home→Diagnostics→ Terms and definitions for computed tomography of the kidneys. Kidney hypertrophy - what does this pathology lead to? Hypertrophied bertini column

Terms and definitions for computed tomography of the kidneys. Kidney hypertrophy - what does this pathology lead to? Hypertrophied bertini column

Aplasia of the kidney occupies 35% of all malformations. The kidney does not have a pelvis and a formed pedicle; a fibromatous mass with a diameter of 2-3 cm is determined in place of the kidney.

no parenchyma,
no elements of the pelvicalyceal complex,
no vascular structures.

At agenesis- in place of the kidney, the intended organ is not determined at all. At the same time, we pay all attention to the existing single kidney.

Hypoplasia of the kidney

Kidney hypoplasia is a miniature N-shaped organ. On MRI and CT, the vascular pedicle, pelvis and ureter are determined. With contrast bolus enhancement in the renal parenchyma, even the cortical and medulla can be distinguished. Most often, the process is unilateral, 2-sided process is most common in girls. The opposite kidney, as a rule, is enlarged in size (vicar enlargement), while its function is sufficient.

double kidney

Double kidney - with CT and MRI, it is quite convenient to diagnose. There is a bridge between the upper and lower calyxes; when enhanced, the parenchyma and the bridge are evenly contrasted. Doubled kidney - when there are two veins and two arteries, if the vessels are not doubled, then this is already a doubling of the pelvis. The doubled kidney, as a rule, has the big sizes.

Localized hypertrophy of the central column (Bertini)

Local hypertrophy of the renal parenchyma (hypertrophy of the central column of Bertini) is the most common variant of the structure of the renal parenchyma, which raises the suspicion of a tumor lesion of the kidney. These false conclusions are often found after patients undergo ultrasound or computed tomography studies. The ability of MRI to transmit cortico-medullary differentiation of the parenchyma in most of these cases removes the assumption of a kidney tumor.

parenchymal differentiation preserved,
no signs of destruction of the parenchyma,
there are no signs of deformation of the pelvicalyceal complex.

horseshoe kidney

Horseshoe kidney - the kidneys are fused at the lower or upper ends. The kidneys are located below normal and are determined at the level of 4-5 lumbar vertebrae. Half of the kidneys can be of different sizes, the isthmus is most often represented by parenchymal tissue, less often fibrous (when enhanced, it is evenly contrasted). In most cases, the isthmus is located above the aorta, but may also be behind the aorta, the pelvis of the halves of the kidneys are located ventrally. The kidneys have multiple vessels (up to 20 pieces). Horseshoe kidney manifests itself after 50 years (arterial sclerosis -> kidney ischemia -> acute pain). It is 2.5 times more common in men than in women.

kidney dystopia

homolateral,
heterolateral (cross dystonia).

Homolateral dystonia - the kidneys in their embryogenesis did not rise up from the pelvis and did not turn along the longitudinal axis.

Distinguish dystopia:

thoracic (kidneys are determined under the diaphragm),
lumbar,
iliac,
pelvic.

The size of the dystonated kidney is reduced, pronounced lobulation is noted and in most cases it is hypoplastic (especially the pelvic one), the cups are turned anteriorly, the vessels are multiple, they do not always penetrate the kidney from the side of the gate, and often the vessels around the kidney form plexuses, which gives it a bizarre shape.

Pelvic dystopia is more often observed on the right, the adrenal gland is always in its place, because. the adrenal gland undergoes its own embryogenesis, separately from the kidney.

Heterolateral dystopia - the kidneys are located on one side, cross dystonia is located above the usual kidney, they have a more embryonic type of structure (pronounced lobulation).

Literally translated from Greek, "parenchyma" means: a mass filling something, or a filling. The medical interpretation is stricter: this is a tissue structure that allows you to perform a given function.

Since the functions of organs are usually not limited to any one task, their structure is complex, and the kidney parenchyma is no exception to this rule.

Given that the kidney is enclosed in a rather dense connective tissue capsule that prevents the organ from stretching, its parenchyma is the most consistent with the literal meaning of the word - filling.

The structure and purpose of the parenchyma

Several layers of the dense substance of the parenchyma lie under the capsule, differing both in their color and in consistency - in accordance with the presence of structures in them that allow them to perform the tasks facing the organ.

In addition to its most famous purpose - to be part of the excretory (excretory) system, the kidney also performs the functions of an organ:

endocrine (intrasecretory);
osmo- and ion-regulating;
participating in the body both in general metabolism (metabolism), and in hematopoiesis - in particular.

This means that the kidney carries out not only blood filtration, but also regulates its salt composition, maintains the optimal water content in it for the needs of the body, affects the level of blood pressure, and in addition - produces erythropoietin (biologically active substance, which regulates the rate of formation of erythrocytes).

Cortical and medulla

According to the generally accepted position, the two layers of the kidney are called:

The layer lying directly under the densely elastic capsule, the outermost in relation to the center of the organ, the most dense and the most light-colored, is called the cortical layer, located below it, darker and closer to the center, is the medulla layer.

A fresh longitudinal section even reveals to the naked eye the heterogeneity of the structure of the renal tissues: it shows radial striation - structures of the medulla, semicircular tongues pressed into the cortical substance, as well as red dots of the renal bodies-nephrons.

With a purely external solidity, the kidney is characterized by lobulation, due to the existence of pyramids, delimited from each other by natural structures - renal columns formed by a cortical substance that divides the medulla into lobes.

Glomeruli and urine production

For the possibility of cleaning (filtering) blood in the kidney, there are zones of direct natural contact of vascular formations with tubular (hollow) structures, the structure of which allows the use of the laws of osmosis and hydrodynamic (resulting from fluid flow) pressure. These are the nephrons arterial system which forms several capillary networks.

The first is a capillary glomerulus, completely immersed in a cup-shaped depression in the center of the flask-shaped dilated primary element of the nephron - the Shumlyansky-Bowman capsule.

The outer surface of the capillaries, consisting of a single layer of endothelial cells, is here almost completely covered with cytopodia intimately adjacent to it. These are numerous stem-like processes, originating from the centrally passing beam-cytotrabeculae, which in turn is a process of the podocyte cell.

They arise as a result of the entry of the "legs" of some podocytes into the gaps between the same processes of other, neighboring cells with the formation of a structure resembling a "lightning" lock.

The narrowness of the filtration slits (or slit diaphragms), due to the degree of contraction of the "legs" of podocytes, serves as a purely mechanical obstacle for large molecules, preventing them from leaving the capillary bed.

The second miraculous mechanism that ensures the fineness of filtration is the presence on the surface of slit diaphragms of proteins that have an electric charge that is the same as the charge of the molecules approaching them in the composition of the filtered blood. This electrical "veil" also prevents unwanted components from entering the primary urine.

The mechanism of formation of secondary urine in other parts of the renal tubule is due to the presence of osmotic pressure directed from the capillaries into the lumen of the tubule, braided by these capillaries to the state of "sticking" of their walls to each other.

Parenchyma thickness at different ages

In connection with the onset of age-related changes, tissue arthrosis occurs with thinning of both the cortical and medulla layers. If at a young age the thickness of the parenchyma is from 1.5 to 2.5 cm, then upon reaching 60 years or more it becomes thinner to 1.1 cm, leading to a decrease in the size of the kidney (its wrinkling, usually bilateral).

Atrophic processes in the kidneys are associated with both the maintenance of a certain lifestyle and the progression of diseases acquired during life.

Both general vascular diseases of the sclerosing type and the loss of the ability of the kidney structures to perform their functions lead to conditions that cause a decrease in the volume and mass of the renal tissue due to:

voluntary chronic intoxication;
sedentary lifestyle;
the nature of the activity associated with stress and occupational hazards;
living in a particular climate.

Bertini column

Also called Bertinian columns, or renal columns, or Bertin columns, these beam-like bands of connective tissue, passing between the pyramids of the kidney from the cortical layer to the medulla, divide the organ into lobes in the most natural way.

Because inside each of them there are blood vessels that ensure the metabolism in the organ - the renal artery and vein, at this level of their branching they are called interlobar (and at the next - lobular).

Thus, the presence of Bertin's columns, which differ in a longitudinal section from the pyramids in a completely different structure (with the presence of sections of the tubules passing in different directions), allows communication between all zones and formations of the renal parenchyma.

Despite the possibility of the existence of a fully formed pyramid inside the especially powerful column of Bertin, the same intensity of the vascular pattern in it and in the cortical layer of the parenchyma indicates their common origin and purpose.

Parenchymal bridge

The kidney is an organ that can take any shape: from the classic bean-shaped to the horseshoe-shaped or even more unusual.

Sometimes an ultrasound of an organ reveals the presence of a parenchymal bridge in it - a connective tissue retraction, which, starting on its dorsal (posterior) surface, reaches the level of the median renal complex, as if dividing the kidney across into two more or less equal "half beans". This phenomenon is explained by too strong wedging of the Bertin columns into the kidney cavity.

For all the seeming unnaturalness of this appearance of the organ, with the non-involvement of its vascular and filtering structures, this structure is considered a variant of the norm (pseudopathology) and is not an indication for surgical treatment, just like the presence of a parenchymal constriction dividing the renal sinus into two seemingly separate parts, but without complete doubling of the pelvis.

Ability to regenerate

Regeneration of the kidney parenchyma is not only possible, but also safely carried out by the body in the presence of certain conditions, which has been proven by many years of observation of patients who have had glomerulonephritis - an infectious-allergic-toxic disease of the kidneys with massive damage to the renal bodies (nephrons).

Studies have shown that the restoration of the function of an organ occurs not through the creation of new ones, but through the mobilization of existing nephrons, which were previously in a conserved state. Their blood supply remained sufficient only to maintain a minimum life activity in them.

