home→Diagnostics→ Difficulties and errors of ultrasound and X-ray diagnostics of kidney pseudotumors. Terms and definitions for computed tomography of the kidneys What is a bertini column in the kidney

Difficulties and errors of ultrasound and X-ray diagnostics of kidney pseudotumors. Terms and definitions for computed tomography of the kidneys What is a bertini column in the kidney

Modern ultrasound diagnostics of kidney diseases is impossible without a clear understanding of the normal echoanatomy of the kidney, based on a comparison of the echographic picture and the histomorphological substrate.

The issues of normal echoanatomy of the kidney are quite fully covered in foreign textbooks, monographs, articles and insufficiently covered in domestic literature.

The kidneys are located retroperitoneally. The right kidney is at the level of Th-12-L-4, the left kidney is located higher - at the level of Th-11-L3 vertebra. However, it is quite inconvenient to determine the position of the kidney relative to the vertebrae, therefore, in echographic practice, the hypoechoic acoustic "shadow" from the twelfth rib, the dome of the diaphragm (or the diaphragmatic contour of the liver), the hilum of the spleen, and the contralateral kidney are used as a guideline for determining the position of the kidney. Normally, the acoustic "shadow" from the twelfth rib crosses (with longitudinal scanning from the back parallel to the long axis of the kidney) the right kidney at the level of the boundaries of the upper and middle thirds, the left kidney - at the level of the hilum of the kidney. The upper pole of the right kidney is located at or slightly below the upper diaphragmatic contour of the right lobe of the liver. The upper pole of the left kidney is located at the level of the hilum of the spleen. The distances from the upper pole of the right kidney to the contour of the diaphragm and from the upper pole of the left kidney to the hilum of the spleen depend on the degree of development of the perirenal tissue of the subject.

The size of the kidneys, according to N.S. Ignashin, are 10-12 cm and 3.5 - 4.5 cm on a longitudinal section, 5-6 cm and 3.5 - 4.5 cm on a transverse section. The total thickness of the parenchyma is 1.2 - 2.0 cm in the middle segment, 2.0 - 2.5 cm in the region of the poles of the kidney. The normal volume of the kidney is 300 cm3. According to V.N. Demidov, kidney length 7.5–12 cm, width 4.5–6.5 cm, thickness 3.5–5 cm. According to M.P. Burykh and specialists who conducted anatomical and echographic correlations, the length of the kidney is 10.41 ± 1.3 cm, the width of the kidney is 5.45 ± 1.3 cm, and the thickness is 3.63 ± 0.5 cm.

The shape of a section of a normal kidney in all projections is bean-shaped or oval. The contour of the kidney is usually even, and in the presence of preserved fetal lobulation of the kidney, it is wavy (this is a variant of the normal structure of the kidney). Quite often, in the norm, a local bulging of the contour is determined in the region of the lateral edge of the kidney (in this case, the so-called "humped" kidney is determined) or in the region of the edge of the renal sinus, which simulates a tumor of the kidney. These conditions are described as pseudotumors and are also variants of the normal structure of the kidney. One of the distinguishing features of pseudotumor "bulging" of the parenchyma with preserved fetal lobulation of the kidney, in contrast to the tumor, is the preservation of the parallelism of the outer and inner contours of the parenchyma, the preservation of the normal echostructure of the parenchyma.

On fig. 18 shows an echogram of a normal adult kidney.

Sonographic characteristics of the renal capsule and parenchyma of the normal kidney are generally accepted. Along the periphery of the ultrasonic cut of the kidney, a fibrous capsule is visible in the form of a hyperechoic, even, continuous structure 2–3 mm thick, then the parenchyma layer is determined. The hilum of the kidney is located sonographically in the form of a "rupture" of the medial contour of the kidney parenchyma, while scanning from the side of the anterior abdominal wall at the top of the scan, an anechogenic tubular structure located in front is visualized - the renal vein, located behind the hypoechoic renal artery. The parenchyma is heterogeneous and consists of two layers: the cortex and the medullary (or the substance of the pyramids of the kidney). The morphological substrate of the renal cortex (kidney cortex) is predominantly the glomerular apparatus, convoluted tubules, interstitial tissue containing blood, lymphatic vessels, and nerves. The medullary substance contains loops of Henle, collecting ducts, Bellini ducts, and interstitial tissue. The cortical substance of the kidney is located along the periphery of the ultrasonic cut of the kidney with a thickness of 5–7 mm, and also forms invaginations in the form of columns (columnae Bertini) between the pyramids. On fig. 19, 20 show a schematic representation of the layers of the parenchyma and a technique for measuring the thickness of the elements of the parenchyma. 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 parenchymal "bridge", the so-called hypertrophied column of Bertin, is the unresolved parenchyma of the pole of one of the lobules of the kidneys, which merge during ontogenesis, forming the kidney of an adult. This lintel consists of the cortical substance, Bertin's columns, kidney pyramids. All elements of the bridge are normal parenchymal tissue without signs of hypertrophy or dysplasia.

