder, should raise the operators
suspicion in the patient with acute loin pain. Doppler ultrasound of the kidneys
shows a higher resistance index in the obstructed kidney than in the normal
side. Upper tract obstruction can be relieved via cystoscopy-guided ureteric
stent placement.
Ultrasound-guided percutaneous nephrostomy may be
required if this is not practicable, or if there is evidence of infection. Renal
infection with parenchymal involvement (acute pyelonephritis) may be the cause
of severe acute loin pain with fever, but ultrasound examination mostly shows no
abnormality. Occasionally the skilled operator using high-specification
equipment may be able to identify segmental areas of high reflectivity, showing
decreased blood flow with power Doppler. The diagnosis of this condition is
usually based on clinical criteria, but these segments can be demonstrated with
CT if necessary.
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