But the activation of neurohumoral regulation after the subsidence of the acute inflammatory process led to the restoration of microcirculation in areas where the renal tissue was not subjected to diffuse sclerosis.

These observations allow us to conclude that the key point for the possibility of regeneration of the renal parenchyma is the ability to restore blood supply in areas where it has significantly decreased for any reason.

Diffuse changes and echogenicity

In addition to glomerulonephritis, there are other diseases that can lead to the appearance of focal atrophy of the renal tissue, which has a different degree of extent, called the medical term: diffuse changes in the structure of the kidneys.

These are all diseases and conditions that lead to vascular sclerosis.

The list can begin with infectious processes in the body (flu, streptococcal infection) and chronic (habitual household) intoxications: alcohol intake, smoking.

It is completed by industrial and service-related hazards (in the form of work in an electrochemical, galvanizing shop, activities with regular contact with highly toxic compounds of lead, mercury, as well as those associated with exposure to high-frequency electromagnetic and ionizing radiation).

The concept of echogenicity implies the heterogeneity of the structure of an organ with varying degrees of permeability of its individual zones for ultrasound examination (ultrasound).

Just as the density of different tissues is different for “transmission” by X-rays, on the path of the ultrasonic beam there are also both hollow formations and areas with high tissue density, depending on which the ultrasound picture will be very diverse, giving an idea of the internal structure organ.

As a result, the ultrasound method is a truly unique and valuable diagnostic study, which cannot be replaced by any other, which allows to give a complete picture of the structure and functioning of the kidneys without resorting to an autopsy or other traumatic actions in relation to the patient.

Also, an outstanding ability to recover in case of damage, it is possible to largely regulate the life of the organ (both by saving it by the owner of the kidneys, and by providing medical care in cases requiring intervention).

Are hyperechoic inclusions in the kidneys life-threatening?

Hyperechoic inclusions are usually detected during renal ultrasound. They represent a certain kind areas of tissue with large acoustic seals, which may be simple stones from urolithiasis or be dangerous formations in the form of a benign or malignant tumor. These are structures that are denser compared to the surrounding tissues of the organ, perfectly repelling ultrasound and thereby creating hyperechogenicity. On the monitor of the ultrasound machine, they are indicated by white spots.

What are hyperechoic inclusions?

On ultrasound of the kidneys, such neoplasms are visualized in the form of small linear, dotted or volumetric structures with a high echogenicity index. They are located within the renal tissue. In medical practice, it is noted that such hyperechoic inclusions are a kind of calcifications, from which microcalcifications are isolated - point particles without acoustic shadow. If the presence of microcalcification is diagnosed in the nodular formation, then many doctors talk about the development of a malignant tumor.

Quite often, experts come to just such an opinion, since hyperechoic formations mainly begin to manifest themselves precisely in malignant tumors. There are three types of structures in a malignant tumor:

psammoma bodies - make up half of the echogenic formation;
calcifications - only 30%;
areas of sclerosis - 70%.

In a benign tumor of the kidneys, psammoma bodies are completely absent, calcifications can also be found quite rarely. Basically, these are sclerotic areas.

Varieties of hyperechoic inclusions. Diagnostics

Only a specialist is able to detect hyperechoic inclusions in the kidneys during diagnosis. It can be stones or sand in the kidneys. Today, several varieties of such inclusions are known:

point inclusions, which are visualized quite brightly: they are small and do not have an acoustic shadow;
large formations that also lack an acoustic shadow. In the kidneys, they are rarely formed, doctors mainly diagnose them during an ultrasound of the kidneys. They can be localized not only in a malignant, but also in a benign tumor;
large formations, which include an acoustic shadow. They fully correspond to the sclerotic parts.

Hyperechoic inclusions in the kidneys can be detected by ultrasound of the kidneys or suspected of their presence by severe symptoms:

high temperature,
change in color of urine
frequent colic in the kidney area,
severe pain in the abdomen or below the belt or constant pain in the groin,
vomiting and nausea.

These symptoms are similar to manifestations of other diseases, so at the first suspicion of kidney stones, you should immediately consult a doctor. In order not to start the disease, it is necessary to undergo a complete examination every six months, to take blood, urine, and feces for analysis. Thus, it is possible not only to prevent the development of any diseases, but also to avoid some diseases.

To prevent stones in the stomach, it is necessary to use liquid more often: water, rose hips, tea with herbs (mint, oregano, mountain ash, etc.). This will cleanse the body of toxins and salts through frequent urination.

Diseases caused by hyperechoic inclusions of the kidneys. Treatment

In most cases, hyperechoic inclusions of the kidneys appear as:

inflammatory process: carbuncle, kidney abscess.
cystic growths (usually they have liquid in their composition).
hemorrhages in the kidney (peculiar hematomas).
kidney tumors (benign or malignant).

If the doctor suspects the above diseases, he sends the patient for a comprehensive examination using MRI. In some severe cases, a kidney biopsy is required.

Hyperechoic inclusions are not easy to cure, but possible. Stones are removed in two main ways. The first method is based on frequent urination, for which special diuretic herbs or medicines prescribed by the doctor. The second method is the removal of stones with the help of laser beams when they are crushed. Using the first method, it is possible to treat small formations of stones, no more than 5 mm. In the case of an advanced disease, the kidney is removed, then chemotherapy is prescribed in order to remove the remaining formations. In such radical situations, constant adherence to the diet is necessary.

Remember: only a specialist can make an accurate diagnosis. Based on the ultrasound of the kidneys and the results of the tests, he will prescribe the appropriate treatment. Never self-medicate - this can make the situation worse.

Kidney parenchyma and its pathology

It happens that you have heard a word and even intuitively understand what it is about, but you cannot clearly formulate your knowledge. It seems to me that "parenchyma" is just one of those words.

The resulting uncertainty can be understood, because this term does not mean something specific. Historically, the term "parenchyma" was introduced to distinguish the totality of tissues that fill the organ from its outer shell and the internal bridges that extend from this shell. This term describes structures of different origin or functionality that are located in the space between the connective tissue frame of the organ, which is called the stroma. Schematically, the structure of an organ can be represented as follows: on the outside, the organ is covered with a sheath of connective tissue, often containing smooth muscle fibers.

From this shell, partitions extend into the thickness of the organ - trabeculae, through which nerves, lymphatic and blood vessels penetrate inside. The gap between these partitions is filled with the working part of the organ - the parenchyma. It is different in different kinds of organs: the liver parenchyma is a glandular tissue, in the spleen it is a reticular connective tissue. The parenchyma can have a different structure within the same organ, for example, as a cortical and medulla. Organs rich in parenchyma are called parenchymal.

Internal organization of the kidneys

Based on the above, we can say for sure that the kidney is a parenchymal organ. Outside, she has a fibrous capsule containing many myocytes and elastic fibers. On top of this shell is another capsule of fatty tissue. This whole complex, together with the adrenal glands, is surrounded by a thin connective tissue fascia.

Kidney parenchyma, what is it? On a longitudinal section, you can see that the pulp of the organ is represented, as it were, by two layers, different in color. Outside is a lighter cortical layer, and a darker medulla is located closer to the center. These layers mutually penetrate each other. Parts of the medulla in the cortex are called "pyramids" - they look like rays, and parts of the cortical parenchyma form "Bertin's columns" between them. With their wide part, the pyramids face the cortical layer, and with their narrow part (renal papilla) - towards the inner space. If we take one pyramid with the adjacent cortical substance, then we get the renal lobe. In a child under 2-3 years old, due to the fact that the cortical layer is not yet sufficiently developed, the lobules are well defined, i.e. the kidney has a lobular structure. In adults, lobulation practically disappears.

Both layers of the renal parenchyma are formed by different parts of the nephrons.

Nephron is a mini filter consisting of different functional departments:

renal corpuscle (glomerulus in a capsule - "Bowman's capsule");
tubule (it defines the proximal section, a loop with a descending and ascending part - the “loop of Henle” and the distal section).

The cortical substance is formed by the renal corpuscles, the proximal and distal parts of the nephron. The medulla and its protrusions in the form of rays are formed by the descending and ascending parts of the loops of the cortical nephrons.

In the middle you can see the pyelocaliceal system. After filtration and reabsorption occurring in the nephrons, urine through the renal papillae enters the small, and then into the large renal calyx and pelvis, passing into the ureter. These structures are formed by mucous, muscular and serous tissues. They are located in a special depression called the "renal sinus".

Measured indicators

Like any organ, the kidneys have their own health indicators. And if laboratory methods for examining urine and monitoring the rhythm of urination are used to assess the functionality of the kidneys, then the integrity of the organ, its acquired or congenital anomalies can be judged by the examination of ultrasound, CT (computed tomography) or MRI. If the obtained indicators fit into the norm, then the renal tissue was not affected, but this does not give reason to talk about the preservation of its functions.

Normally, the size of this organ of an adult reaches 10-120 mm in length and 40-60 mm in width. The right kidney is often smaller than the left. With a non-standard physique (too large or fragile), it is not the size that is estimated, but the volume of the kidney. Its normal figure in digital terms should be twice the body weight ± 20 ml. For example, with a weight of 80 kg, the volume norm is from 140 to 180 ml.

echostructure of the kidney

Ultrasound evaluates organs and tissues by their ability to reflect or transmit ultrasonic waves. If the waves pass freely (the structure is hollow or filled with liquid), then they speak of its anechoic, echo-negative. The denser the tissue, the better it reflects ultrasound, the better its echogenicity. Stones, for example, show themselves as structures in which the echogenicity is increased (hyperechoic).

