D

1. Doppler US of the kidney

3. V
A
V

5. NORMAL RENAL DOPPLER WAVE FORM
 Rapid systolic rise.
 High-velocity diastolic flow.
 Small spike at the end of the systolic rise.

9. Renal Vascular Disorders
Renal Artery Stenosis (RAS)
Arerio-Venous Malformation (AVM)
Arerio-Venous Fistula (AVF)
Renal Artery Aneurysm (RAA)
Renal Vein Thrombosis

10. Renal Artery Stenosis
RAS

11. Causes:
- Atherosclerosis
- Intimal Fibrosis
- True Fibromuscular Hyperplasia
- Medial Fibroplasia
- Perimedial (Subadventitial) Fibroplasia:
- Miscellaneous: RAA, Middle Aortic Syndrome,
Periarterial Fibrosis & Post-traumatic intimal disease.

12. •Severe hypertension under age of 40.
•Recent onset of accelerated-phase hypertension.
•Failure to respond to adequate 4 drug treatment.
•High peripheral renin activity.
•Abdominal bruit.
Clinical features suggestive of renal artery
stenosis:

13. RENAL DOPPLER STUDY

14. Color Flow Doppler (CFD)
Non invasive and inexpensive.
Limited by the need of experienced operator.
Positive US results must be confirmed with DSA.

15. Starts by examination of intra-renal arteries.
Examination must include upper, middle & lower
kidney segments.
One Doppler spectral signal within the time of breath
hold is enough for the diagnosis.
If the examination of intra-renal arteries is normal,
examine the main renal artery.

16. NORMAL RENAL DOPPLER WAVE FORM
 Rapid systolic rise.
 High-velocity diastolic flow.
 Small spike at the end of the systolic rise.

17. CFD criteria of RAS
• MAIN RENAL ARTERY
Increase in PSV (100- 200 cm/sec).
Renal / aortic ratio >3. 5
Turbulent flow
Occlusion
• INTRARENAL ARTERIES
Dampened appearance
AI < 3m/sec. pulsus tardus
AT > 0.05-0.08 sec. pulsus parvus
Delta RI > 5 %.
Normal Wave

18. Cases

19. Right renal artery stenosis

20. Left renal artery stenosis

21. kidney transplant recipient artery stenosis

22. kidney transplant recipient artery stenosis

23. Renal Vascular Disorders
Renal Artery Stenosis (RAS)
Arerio-Venous Malformation (AVM)
Arerio-Venous Fistula (AVF)
Renal Artery Aneurysm (RAA)
Renal Vein Thrombosis

24. Abnormal connection between the arterial &
venous circulation with bypass of the capillary
system
Arteriovenous Malformations
AVM

25. Congenital or Acquired
Most common cause is trauma.
Other causes : surgery, tumors, or
idiopathic.
Arteriovenous fistulas comprise 70-
80% of AVMs in the kidney

26. Focal turbulance and color aliasing
Pulsating venous flow
Decreased RI

27. AVM

28. Renal Vascular Disorders
Renal Artery Stenosis (RAS)
Arerio-Venous Malformation (AVM)
Arerio-Venous Fistula (AVF)
Renal Artery Aneurysm (RAA)
Renal Vein Thrombosis
Vasculitis

29. Arteriovenous Fistula (AVF)
Simultaneous laceration of a renal artery branch and an
adjacent vein during biopsy.
These occur in up to 18% of biopsied kidneys but are
almost always small and asymptomatic.

30. Mosaic colour asignment

31. High velocity, low resistance flowPulsatile venous flow

32. Renal Vascular Disorders
Renal Artery Stenosis (RAS)
Arerio-Venous Malformation (AVM)
Arerio-Venous Fistula (AVF)
Renal Artery Aneurysm (RAA)
Renal Vein Thrombosis

33. Renal Artery Aneurysm
The most common cause is atherosclerosis
Less common causes include medial fibroplasia,
pregnancy, and mesenchymal diseases such as
neurofibromatosis
Renal pseudoaneurysms are usually posttraumatic or
inflammatory (eg, Behçet’s disease, mycotic aneurysm)

36. Renal Vascular Disorders
Renal Artery Stenosis (RAS)
Arerio-Venous Malformation (AVM)
Arerio-Venous Fistula (AVF)
Renal Artery Aneurysm (RAA)
Renal Vein Thrombosis

37. Renal Vein Thrombosis

38. Hypercoagulable state
Nephrotic syndrome
Membranous glomerulonephritis
Membranoproliferative glomerulonephritis
Lupoid nephrosis
SLE
Inherited hypercoagulable state
Antithrombin III deficiency
Protein C deficiency
Protein S deficiency
Dehydration
Mechanical process
Trauma
Neoplasm
Renal cell carcinoma
Transitional cell carcinoma
Wilms tumor
Left adrenal carcinoma
Abscess
Aneurysm
Adrenal hematoma
Left ovarian vein thrombosis
Causes of Renal Vein Thrombosis

40. Renal enlargement with hypoechoic cortex from edema (early phase)
Decreasing size and increased echogenicity (late)
Reversal of arterial diastolic flow
Absent venous flow
Visualization of thrombus within the lumen
High resistance in the renal artery with elevated resistive index