Normal ultrasound of neonatal kidney.

1. Dr/Ahmed Bahnassy
Consultant radiologist
RMH

2. • Echostructure.
• Size.
• Variations.
• Congenital anomalies.
• Renal abnormality.

3. RENAL ANATOMY
MEDULLA
RENAL
CORTEX
RENAL
COLUMN
MAJOR
CALYCES
RENAL
PELVIS RENAL
URETER CAPSULE
MINOR
CALYX
RENAL
MEDULLARY
PYRAMID

4. NORMAL RENAL
SONOGRAPHY
• Paired retroperitoneal organs
• Renal sinus- dense central echoes
due to renal fat
– Contains:
• Collecting system: calyces, infundibula, &
part of renal pelvis
– bifid system seen as two separate lobulations
• Renal vessels: renal hilium
• Lymphatics
• Fat
• Fibrous tissues

5. RENAL SINUS
• Central area of the kidney
from the medial border
• Bounded by fat
– anteriorly and posteriorly by
fibrous sheath known as
Gerota’s fascia
– laterally by the laterocoronal
fascia which becomes
continuous with peritoneum
& abdominal wall

6. RENAL SONOGRAPHY
• Renal parenchyma - 2 parts cortex & medulla
– thickest at the renal poles
• Cortex located between capsule & medulla
– low level uniform echoes
– less echogenic than liver & spleen
– Columns of Bertin = columns of cortical tissue located between
pyramids
» can enlarge & mimic a mass
» normal variant
• medulla
– renal volume is estimated by water displacement
• V = 0.49 x length x width x anterior posterior dimension

7. RENAL SONOGRAPHY
• Renal parenchyma - 2 parts cortex & medulla
– Medulla
• Pyramids - triangular or rounded hypoechoic areas
• Rounded zones of decreased echogenicity between
cortex & renal sinus
• Specular echoes interspersed at the junction of the
cortex & medulla represents arcuate arteries & veins
(known as corticomedullary junction)

8. Dysplastic kidney

9. RENAL SONOGRAPHY
• Vascular exchange
– renal arteries
• come off of aorta - can be multiple
• right renal artery (RRA) - seen posterior to IVC in
sagittal plane
– renal veins
• come off of IVC
• left renal vein (LRV) - seen between SMA & aorta
in the transverse plane

10. RENAL ARTERY

11. RENAL SIZE

12. Normal renal size
Normal Liver, Spleen,
and Kidney
Dimensions in
Neonates, Infants,
and Children:
Evaluationwith
Sonography..
AJR:171,December19
98

13. Development

14. Anomalies and variations
• Congenital variations
– fetal lobulations
– dromedary hump.
– Fusion anomalies :horseshoe -
isthmus of tissue that connects
both kidneys
– Ascent anomalies: pelvic kidney
fails to migrate from pelvic area
during embryology

15. • Normal neonatal kidney should be
evaluated according to:
• Normal echotexture.
• Normal size for age.
• Normal development.
• Excluding normal variants.
• Diagnosing congenital anomalies ..and
lastly evaluating a diseased kidney
accordingly .