Normally, on ultrasound, the kidney has a heterogeneous structure:

pyramids are hypoechoic;
the cortical substance and pillars are isoechoic (identical to each other);
the sinuses are hyperechoic due to the connective, fibrous, adipose tissues and the vessels and tops of the pyramids located there. The pyelocaliceal complex is normally not visualized.

Pseudopathologies

In some cases, with ultrasound, what, at first glance, seems to be a pathology, is not. So, often enlarged columns of Bertin go deep enough beyond the parenchyma into the renal sinus. It seems that this parenchymal bridge literally divides the kidney in two. However, all the structures that make up the septum are normal renal tissue. Often enlarged columns of Bertin or such bridges are mistaken for a tumor.

Should not be considered pathological various options structure of the pelvicalyceal system. There are a great many options for their configuration, even in one person the structure of the right and left kidneys is individual. This also applies to anatomical structure kidney parenchyma.

Partial doubling of the kidney can be considered ambiguously. At the same time, the parenchymal constriction divides the sinus into two, as it were, separate sections, but the complete bifurcation of the pelvis does not occur. This condition is considered a variant of the norm and basically does not bring discomfort.

Diseases affecting the renal parenchyma

Tuberculosis

Kidney damage usually occurs as a result of common disease organism. Mycobacterium tuberculosis enters the kidneys with blood flow, less often lymph or through the urinary tract. As a rule, the disease affects both organs at once, and when it progresses in one of the kidneys, it is in a dormant state in the other at that time.

A specific change in the parenchyma is characterized by the appearance of tuberculous tubercles in the cortex. Further, the process passes to the medulla and renal papillae. The tissues ulcerate, cavities (cavities) are formed, tuberculous tubercles continue to appear around these cavities, creating an even larger area for tissue decay. When this process is transferred to the renal sinus and ureter, the functions of the kidney are turned off with a violation of urinary excretion.

In addition to direct damage to the kidney parenchyma, tuberculosis provokes the formation of calcifications. Calcification is the process of replacing damaged tissue, an irreversible change caused by the deposition of calcium salts.

Treatment of calcifications does not imply its "crushing" or drug destruction. They themselves are able to resolve after the cure for the underlying disease that caused tissue damage.

Therapy for kidney tuberculosis involves anti-tuberculosis drugs - Isoniazid, Streptomycin and Rifampicin intravenous administration, with the transition to oral forms. Treatment is long - a year and a half. At the same time, surgical removal of damaged kidney tissue is performed.

Tumor process

A kidney tumor is quite common because it can be caused by a variety of reasons:

Regarding the nature of the kidneys, tumors can be primary - occur in the kidney itself or secondary - germinate from other organs. According to the nature of tumor growth, they are divided into benign and malignant. Among malignant neoplasms of the kidneys, the first place is occupied by hypernephroid (renal cell) cancer, located mainly in the cortical layer. However, it can also occur in the medulla and sinus. Non-hypernephroid cancer and sarcoma are also distinguished. The difference is in the nature of the tissue from which the tumor develops.

Mixed tumors stand apart. They are most common in children because they develop from still undifferentiated tissues in the embryonic stage. In such mixed tumors at the cellular level, areas of adipose, muscle and nervous tissues are determined.

On ultrasound, the malignant formation has an irregular shape, without clear boundaries with the possible inclusion of blood vessels. Calcifications and cysts may also be present at sites of parenchymal necrosis.

It is possible to reliably distinguish benign tumors from malignant tumors only with the help of a biopsy.

Urolithiasis disease

Stone formation is a physicochemical process during which crystals are formed from a supersaturated saline solution. In the kidneys, this process is regulated by special enzymes, in the absence of which the function of the nephron tubules is disrupted, the salt content in the urine increases, the conditions for their dissolution change and they precipitate. Stones cause sclerosis and atrophy of the renal pelvis, from where the process can spread to the parenchyma. Its functional units die and are replaced by adipose tissue, and the kidney capsule thickens.

Large stones can block the flow of urine from the pelvis through the ureter. Due to the increasing intrarenal pressure, the ureter expands, and then the pelvicalyceal complex expands. With prolonged blockage of the ureter duct, not only the affected kidney loses its functional ability, but also the second organ.

Symptoms of parenchymal damage and treatment prospects

Damage to the renal parenchyma affects its functions - filtration and excretion, which is immediately reflected in the state of the whole organism.

There is weakness and signs of intoxication; the temperature rises; skin color changes, it becomes dry; the rhythm and volume of urination is disturbed; rises blood pressure; swelling on the face, arms and legs; laboratory parameters of urine change, and turbidity, pus or blood is determined in it with the naked eye.

A urologist has in his arsenal a variety of instrumental and laboratory research methods to determine the cause of kidney disease and prescribe adequate treatment.

The good news is that the kidney is able to function while maintaining even 1/3 of the organ. Restoration of the parenchyma occurs not due to the formation of new nephrons, but due to an increase in the remaining ones under the influence of neurohumoral regulation. To do this, it is necessary to stop the action of the damaging factor. Then conditions are created in the organ for the restoration of microcirculation and hemodynamics, which underlies the resumption of kidney function. Unfortunately, if the kidney tissue is sclerotic and there is no possibility of its vascularization (germination of vessels), then it is impossible to restore the function.

SonoAce-R7

Introduction

Tumors of the kidneys account for 2-3% of all malignant neoplasms. Most often they occur at the age of 40-60 years. Among all kidney tumors, 80-90% have renal cell carcinoma. AT last years the probability of its detection increases, which is associated both with an increase in the number of all malignant tumors and with early preclinical diagnosis. To recognize malignant tumors, first of all, constantly improving and widely used ultrasound examinations of the kidneys allow.

The first report on the use of ultrasound in the diagnosis of kidney tumors was published in 1963 by J. Donald. Since then, the accuracy of ultrasound diagnosis of kidney tumors has increased from 85-90% to 96-97.3%. When using modern ultrasound scanners operating in tissue and second harmonic modes, as well as color Doppler and energy mapping and dynamic echocontrast angiography, the sensitivity of ultrasound (ultrasound) is 100% with a specificity of 92 and a positive test predictability of 98% and a negative test of 100% .

In the literature, there are often publications devoted to errors not only in ultrasound, but also in other methods of radiation diagnostics. There is a point of view that up to 7-9% of all volumetric processes in the kidneys cannot be differentiated before surgery for cysts, tumors, abscesses, etc. . The picture of a kidney tumor with ultrasound and other radiation diagnostic methods can be simulated by many processes. Among them: various anomalies of the kidneys; "complex" or mixed cysts; acute and chronic nonspecific inflammatory processes (carbuncle, abscess, chronic, including xanthogranulomatous pyelonephritis); specific inflammatory processes (tuberculosis, syphilis, fungal infections of the kidneys); changes in the kidneys with leukemia and lymphomas, including with HIV infection; kidney infarctions; organized hematomas and other causes.

In this report, we will only talk about kidney anomalies, which in the literature are defined by the term pseudotumors. With them clinical manifestations are almost always absent or are determined by concomitant diseases, and the correct diagnosis can only be made by means of radiation diagnostics (Fig. 1).

a) Fetal lobulation, "humped" kidney.

b) Hypertrophy of Bertin's column, enlarged "lip" above the hilum of the kidneys.

Materials and methods

For 1992-2001 177 patients were observed with different structures of the kidney parenchyma according to the type of kidney pseudotumors. All of them repeatedly underwent ultrasound scanning of the kidneys, ultrasound dopplerography (USDG) of the vessels of the kidneys - 78, including using the modes of the second and tissue harmonics and power Doppler - 15, excretory urography (EU) - 54, X-ray computed tomography (CT) - 36, renal scintigraphy or emission computed tomography (ECT) with 99 m Tc - 21.

Research results

Fetal lobulation of the kidney (see Fig. 1) with multiple bulges along the lateral contour of the kidney was not considered in this report, since it did not necessitate differential diagnosis with kidney tumor. Among 177 patients with pseudotumors of the kidneys, 22 (12.4%) patients had a variant of the lobular kidney - the "humped" kidney" (Fig. 2).

b) A series of computed tomograms.

In 2 (1.2%) patients, an enlarged "lip" above the hilum of the kidney was noted (Fig. 3a-c).

b) Excretory urogram.

in) CT with contrast enhancement.

The most common cause of pseudotumor was "hypertrophy" of Bertin's columns or "bridging" of the kidney parenchyma in 153 (86.4%) patients (Fig. 3d-f). "Barriers" of the parenchyma were noted not only in various doublings of the pyelocaliceal systems of the kidneys, but also in their various adhesions and incomplete turns of the kidneys.

e) Excretory urogram.

e) CT with contrast enhancement.

37 (21%) patients needed differential diagnosis of pseudotumors and kidney tumors. For this purpose, first of all, repeated "targeted" ultrasound scans were carried out using various additional ultrasound techniques in the conditions of the urological clinic, as well as other methods of radiation diagnostics indicated above. Only one patient with pseudotumor of the kidney underwent exploratory lumbotomy with ultrasound-guided intraoperative biopsy to rule out the diagnosis of a tumor. In the remaining 36 patients, the diagnosis of renal pseudotumors was confirmed by radiological studies and ultrasound monitoring.

Difficulties and errors in radiodiagnosis for kidney pseudotumors usually arose at the first prehospital stages diagnostics. In 34 (92%) patients, they were associated with both objective difficulties in interpreting unusual echographic data and their incorrect interpretation due to insufficient qualification of specialists and a relatively low level of diagnostic equipment. In 3 (8%) patients, an erroneous interpretation of X-ray data was noted. computed tomography when a discrepancy was noted between them and the data of repeated ultrasound scans and X-ray computed tomography in the urological clinic.

Tumors of the kidneys, which had their combination with a pseudotumor in one kidney, were verified in 2 patients after nephrectomy, and pseudotumors — in one patient during ultrasound-guided biopsy during exploratory lumbotomy; the rest - with ultrasound monitoring in terms of 1 to 10 years.