Therefore, the name existing in the literature " hypertrophied column Bertin" does not reflect the morphological essence of the substrate, and, probably, the definition of Zh.K. Yen et al., who called this formation a parenchymal bridge, can be considered more accurate. The echogenicity of the cortical substance of the kidney is usually slightly lower or comparable to the echogenicity of the normal liver parenchyma. in the form of structures of a triangular shape with reduced echogenicity compared to the cortex.At the same time, the top of the pyramid (papilla of the pyramid) faces the renal sinus - in the central part of the kidney section, and the base of the pyramid is adjacent to the cortical substance of the parenchyma, located along the periphery of the section (see Fig. 19 The pyramids of the kidney have a thickness of 8-12 mm (the thickness of the pyramids is defined as the height of the triangular structure, the apex of which is facing the renal sinus), although the normal size of the pyramids largely depends on the level of diuresis. substances significantly higher than the echogenicity of the pyramids ok kidneys. Often this difference in echogenicity is the cause of a false positive diagnosis of hydrocalicosis, when very dark, low echogenicity pyramids are mistaken for dilated cups by novice ultrasound diagnosticians. Modern histomorphological studies of the kidney parenchyma and their comparison with the echographic picture suggest that the pronounced echographic corticomedullary differentiation is due to a significant difference in the number of fat vacuoles in the epithelium of the tubular structures of the cortex and pyramids. However, it is impossible to explain the different echogenicity of the cortex and pyramids only by the different content of fat vacuoles in the epithelium of the tubular structures, since it is known that the echogenicity of the kidney pyramids at a high level of diuresis is significantly lower than the echogenicity of the pyramids of the same kidney under normal conditions, while the number of fat vacuoles, depending on diuresis level does not change. It is also impossible to explain the low echogenicity of the pyramids by the presence of liquid in the tubular structures, since the resolution of the ultrasound apparatus under any conditions does not allow differentiating the lumen of the tubule and the liquid in it. It can be assumed that the low echogenicity of the medullary substance is associated with:

1) with a high content of glycosaminoglycans in the interstitial tissue, where most of the functional processes take place, providing ion exchange, reabsorption of water and electrolytes, urine transport; glycosaminoglycans are able to "bind" the liquid, according to the authors of the hypothesis, "swelling and swelling very quickly";

2) the presence of smooth muscle fibers in the interstitial tissue surrounding the excretory ducts of the renal papilla.

In children, the echogenicity of the cortical substance is significantly higher than in adults, which is explained by a more compact arrangement of the glomeruli and a smaller amount of interstitial tissue. Pyramids occupy a larger area than in adults. Morphometric studies have shown that in newborns the cortex and pyramids occupy about 90% of the volume of the kidney, in adults the percentage decreases to 82%.

In the center of the echographic section of the kidney, a hyperechoic complex of an oval or round shape (depending on the scanning plane) is determined, the renal sinus, the size and echogenicity of which are differentiated to a large extent depending on the age of the subject and his dietary habits.

If the echographic characteristics and interpretation of the image of the normal parenchyma are generally accepted in medical practice and in scientific developments, then the interpretation of the central echo complex varies significantly among different authors. In practical work, as well as in scientific articles by some authors, there is a semantic identification of the central echo complex and the pyelocaliceal system of the kidney. However, the conduct of modern histomorphological and echographic correlations of a normal kidney has convincingly proved that the central echo complex is a summary display not of the pelvicalyceal system, but of the entire set of elements of the renal sinus. By comparing the anatomical and echographic data, it was found that it is the renal sinus, and not the pelvicalyceal system, as previously thought, that is the morphological substrate of the central echo complex.

Very little has been written about the renal sinus as an anatomical entity, although there is abundant medical research data describing various pathologies of the renal sinus. When an image is acquired, many conditions give a similar picture. There may be misdiagnosis when trying to make a diagnosis without considering the various possibilities.