Discussion

One of the most common causes that mimics a kidney tumor on ultrasound, the so-called pseudotumor, is most often defined in the literature by the term Bertin's column hypertrophy.

As is known, along the periphery of the ultrasonic cut of the kidney, the cortical substance forms invaginations in the form of pillars (columnae Bertin) between the pyramids. Quite often, Bertin's column goes far enough beyond the inner contour of the parenchyma into the central part of the kidney - into the renal sinus, dividing the kidney more or less completely into two parts. The resulting peculiar parenchymal "bridge" is the non-absorbed parenchyma of the pole of one of the lobules of the kidneys, which merge into the kidney of an adult in the process of ontogenesis. The anatomical substrate of the "bridges" are the so-called connective tissue defects of the parenchyma or prolapse of the latter into the sinus of the kidney. It consists of cortical substance, Bertin's columns, pyramids of the kidneys.

All elements of the "bridge" are normal parenchymal tissue without signs of hypertrophy or dysplasia. They represent a doubling of the normal cortical substance of the kidney or an additional layer of it, located lateral to the cups. The latter is a variant of the anatomical structure of the parenchyma, in particular, the corticomedullary relationship of the parenchyma and the sinus of the kidney. They can be most clearly seen on ultrasound and computed tomography sections of the kidney.

The absence of hypertrophy or dysplasia of the parenchyma in the so-called hypertrophy of Bertin's columns or "bridges" of the parenchyma was also confirmed by histological studies. biopsy material in one patient with "bridges" of the parenchyma, taken before exploratory lumbotomy for a tumor of the kidney, as well as in two patients with a morphological study of the kidneys, removed due to a combination of a tumor and a pseudotumor in one kidney ("bridges" of the parenchyma).

In this regard, in our opinion, the term hypertrophy of Bertin's columns, which is the most common in the literature, does not reflect the morphological essence of the substrate. Therefore, we, like a number of authors, believe that the term "bridge" of the parenchyma is more correct. For the first time in the domestic literature on ultrasound diagnostics, it was used by us in 1991. It should be noted that the term "bridge" of the parenchyma had other names in the literature (table).

Years of experience in excretory urography has shown that the pelvicalyceal systems have an extremely large number of structural variants. They are practically individual not only for each person, but also for the left and right kidneys in one subject. With the development and increasing use of ultrasound and CT, which makes it possible to trace both the internal and external contours of the kidney parenchyma, in our opinion, a similar situation is emerging with respect to variants of the anatomical structure of the kidney parenchyma. Comparison of echo and computed tomography data with urographic data in various types of kidney pseudotumors showed that there is a relationship between the anatomical structure of the parenchyma and pyelocaliceal systems of the kidneys. It is expressed in the congruence of the medial contour of the parenchyma in an echo or computed tomographic image with the lateral contour of the pelvicalyceal systems, conditionally carried out on excretory urograms or on computed tomograms with contrast enhancement. This symptom can be traced in the usual structure of the parenchyma and pyelocaliceal systems, as well as in the "bridge" of the kidney parenchyma, which is a variant of the anatomical structure. With a kidney tumor, which is an acquired pathological process, the congruence of the contours of the parenchyma and the pyelocaliceal systems of the kidneys is disturbed (Fig. 4).

Rice. 4. A symptom of congruence of the contours of the parenchyma and the pyelocaliceal system of the kidney with an incomplete "bridge" of the parenchyma (explanation in the text).

findings

Thus, for the first time, the typical echographic pictures of the "bridge" of the parenchyma of the kidney, the "humped" kidney and the enlarged "lip" above the hilum of the kidney, without signs of expansion of the pelvicalyceal systems, identified for the first time, do not require further examination.

If it is necessary to differentiate between pseudotumors and kidney tumors, which was required in 37 (21%) patients, we propose the following algorithm for their diagnosis (Fig. 5).

Rice. 5. Algorithm for radiodiagnosis in pseudotumor of the kidney.

Repeated ultrasound by qualified specialists on higher-class ultrasound scanners using ultrasound, mapping techniques, tissue and second harmonics.
X-ray computed tomography with contrast enhancement or excretory urography with comparison of uro- and echographic data and data of repeated "targeted" ultrasound.
Methods of choice - renal scintigraphy or emission computed tomography with 99 m Tc (false-negative results are possible with small tumors).
If a malignant tumor is still suspected, an ultrasound-guided biopsy is performed (only a positive result has diagnostic value).
If the biopsy result is negative or the patient refuses to take a biopsy and an operative revision of the kidney, ultrasound monitoring is performed at a frequency of at least once every 3 months in the first year of observation, and then 1-2 times a year.

Literature

Demidov V.N., Pytel Yu.A., Amosov A.V.// Ultrasound diagnostics in urology. M.: Medicine, 1989. P.38.
Hutschenreiter G., Weitzel D. Sonographic: einewertwolle erganzung der urologichen Diagnostic // Aktuel. Urol. 1979 Vol. Bd 10 N 2. P. 45-49.
Nadareishvili A.K. Diagnostic capabilities of ultrasound in patients with kidney tumor // 1st Congress of the Association of Specialists in Ultrasound Diagnostics in Medicine: Abstracts. Moscow. October 22-25, 1991. P.121.
Buylov V.M. Complex application and algorithms for ultrasound scanning and X-ray diagnostics in diseases of the kidneys and ureters: Dis. . doc. honey. Sciences. M., 1995. S. 55.
Modern ultrasound diagnostics of volumetric kidney formations / A.V. Zubarev, I.Yu. Nasnikova, V.P. Kozlov et al. // 3rd Congress of the Association of Specialists in Ultrasound Diagnostics in Medicine: Abstracts. Moscow. October 25-28, 1999, p.117.
US, CT, X-ray diagnosis of Renal Masses / R.K. Zeman, J.J. Croman, A.T. Rosenfield et al. // Radiographics. 1986. Vol.6. P. 351-372.
Thomsen H.S., Pollack H.M. The Genitourinary System // Global TextBook of Radiology. (Ed.) Petterson H. 1995. P. 1144-1145.
Lopatkin N.A., Lyulko A.V. anomalies genitourinary system. Kyiv: Health, 1987. S. 41-45.
Mindel H.J. Pitfalls in Sonography of Renal Masses // Urol. Radiol. 1989. 11. 87. N 4. R. 217-218.
Burykh M.P., Akimov A.B., Stepanov E.P. Echography of the kidney and its pelvicalyceal complex in comparison with the data of anatomical and radiological studies // Arch.Anat.Gistol.Embriol. 1989. T.97. N9. S.82-87.
Junctional Parenchyma: Revised Definition of Hypertrophic Column of Bertin / H-Ch. Yeh, P.H. Kathleen, R.S. Shapiro et al. // Radiology. 1992. N 185. R.725-732.
Bobrik I.I., Dugan I.N. Anatomy of human kidneys during ultrasound examination // Vrach. case. 1991. No. 5. S. 73-76.
Khitrova A.N., Mitkov V.V. Ultrasound procedure of the kidneys: A clinical guide to ultrasound diagnostics. M.: Vidar, 1996. T. 1. S. 201-204, 209, 212.
Builov V. Junctional parenchyma or hypertrophic column of Bertini: the congruence of their contours and calyceal-pelvic system // Abstracts of ECR’99, March 7-12. 1999 Vienna Austria.-Europ. Radiol. Supp.1. Vol.9. 1999. S.447.
Buylov V.M., Turzin V.V. Echotomography and excretory urography in the diagnosis of "bridges" of the kidney parenchyma // Vestn. X-ray radiol. 1992. N 5-6. pp. 44-51.
Buylov V.M., Turzin V.V. Diagnostic value of atypical "bridges" of the parenchyma in renal sonography // 1st Congress of the Association of Specialists in Ultrasound Diagnostics in Medicine: Abstracts. Moscow. October 22-25, 1991. S. 121.
Buylov V.M. Questions of terminology and a symptom of congruence of the contours of "hypertrophied" Bertini columns or "bridges" of the parenchyma and pyelocaliceal systems of the kidneys // Vestn. rentgenol. and radiol. 2000. N 2. S. 32-35.
Buylov V.M. Algorithm for radiodiagnosis of kidney pseudotumors // Abstracts of reports. 8th All-Russian. Congress of radiologists and radiologists. Chelyabinsk-Moscow. 2001. S. 124-125.

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The structure of the kidneys

The kidneys are located retroperitoneally in the lumbar region at the level of the last two thoracic and first two lumbar vertebrae. The right kidney is usually 1-2 cm lower than the left.

The kidney parenchyma consists of a cortical layer and pyramids. The renal columns (Bertini columns) between the pyramids consist of cortical substance. The pyramid and the cortex covering it form the renal lobule. At the top of the pyramid openings of the papillary tubules open.

The renal sinus contains the pelvicalyceal complex (PCC), vessels, nerves, connective tissue and fat. The small cup sits on top of the pyramid like a breast pump on a nipple. Urine actively flows into small and large calyces → renal pelvis → ureter → bladder→ urethra.

Click on pictures to enlarge.

Ultrasound of the kidneys

A convex probe 2.5-7.5 MHz is used. If a pathology is suspected, the study is carried out with a filled bladder when there is an urge to urinate. After urination, the kidneys are examined again.

We are interested in the location, size, echogenicity, echostructure of the kidneys, as well as patency urinary tract. How to assess the size of the kidneys in children and adults, see more details.

Bladder and distal ureter on ultrasound

In the position of the patient lying on his back in the suprapubic region, we remove the bladder. Assess bladder filling and distal ureters. Normally, the distal ureter is not visible. Ureter more than 7 mm in diameter - megaureter.

Picture. Ultrasound shows an enlarged distal ureter (1, 2, 3). About ureterocele (3) see more.

Echogenicity of the kidneys

In the position of the patient on the back along the midclavicular and anterior axillary lines, we bring out the right kidney in the vicinity of the liver, and the left kidney near the spleen. Assess the echogenicity of the kidneys. The cortical layer of the kidney is normally iso- or hypoechoic in relation to the liver and hypoechoic in relation to the spleen.

Picture. The echogenicity of organs is compared on one section. Ultrasound shows a normal kidney next to the liver (1) and spleen (2). In children under 6 months of age, the renal parenchyma may normally be hyperechoic compared to the liver (3).

The shape of the kidneys on ultrasound

To see the upper pole of the kidney, ask the patient to take a deep breath. The shape of the kidney is bean-shaped - convex from the lateral and concave from the medial side. As a variant of the norm, the embryonic lobular kidney, as well as the humpbacked left kidney, are regarded.

Picture. On ultrasound (1) and CT (2, 3), the contour of the kidneys is wavy. In the embryo, the kidney develops from individual lobules that merge as they grow. The lobular structure of the kidneys is clearly visible in the fetus and newborns, in isolated cases it persists in adults.

Picture. You can find a humpbacked left kidney - a convex, uneven outer contour due to parenchymal hypertrophy in the middle third of the kidney. It is believed that the "hump" is formed in the fetus under pressure from the lower edge of the spleen.

Picture. Scanning from the side of the anterior abdominal wall allows you not to miss the isthmus between the kidneys. The isthmus in front of the spine is evidence of fusion of the kidneys - a horseshoe kidney. Variants of the anatomy of horseshoe kidneys, see.

Video. Horseshoe kidney on ultrasound

Echostructure of the kidneys

In a normal kidney, the pyramids are hypoechoic, the cortex and columns of Bertini are isoechoic to each other. In the sinus, there is normally an invisible PCL, hyperechoic connective and adipose tissue, hypoechoic vessels, and the tops of the pyramids.

When pyramids, cortex, renal columns are distinguished, the echostructure of the kidney parenchyma is not changed. If they are not visible, then the echostructure is changed due to the lack of a clear cortical-brain differentiation.

Picture. On ultrasound, a kidney with an unchanged echostructure: a cortical layer hypoechoic in relation to the liver and Bertini columns, almost anechoic pyramids, hyperechoic sinus.

Picture. In 37% of healthy newborns on the first day of life, the symptom of "white pyramids" is determined by ultrasound. Precipitation of the Tamm-Horsfall protein and uric acid causes reversible tubular obstruction. By 6 weeks of age, it resolves without treatment.

Picture. On ultrasound, a healthy kidney shows linear hyperechoic structures along the base of the pyramids (corticomedullary junction) with a hypoechoic path in the center. These are arcuate arteries, which are mistakenly regarded as nephrocalcinosis or stones.

Video. Arcuate arteries of the kidney on ultrasound

Picture. On ultrasound, the lower pole of the kidney is separated by a hyperechoic fibrous septum; pelvis of the lower segment 7 mm. This is a variant of the normal structure of the kidney. The kidney may be deformed, so its size and length is slightly less than the opposite. A small expansion of the pelvis under the bridge is preserved for life.

Video. On ultrasound, a fibrous bridge in the kidney (structural variant)

Sometimes the Bertini column cuts into the central part of the kidney, dividing it completely or incompletely into two parts. Such a parenchymal bridge is the parenchyma of the pole of one of the embryonic lobules, which merge to form a kidney; consists of the cortex, pyramids, Bertini columns - all elements without signs of hypertrophy or dysplasia. The term hypertrophy of the Bertini column does not reflect the morphology of the structure; it is more accurate to consider this formation as a parenchymal bridge.

Picture. On ultrasound, a round formation divides the renal sinus into two segments with a common pelvis; interlobar arteries go around the formation; echogenicity and intensity of the vascular pattern inside is close to the cortical zone. Conclusion: Hypertrophy of the Bertini column or incomplete parenchymal septum. This is a variant of the normal structure of the kidney. The term "incomplete doubling of the PCL" is incorrect, because. an incomplete parenchymal bridge is not a sign of doubling of the PCL.

Picture. On ultrasound, the renal sinus is separated by a complete parenchymal septum (1, 2). In such cases, excretory urography will help to distinguish between doubling of the kidney from hypertrophy of the Bertini column. The doubled kidney is covered with a common fibrous capsule. Complete duplication implies the presence of two pelvises, two ureters and two vascular bundles. An incompletely doubled kidney (3) is fed by one vascular bundle, the ureter can be doubled at the top and flow into the bladder with one or two mouths. Doubling of the PCL and ureters is a risk factor for the development of pathology (pyelonephritis, hydronephrosis, etc.).

Picture. On ultrasound, the sinus of the kidneys is wide, heterogeneous echostructure (1, 2). Against the background of hyperechoic fat, a hypoechoic focus of a rounded shape (2), with CDI, interlobar vessels pass through the hypoechoic zone without displacement (3) - this is hypoechoic fat. In obesity, sinus lipomatosis can be mistaken for parenchymal atrophy.

The ureter, small and large cups are normally not visible on ultrasound. There are three types of location of the pelvis: intra-, extrarenal and mixed (partly inside the kidney, partly outside it). With an intrarenal structure, the lumen of the pelvis at an early age is up to 3 mm, at 4-5 years old - up to 5 mm, in puberty and in adults - up to 7 mm. With extrarenal and mixed type of structure - 6, 10 and 14 mm, respectively. With a full bladder, the pelvis can increase to 18 mm, but 30 minutes after urination it is reduced.

Picture. Regardless of the filling of the bladder, ultrasound shows the pelvis of mixed (1, 2) and extrarenal (3) locations.

Picture. In children under 1 year of age, the sinus of the kidney is poorly defined on ultrasound, anechoic pyramids can be mistaken for an extended PCL (1). On ultrasound at the hilum of the kidney, the linear hypoechoic structure looks like an enlarged pelvis (2); with color flow it is clear that these are vessels (3).

Anomalies in the location of the kidneys on ultrasound

Anomalies in the location of the kidneys occur when there is a violation of the movement of the primary kidney from the pelvis to lumbar region. Almost always, the shape of the kidney is changed, and the gate is open forward.

In thoracic dystopia, the kidney is usually part of a diaphragmatic hernia. With lumbar dystopia, the pelvis is at the level of L4, with iliac - L5-S1. The pelvic kidney is located behind or slightly above the bladder. With cross dystopia, the ureter flows into the bladder in the usual place, and the kidney is displaced contralaterally.

Picture. Kidney dystopia in relation to the skeleton: thoracic on the right (1), bilateral lumbar (2), pelvic on the left (3), lumbar on the right and pelvic on the left (4), lumbar of the double left kidney (5), cross (6).

Picture. Dystopia of the kidneys in relation to each other and their fusion with each other: fusion of the upper ends (1), lower ends and doubling of the left kidney (2), middle parts of the pelvic-dystopic kidneys (3), lateral parts of the pelvic-dystopic kidneys (4), different ends (5), at an angle (6).

Picture. On ultrasound, the renal bed on the left is empty (1). Both kidneys are located on the right, grow together with poles (2, 3). Conclusion: Anomaly of the relative position of the kidneys - I-shaped doubled right kidney.

Picture. Ultrasound in the small pelvis (bladder - acoustic window) reveals the kidneys connected by a narrow isthmus (1, 3); differentiation of the parenchyma is preserved, the blood flow can be traced to the capsule (2, 3). Conclusion: The anomaly of the relative position of the kidneys is the fusion of the lower poles of the pelvic-dystopic kidneys.

Kidney mobility on ultrasound

Mark on the skin the level of the upper pole of the kidney in the position of the patient lying on his stomach and standing. Ask the patient to jump before remeasurement.

Normally, on inspiration, the kidneys descend by 2-3 cm. In adults, pathological mobility of the kidney can be said if the kidney is displaced by 5 cm on ultrasound in a standing position. In children, a displacement of 1.8-3% of the height indicates excessive mobility, displacement> 3% - an indirect sign of nephroptosis. Nephroptosis is established by x-ray - this is the movement of the kidney more than 2 heights of the vertebral body.

How to distinguish nephroptosis from dystopia on ultrasound? Normally, PA departs from the aorta immediately below the SMA, with lumbar dystopia - near the aortic bifurcation, with pelvic dystopia - from the iliac artery.

Picture. With pelvic dystopia on intravenous urography in the supine position, the ureter is short, the kidney is in the pelvis (1, 2). With nephroptosis on intravenous urography in the supine position, the kidney is determined in a typical place (3), in the standing position, the kidney is significantly lowered (4).

Take care of yourself, Your Diagnostician!

Video. Kidneys at an ultrasound lecture by Vladimir Izranov

Hyperechoic inclusions are usually detected during renal ultrasound. They are a certain kind of tissue areas with large acoustic seals, which can be simple stones from urolithiasis or be dangerous formations in the form of a benign or malignant tumor. These are structures that are denser compared to the surrounding tissues of the organ, perfectly repelling ultrasound and thereby creating hyperechogenicity. On the monitor of the ultrasound machine, they are indicated by white spots.

What are hyperechoic inclusions?

psammoma bodies - make up half of the echogenic formation;
calcifications - only 30%;
areas of sclerosis - 70%.

In a benign tumor of the kidneys, psammoma bodies are completely absent, calcifications can also be found quite rarely. Basically, these are sclerotic areas.

Varieties of hyperechoic inclusions. Diagnostics

Only a specialist is able to detect hyperechoic inclusions in the kidneys during diagnosis. It can be stones or sand in the kidneys. Today, several varieties of such inclusions are known:

point inclusions, which are visualized quite brightly: they are small and do not have an acoustic shadow;
large formations that also lack an acoustic shadow. In the kidneys, they are rarely formed, doctors mainly diagnose them during an ultrasound of the kidneys. They can be localized not only in a malignant, but also in a benign tumor;
large formations, which include an acoustic shadow. They fully correspond to the sclerotic parts.

Hyperechoic inclusions in the kidneys can be detected by ultrasound of the kidneys or suspected of their presence by severe symptoms:

high temperature,
change in color of urine
frequent colic in the kidney area,
severe pain in the abdomen or below the belt or constant pain in the groin,
vomiting and nausea.

To prevent stones in the stomach, it is necessary to use liquid more often: water, rose hips, tea with herbs (mint, oregano, mountain ash, etc.). This will cleanse the body of toxins and salts through frequent urination.

Diseases caused by hyperechoic inclusions of the kidneys. Treatment

In most cases, hyperechoic inclusions of the kidneys appear as:

inflammatory process: carbuncle, kidney abscess.
cystic growths (usually they have liquid in their composition).
hemorrhages in the kidney (peculiar hematomas).
kidney tumors (benign or malignant).

If the doctor suspects the above diseases, he sends the patient for a comprehensive examination using MRI. In some severe cases, a kidney biopsy is required.

Hyperechoic inclusions are not easy to cure, but possible. Stones are removed in two main ways. The first method is based on frequent urination, for which special diuretic herbs or drugs prescribed by a doctor are used. The second method is the removal of stones with the help of laser beams when they are crushed. Using the first method, it is possible to treat small formations of stones, no more than 5 mm. In the case of an advanced disease, the kidney is removed, then chemotherapy is prescribed in order to remove the remaining formations. In such radical situations, constant adherence to the diet is necessary.

Kidney parenchyma and its pathology

It happens that you have heard a word and even intuitively understand what it is about, but you cannot clearly formulate your knowledge. It seems to me that "parenchyma" is just one of those words.

Internal organization of the kidneys

Both layers of the renal parenchyma are formed by different parts of the nephrons.

Nephron is a mini filter consisting of different functional departments:

renal corpuscle (glomerulus in a capsule - "Bowman's capsule");
tubule (it defines the proximal section, a loop with a descending and ascending part - the “loop of Henle” and the distal section).

Measured indicators

echostructure of the kidney

Normally, on ultrasound, the kidney has a heterogeneous structure:

pyramids are hypoechoic;
the cortical substance and pillars are isoechoic (identical to each other);
the sinuses are hyperechoic due to the connective, fibrous, adipose tissues and the vessels and tops of the pyramids located there. The pyelocaliceal complex is normally not visualized.

Pseudopathologies

Various variants of the structure of the pyelocaliceal system should not be attributed to pathology. There are a great many options for their configuration, even in one person the structure of the right and left kidneys is individual. This also applies to the anatomical structure of the kidney parenchyma.

Diseases affecting the renal parenchyma

Tuberculosis

Usually, kidney damage occurs against the background of a general disease of the body. Mycobacterium tuberculosis enters the kidneys with blood flow, less often lymph or through the urinary tract. As a rule, the disease affects both organs at once, and when it progresses in one of the kidneys, it is in a dormant state in the other at that time.

Treatment of calcifications does not imply its "crushing" or drug destruction. They themselves are able to resolve after the cure for the underlying disease that caused tissue damage.

Therapy for kidney tuberculosis involves anti-tuberculosis drugs - Isoniazid, Streptomycin and Rifampicin for intravenous administration, with the transition to oral forms. Treatment is long - a year and a half. At the same time, surgical removal of damaged kidney tissue is performed.

Tumor process

A kidney tumor is quite common because it can be caused by a variety of reasons:

It is possible to reliably distinguish benign tumors from malignant tumors only with the help of a biopsy.

Urolithiasis disease

Symptoms of parenchymal damage and treatment prospects

Damage to the renal parenchyma affects its functions - filtration and excretion, which is immediately reflected in the state of the whole organism.

There is weakness and signs of intoxication; the temperature rises; skin color changes, it becomes dry; the rhythm and volume of urination is disturbed; blood pressure rises; swelling on the face, arms and legs; laboratory parameters of urine change, and turbidity, pus or blood is determined in it with the naked eye.

A urologist has in his arsenal a variety of instrumental and laboratory research methods to determine the cause of kidney disease and prescribe adequate treatment.

- delimited accumulation of pus in the cortical or medulla of the kidney. On computed tomography without contrast, it looks like a formation with fuzzy contours, containing a liquid component in the center, as well as gas bubbles (in case of infection with a gas-forming flora). The pyogenic membrane has the property of being enhanced by contrast to a great extent.

Renal agenesis

- complete absence of the kidney, as well as the ureter, renal arteries and veins on one side.

kidney adenoma

- a frequent finding in CT studies of the organs of the retroperitoneal space. When performing computed tomography of the kidneys (with or without contrast), adenoma cannot be clearly differentiated from renal cell carcinoma, it looks similar - in the form of a hypo- or hypervascular node in the renal parenchyma, heterogeneous - cystic-solid structure, which increases with contrast.

Angiomyolipoma of the kidney

- a tumor consisting of adipose, muscle and vascular proliferative tissue. On CT scan of the retroperitoneum, it looks like a formation of heterogeneous density (areas of low density -20 ... -60 Hounsfield units against the background of strands of a higher, soft tissue density), with uneven edges, deforming the contour of the kidney. Angiomyolipoma is the only kidney tumor whose benign nature can be confirmed without performing any other studies.

Angiomyolipoma of the kidney on computed tomography looks like a rounded formation with an inhomogeneous density due to the fact that it contains adipose, muscle and vascular tissue in various proportions. In the presented example, the average density of formation near the lower pole of the right kidney is -20 Hounsfield units.

Renal artery aneurysm

- local expansion of the lumen of the renal artery as a result of weakening and stretching of its wall. It is diagnosed by CT angiography of the renal artery, with a clearly visible expansion of the lumen, in which blood clots can also be detected.

Aplasia of the kidney

- a decrease in the volume of the kidney and a violation of its normal structure. With aplasia in the kidney, the number of pyramids is less than normal, the pyelocaliceal complex may look like an "onion".

Atresia of the ureter

- absence of the lumen of the ureter, congenital pathology.

Vesicoureteral reflux

- a condition in which there is a reverse flow of urine from the bladder into the ureter. This type of reflux can only be detected with retrograde cystography (filling the bladder with contrast from the outside) by contrasting the distal ureters.

Substance cortical kidney

- a complex of structures containing renal vessels, tubules and glomeruli. On CT scan of the retroperitoneum, the renal cortex is isodense to the renal medulla, with contrast enhancement it becomes hyperdense (due to greater vascularization).

On the axial scan, the arrows indicate the renal cortex, which looks hyperdense in relation to the medulla in the arterial contrast phase due to better vascularization.

Substance brain kidney

- a structure consisting of renal pyramids separated from each other by a cortical substance (Bertini columns). The tops of the pyramids, merging, form the renal papillae, which conduct urine into the pyelocaliceal system.

Bulging of the contour of the kidney

– on CT of the kidneys without contrast, the local area where the contour of the kidney bulges outward is always suspicious for a tumor and requires contrast enhancement.

Local bulging of the contour of the left kidney on native CT. Suspicion of hypernephroma. A study with contrast enhancement is required.

biscuit kidney

- an anomaly characterized by the complete fusion of both kidneys with the location of the formed biscuit-shaped kidney prevertebral (middle) or near the sacrum - in the cavity of the small pelvis.

kidney hematoma

- the result of a traumatic impact (most often - a blow with a blunt object in the lumbar region or a fall on the back), in which, as a result of the application of force, a rupture of blood vessels occurs and blood comes out. Hemorrhages in the parenchyma of the kidney appear on CT as hyperdense areas, the density of which remains approximately the same for a long period of time. Hematomas can be intraparenchymal, subcapsular; may also rupture into the urinary tract.

Hematuria

- a condition in which the hemorrhagic component is determined in the urine. CT of the urinary system can reveal hyperdense blood clots in the bladder or dilated ureter.

Hemorrhagic cyst of the kidney

- high-density formation in the kidney (60-70 Hounsfield units), containing fresh or partially lysed blood. All hemorrhagic cysts are category 3 according to the Bosniak classification.

An example of a hemorrhagic cyst of the right kidney on computed tomography (marked with an arrow). The hemorrhagic cyst of the kidney is more dense (60–65 Hounsfield units). In this case, the patient has polycytosis of the kidneys with the presence of cysts of various structures and densities.

hydronephrosis

- a condition manifested by the expansion of the pyelocaliceal complex of the kidney on computed tomography as a result of obstruction or obstruction of the ureter in urolithiasis, with tumors that compress the ureter from the outside.

Left-sided hydronephrosis on computed tomography of the kidneys is manifested by the expansion of the pyelocaliceal complex of the kidney. Nephrographic contrast phase.

hydronephrotic sac

- a condition characterized by an extremely pronounced expansion of the calyces and renal pelvis, in which the medulla and cortex of the kidneys are visualized as a thin strip of tissue on computed tomography. The final stage of hydronephrosis.

Hydrocalyx

- expansion of only one group of cups, a private variant of hydronephrosis.

Hydroureter

An example of a sharp unilateral expansion of the ureter due to its obstruction of stones in the mouth area is a right-sided hydroureter.

Left-sided hydroureter on axial sections on CT of the pelvis (in different patients).

Hypernephroma

- syn. renal cell carcinoma is a malignant tumor of the kidney of various histological structures (clear cell carcinoma of the kidney occurs with a frequency of up to 80%, papillary cell carcinoma - with a frequency of 10-15%, chromophobe cell carcinoma of the kidney - about 5%). Hypernephroma causes deformation of the contour of the kidney, before contrasting it looks like a solid node, isodense to the renal parenchyma, which may also contain calcifications and hemorrhages in the structure. In the arterial phase of contrasting, hypernephromas increase markedly due to their high vascularization, after which their heterogeneous structure becomes clearly visible - with the presence of solid and cystic components.

A classic example of hypernephroma on CT scan of the retroperitoneal organs in the form of a volumetric formation in the upper sections of the left kidney, which has heterogeneous structure due to different contrasting of the solid and liquid (cystic) components, as well as the presence of hemorrhages.

An example of renal cell carcinoma on CT of the kidneys without contrast, in the arterial, venous phases of contrasting, as well as in the nephrographic phase.

Changes highly suspicious of hypernephroma on renal CT without contrast.

Hypertrophy of the renal columns

- a variant of the development of the kidney, in which the thickened columns of Bertini can mimic the tumor process.

Functional kidney hypertrophy

- unilateral increase in the size of the organ that occurs in connection with nephrectomy. The remaining single kidney has a large load on blood filtration, as a result of which its compensatory hypertrophy occurs.

Glomerulonephritis

- in the acute stage of glomerulonephritis, computed tomography of the kidneys does not reveal any changes, in the chronic stage, atrophy of the renal cortex can be detected with an increase in the renal sinus.

Cortical post-resection defect

- a local area where the cortex is absent, resulting from surgical treatment - marginal resection. On computed tomography of the kidneys, small post-resection defects are difficult to detect due to their filling with retroperitoneal fat.

kidney dystopia

- the location of the kidney in an atypical place for it, for example, in the small pelvis or in the chest cavity (an extremely rare variant of dystopia is the intrathoracic kidney).

An example of pelvic dystopia of the kidney. On computed tomograms, a polycystic altered kidney with multiple large calcified stones is visualized, localized in the cavity of the small pelvis presacral - near the sacrum.

Dystopia cross with fusion

- an anomaly in the development of the kidneys, in which there is a dystopia of one of the kidneys with its movement on one side of the spine and merging with the other kidney. CT urography can reveal two ureters, one of which is located typically, and the other crosses the midline and flows into the bladder from the opposite side. Renal CT can visualize a single kidney big size on one side of the spine.

Dystopia cross without fusion

- a rare anomaly in which there is no fusion of the kidneys with dystopia of one of them. On CT, both kidneys are visualized on the same side of the spine, however, they lie completely separate from each other, have a separate fat capsule.

Kidney infarction

- the death of the renal parenchyma in a limited area (the size of which depends on the degree and level of occlusion of the arterial vessel), which manifests itself on computed tomography of the retroperitoneal organs in the form of a lack of contrasting of the renal parenchyma area - most often wedge-shaped.

The lack of contrasting of the cortical substance of the right kidney in the middle and upper sections due to circulatory disorders in this area is an example of a kidney infarction.

Kidney stone calcified

- the most frequently detected type of renal calculi, which is characterized by high (up to 1000 Hounsfield units) density.

An example of calcified kidney stones on CT.

An example of a high-density stone (calcification) in the renal pelvis.

Stone in the lower group of cups of the left kidney (calcification).

kidney stone xanthine

Renal cyst subcapsular

- renal cyst localized under the capsule.

Kidney cyst, cortical

- cyst with localization in the cortical layer of the kidney.

Renal cyst medullary

- localized in the medulla of the kidney.

Examples of simple cysts of the right kidney, localized mainly in its medulla.

Kidney cyst parapelvic

- localized near the pyelocaliceal complex, can cause its compression with a violation of the outflow of urine (rarely).

A huge cyst of the sinus of the right kidney (parapelvic), causing severe compression and deformation of the renal pelvis and calyx, as well as leading to a violation of the outflow of urine.

Echinococcal cyst of the kidney

- cystic kidney damage caused by echinococcus. On CT, echinococcosis of the kidneys manifests itself as the presence of cysts with clearly defined contours, with often detected calcifications, with septa. The walls of echinococcal cysts and septa are enhanced after the introduction of contrast.

Classification of kidney cysts according to Bosniak

- involves the conditional division of all renal cysts into 4 classes, depending on the degree of their oncological alertness - from 1st (uncomplicated simple cysts) to 4th (reliable malignant neoplasm).

The images show an example of a simple cyst of the lower pole of the right kidney, which does not contain a soft tissue component, septa, hemorrhages and calcifications in its structure. This cyst belongs to the 1st category according to Bosniak.

pelvicalyceal complex

- a structure consisting of the renal calyces and the renal pelvis.

kidney contusion

- traumatic injury to the kidney, in which the leading sign on CT is edema, which manifests itself in the form of an increase in the size of the kidney, blurring of its contours, narrowing of the pelvicalyceal complex.

Cortico-medullary phase

- one of the phases of contrast enhancement in computed tomography of the kidneys, obtained by scanning 20-30 seconds after the injection of contrast, performed to visualize the renal vessels, as well as well-vascularized kidney tumors.

CT urography

- display of the pelvicalyceal complex of the kidney and ureters, obtained by CT of the kidneys after the introduction of contrast into the vein.

Kidney lymphoma

- more often a secondary kidney disease that occurs with non-Hodgkin's lymphoma, as well as with post-transplant lymphoma. Kidney lymphoma on CT may look like: a solitary node that deforms the contours of the kidney and infiltrating perirenal fat; multiple nodes both kidneys up to 5 cm in size, which are clearly visible after contrast enhancement; diffuse changes in the kidney in the form of a decrease in the degree of strengthening of the renal parenchyma in the nephrographic phase and a decrease in renal excretion; retroperitoneal node - with fouling of the renal sinus and ureter.

The defeat of the lymph nodes in the gates of the kidney with lymphoma.

kidney lipoma

- a tumor containing only adipose tissue (density -80 ... -120 Hounsfield units).

An example of a small lipoma of the left kidney is a peripherally located hypodense rounded area with a fat density (in this example, -100 Hounsfield units).

Mesenchymal tumors of the kidneys

- a collective term that includes tumors such as lipomas, fibromas, leiomyomas, histiocytomas - rare tumors that do not have specific signs on CT scan of the kidneys.

Metastases to the kidneys

- secondary kidney damage in tumors of other localization. For example, bronchogenic cancer can metastasize to the kidneys. On CT, renal metastases may appear as multiple hypodense in the nephrographic phase of the formation. Also characteristic is the presence of metastases in other organs - the adrenal glands, the liver.

Native CT of the kidneys

- computed tomography of the kidneys, performed without the introduction of a contrast agent. It is used to diagnose urolithiasis, obstructive lesions of the PCL and ureters, to identify high-density calculi.

Chronic interstitial nephritis

- a disease of the renal interstitium caused by taking analgesics for a long time. Computed tomography of the kidneys reveals changes in the form of a decrease in the size of the kidneys and the formation of calcifications of the renal papillae.

Atrophic changes in both kidneys against the background of interstitial disease.

Nephroblastoma

- syn. Wilms' tumor is a tumor of the renal parenchyma most commonly found in childhood(up to 5 years). On CT, nephroblastoma is visualized as a hypodense formation that deforms the contour of the kidney and has an inhomogeneous density due to hemorrhages and necrotic foci, less often fat and calcifications. Metastasizes to lymph nodes in the hilum of the kidney, para-aortic The lymph nodes.

Nephrographic phase

- one of the phases of contrast enhancement in CT of the kidneys, in which the cortex and medulla of the kidney have the same density. This phase occurs 80-120 seconds after the injection of contrast, it has the highest probability of detecting tumors, especially small ones.

Nephrocalcinosis

- total calcification of the medulla and cortex of the kidneys, which, with computed tomography, become sharply hyperdense, extremely dense.

Nephroptosis

- low location of the kidney, low discharge of the renal artery on the corresponding side, atypically long and tortuous ureter.

On the reformation in the coronal plane, a moderately pronounced right-sided nephroptosis was demonstrated. Pay attention to what level the right and left kidney are - the right one is at least 2/3 of the height of the lumbar vertebra below.

Nephrectomy

- Surgical removal of the kidney. On CT, scar tissue is found in the renal bed if the operation was performed a long time ago, and fresh blood and edema with a recent intervention.

An observation demonstrating a right-sided nephrectomy. A single left kidney is visualized on CT, and a metal clip is visible on the right vascular bundle of the kidney.

Inferior vena cava tumor thrombosis

- a condition that can occur when a kidney tumor (right) grows into the inferior vena cava. It indicates the neglect of the tumor process and is a marker of the T4 stage according to the TNM classification.

Germination of the tumor of the upper pole of the right kidney into the inferior vena cava, in which multiple gas bubbles are also visualized. The prognosis in this case is extremely unfavorable.

Obstruction of the ureteropelvic junction

- a congenital anomaly of the kidneys, manifested by a narrowing in the area of the transition of the pelvis to the ureter, which does not lead to the development of hydronephrosis.

Oncocytoma

— benign tumor kidneys from the epithelium of the renal tubules. On computed tomography of the kidneys, it looks like a single formation with expansive growth, equal in density to the hepatic parenchyma in native studies and intensifying after the introduction of contrast in the form of a "spoked wheel" due to the presence of a central scar of a characteristic (star-shaped) shape.

Perl-Mann tumor

- syn. renal cystadenoma, multilocular cystic nephroma.

Kidney papilloma

- a frequent tumor characterized by damage to any part of the urinary tract - the renal pelvis, ureter, bladder. It is a precancerous condition.

Anterior pararenal space

- anatomical region containing fatty tissue, directly adjacent to the anterior fascia of Gerota on the one hand, and to the capsule of the spleen, pancreas - on the other hand.

posterior pararenal space

- the anatomical region in which fatty tissue is located, bounded by the posterior fascia of Gerota on the one hand, and the lumbar muscles on the other.

Perirenal space

- an area delimited by the anterior and posterior fascia of Gerota, containing perirenal fat (fat "capsule" of the kidney).

Persistent embryonic lobulation of the kidney

- a developmental variant in which defects in the contour of the renal parenchyma are found towards the renal columns.

Pyelonephritis

- inflammation of the renal interstitium with involvement in the process of the pelvis, caused by an infectious agent. With pyelonephritis, CT can detect an increase in the kidney, vagueness of its contours due to swelling of the renal parenchyma and perirenal tissue, as well as local thickening of Gerota's fascia - in the case of the spread of the inflammatory process to them.

Kidney changes on CT scan in pyelonephritis.

Pyelonephritis emphysematous

- a severe variant of the inflammatory process in the kidney, due to the development of gas-forming flora, which manifests itself in the presence of gas bubbles in the perinephric tissue, under the kidney capsule, in the pelvis, as well as signs of edema on computed tomography of the kidneys.

Pyelonephritis xanthogranulomatous

- a chronic inflammatory process in the renal cortex and in the medulla, which occurs a second time - against the background of obstruction urinary tract with urolithiasis. It occurs mainly in women. With xanthogranulomatous pyelonephritis, stones in the renal pelvis are very often detected, sometimes staghorn, as well as signs of hydronephrosis, with expansion of the calyces and the presence of detritus and xanthoma bodies in their cavities.

pyonephrosis

- a condition that develops when the kidney is infected against the background of an existing hydronephrosis. CT of the retroperitoneal space with pyonephrosis reveals a significant expansion of the renal pyelocaliceal system with the presence of an infected fluid with a density of 20–30 Hounsfield units.

Pyonephrosis caseous

- the final stage of the development of tuberculosis of the kidney, in which its caseous purulent fusion occurs, and then wrinkling and diffuse calcification.

piocalyx

- infection of one group of cups with existing hydronephrosis or hydrocalyx - a local variant of pyonephrosis.

Squamous cell carcinoma of the kidney

- malignant neoplasm of the kidney with a tendency to invasive growth. The tumor is localized in the renal pelvis, has the form of a node with a lobed structure. May cause hydronephrosis due to obstruction of the urinary tract. In the bladder with squamous cell carcinoma of the kidney, hyperdense blood clots can be seen.

horseshoe kidney

- fusion of the kidneys in the region of the lower pole due to the presence of an isthmus, consisting of connective or renal tissue. The kidney at the same time has a characteristic appearance of a horseshoe.

An example of visualization of a horseshoe kidney on computed tomography with contrast enhancement in the arterial and excretory phases. In the right image, the arrows mark the renal arteries (there are two of them - one on each side of the horseshoe kidney), in the image on the left and in the middle, the arrows mark separate ureters.

Renal vein thrombosis

- violation of the patency of the renal vein as a result of its occlusion by a thrombus. On CT scan, the renal vein is sharply dilated, plethoric (sometimes more than 2 cm), the degree of contrast enhancement of the vein is lower compared to the other side. In some cases, it is possible to directly visualize the thrombus in the lumen of the vein. With an increase in thrombus in the arterial phase, a tumor of the renal vein can be suspected.

Kidney Page

- compression of the kidneys by large hematomas located subcapsularly, and the development of secondary renal hypertension.

simple kidney cyst

- hypodense formation with a density of 10...15 Hounsfield units in the kidney, not containing a solid component, calcifications, septa, blood. Common finding on CT scan of the kidneys. With contrast, simple cysts do not increase.

Pseudotumor of the kidney

- a volumetric process of the kidney that mimics tumor growth, but is a reflection of normal anatomical renal structures, for example, an enlarged Bertinian column - an outgrowth of the renal cortex.

Kidney rupture

- damage to the cortical and (or) medulla of the kidney, expressed to varying degrees depending on the applied traumatic force, the conditions of injury.

Kidney rupture, AAST classification

- 1 tbsp. - contusion or hematoma of the kidney; 2 tbsp. - rupture of the renal cortex less than 1 cm without extravasation of urine; 3 art. - rupture of the renal cortex more than 1 cm without damage to the collecting system and without extravasation of urine; 4 tbsp. - rupture of the renal parenchyma (cortical and medulla of the kidney, as well as the collecting system); 5 st. - rupture of the parenchyma, as in the case of stage 4, but with separation of the vascular bundle of the kidney and its devascularization.

Cancer of the ureter

- looks on CT of the ureters as a formation of soft tissue density, causing obstruction of the lumen and the development of a hydroureter, and then hydronephrosis, or as a thickening of the wall of the ureter. The distal part of the ureter in this condition is stretched, filled with urine with a density of 12–20 Hounsfield units.

Renal cortical necrosis

- a condition in which the death of the kidney cortex occurs in a limited area or diffusely against the background of sepsis, septic shock. CT of the kidneys with contrast in renal necrosis can detect the absence of contrast of the renal cortex, and subsequently, after a week or more, calcification of the cortical layer begins and the progression of atrophic changes in the kidneys.

Soft tissue ring symptom

- display of the thickened wall of the ureter when it is obstructed by a high-density calculus. On computed tomography, the ureter on axial sections looks like a ring structure with a hypodense wall (ring) and a hyperdense center (urinary stone).

An observation illustrating the “soft tissue ring” symptom in ureteral obstruction with a calcified stone is a high-density center and a low-density soft tissue “rim” along the periphery.

Stage T renal cell carcinoma

(according to TNM classification) - is determined based on the size of the tumor node and its germination of surrounding tissues. T1 - node less than 7 cm in size, localized in the renal parenchyma; T2 - node larger than 7 cm, localized in the kidney; T3 - there is an invasion of the perinephric tissue, as well as adjacent vessels; T4 - there is a germination of the tumor of the anterior or posterior fascia of Gerota.

An example of renal cell carcinoma in different phases of contrast enhancement: native, arterial and acute. The tumor node corresponds to stage T1 according to TNM, as it has a size of less than 7 cm in diameter and does not grow into the surrounding tissues.

Stage N renal cell carcinoma

(according to TNM classification) - displays the defeat of the lymph nodes. N1 - there is a single enlarged lymph node less than 2 cm in size; N2 - there is a single lymph node more than 2 cm in size, or multiple lymph nodes less than 5 cm in size; N3 - there are lymph nodes larger than 5 cm.

Ureteral stricture

- a condition manifested by a narrowing of the lumen of the ureter due to injury, inflammation, ionizing radiation (radiation therapy). Ureteral strictures are the cause of hydronephrosis.

Tuberculosis of the kidney

- one of the most common forms of extrapulmonary localization of tuberculosis infection. On computed tomography, tuberculosis of the kidneys usually does not give specific symptoms and manifests itself in the form of a productive form (with the presence of multiple tubercles in the cortical layer, hypodense in relation to the parenchyma), or an ulcerative-cavernous form (in the form of destructive changes in the kidneys with the development of multiple abscesses, the appearance calcifications, atrophic changes in the kidney parenchyma).

Heaviness of perirenal fat

- a sign of urinary tract obstruction due to urolithiasis.

Doubling of the kidney

- an anomaly of development, consisting in the presence of two separate, fully formed kidneys on the one hand, supplied with blood by separate renal arteries, the outflow of venous blood from which is carried out through separate renal veins.

Doubling of the renal pelvis

- a developmental variant in which there are two separate pelvises (and often two ureters) in one kidney.

Doubling of the ureter

- a variant of development, manifested by the presence of two separate ureters (in this case, doubling of the renal pelvis can also be detected). Doubling of the ureter can also be detected only in the upper sections - the so-called. ureter fissus.

urolithiasis

- a term denoting the presence of urinary stones in the pyelocaliceal complex of the kidney and (or) in the ureter.

Urothelial cancer

- a malignant tumor of the renal pelvis, often also with damage to the ureter and bladder.

Gerota's anterior fascia

- syn. the anterior renal fascia is a connective tissue septum that separates the retroperitoneal tissue, in which the kidneys are located, from the fatty tissue of the abdominal cavity.

Gerota's fascia posterior

- syn. Zuckerkandl's fascia is a connective tissue septum that delimits the adipose capsule of the kidney from behind.

Fibrolipomatosis of the pelvis

- the formation of the renal pelvis with a density corresponding to the density of fat and above - depending on the ratio of connective tissue and fat components. Fibrolipomatosis is characterized by non-intense sharpened contrast enhancement.

Renal cystadenoma

- a tumor of a benign nature, consisting of a large number of cysts filled with myxomatous contents. On CT scan of the kidneys, it is visualized as a large tumor (at least 3 cm, consisting of many cysts, sharply delimited from the surrounding tissues. Calcifications are found in about half of the cases with cystadenoma; hemorrhages and necrosis are much less common.

excretory phase

- one of the phases of contrast enhancement (late) in CT of the kidneys, in which the pelvicalyceal complex, ureters and bladder are contrasted. It is performed more than five minutes after the start of the contrast injection.

Excretory phase delayed

- performed 15 or more minutes after the start of injection of contrast into the vein, it is used to detect urinomas, and also allows you to estimate the delay time of the contrast in the tubules of the kidney.

Extravasation of urine

- a condition resulting from a violation of the integrity of the wall in any part of the urinary tract and the release of urine into the surrounding tissue.

Urography

- display of the organs of the urinary system, obtained during their contrast X-ray or tomographic examination.

Urography excretory

- X-ray examination of the organs of the urinary system (CT or classical radiography), the purpose of which is to visualize the organs of the urinary system after the introduction of a water-soluble contrast into a vein.