The renal sinus is a specific anatomical structure, surrounding and including the collecting system of the kidneys. It borders on the lateral side with kidney pyramids and cortical columns. The medial renal sinus communicates with the panephral space through the renal hilum. The elements of the renal sinus are lymphatic, nervous, renovascular structures surrounded by fatty and fibrous tissue. The decrease in the percentage of parenchyma in the volume of the kidney in an adult compared to a newborn occurs precisely due to an increase in the volume of the renal sinus, which occurs as a result of the “age-related” growth of the cellular tissue of the renal sinus. The adipose tissue of the renal sinus is practically absent in the newborn, which is echographically manifested by the absence of reflected echo signals from the renal sinus or in the minimally pronounced central echo complex in the form of a delicate, branched, weakly echogenic structure. Unlike the kidney of an adult, the medullary layer is more pronounced, the central echo complex is represented by a branched structure smaller in area and in echogenicity. By the age of 10, the renal sinus is almost completely formed. Similar data were obtained in MRI studies of the kidneys of healthy children (an intense signal on T1-weighted images, corresponding to sinus fiber, appears in the age group of children over 10 years old. Normally, there is an age-related increase in the amount of renal sinus fiber. In some cases, pathological proliferation of fiber (in 0.66 - 10% of cases) - sinus fibrolipomatosis. The most common sinus lipomatosis occurs after the age of fifty. It was found that the ratio of the anteroposterior size of the kidney to the anteroposterior size of the renal sinus in both kidneys in both male and female persons is in inverse correlation with age.No significant correlation with gender was found.In addition to age, the causes of lipomatosis can be: obesity, steroid therapy, Cushing's syndrome.Replacing fibrolipomatosis occurs more often as a result of severe renal atrophy against the background of urolithiasis. In such cases, stones are detected in 3/4 of patients. If echography reveals an increase in the central echo complex against the background of staghorn nephrolithiasis, then, as a rule, this is a consequence of replacing fibrolipomatosis against the background of urolithiasis and chronic pyelonephritis. On nephrotomograms, renal sinus lipomatosis cannot be distinguished from renal sinus cysts - there is a classic pattern of elongated and curved calyx necks. Some papers provide observations of echo-negative formations in the projection of the renal sinus, allegedly associated with the process of renal lipomatosis. According to I.S. Amis, who analyzed the reasons for the discrepancy between the data of echography and nephrotomography, these errors are associated with an incorrect interpretation of the X-ray negative zones in the projection of the renal sinus during nephrotomography. This assumption was confirmed in similar cases with computed tomography and punctures. Renal sonography helps distinguish renal sinus lipomatosis from cysts. With sinus lipomatosis, there is an increase and an increase in the echogenicity of the renal sinus.

So, the echogenicity of the central complex is primarily due to the presence and amount of fatty tissue of the renal sinus. However, in addition to reflections of high intensity in the central echo complex, there are small zones of reduced echogenicity and anechoic zones. For quite a long time it was believed that these zones are reflections of the elements of the pyelocaliceal system. There are extremely contradictory and few data on the normal echographic dimensions of the pelvicalyceal system in adult subjects. So, in 1982, A. Deina reports on "the syndrome of echographic invisibility of the pyelocaliceal system." I.S. Amis refers to dilatation of the pyelocaliceal system as any "splitting" of the pyelocaliceal system as an echo-negative strip. K.K. Hayden, L.I. Svishuk allows the normal presence of only a thin layer of fluid in the pyelocaliceal system. At the same time, the presence of expansion of the pelvis and calyx structures and their fusion in the form of a "tree" is, according to these authors, a sign of hydronephrosis. T.S. Khikhashi, comparing the data of echography, dopplerography and excretory urography, came to the conclusion that the classification of hydronephrosis by P.Sh. Illenboden, who describes echographically detected hydronephrosis by degrees as a splitting of the central echo complex in the form of: a) a branched tree structure, b) a lily structure, c) a clover structure, d) in the form of a rosebud, leads to a false positive diagnosis of hydronephrosis. According to these authors, splitting of the central echo complex in the form of a tree corresponds to normal vascular structures, an echo-negative structure in the form of a lily corresponds to a normal pelvis or, possibly, an obstructive process, structures in the form of a rosebud - the initial form of hydronephrosis, in the form of a clover - pronounced hydronephrosis. At the same time, false-positive diagnosis of hydronephrosis occurred in 11%, false-negative - in 22% of cases. Quantitative estimates of the size of the normal pelvicalyceal system are not given in the work of these authors. Although I. Khash tried to use the size of the pelvis as an index that determines the degree of hydronephrosis, data that determine the anteroposterior size of the pelvis as a differential diagnostic criterion for normal and pathological conditions were not given. F.S. Will considers an anteroposterior pelvis size of 30 mm to be normal, which is completely unacceptable from our point of view. V.N. Demidov, Yu.A. Pytel, A.V. Amosov determine the normal anteroposterior size of the pelvis in 1 - 2.5 cm. G.M. Imnaishvili believes that visualization of cups in the form of anechoic, rounded formations up to 5 mm in diameter is normally acceptable. The pelvis can be visualized as two hyperechoic linear structures running towards the hilum of the kidney.

Quite curious are the data of T.Ch. Tzei and co-authors. The study of these authors was undertaken in order to establish the echographic dimensions of the normal renal pelvis in children and to determine the correlation between its size and the presence of a particular renal pathology, as well as the dependence of the size of the pelvis on age. Found that upper bound the norm of the anteroposterior size in children is 10 mm, and only 1.7% of the normal renal pelvis exceeded the size of 10 mm. Correlation analysis did not reveal statistically significant differences in the size of the renal pelvis in different age groups, although the average size values in the normal group and in the pathology group were statistically different (p Potential causes of false positive diagnosis of hydronephrosis, according to T.Ch. Tzei and other authors, are: overdistension of the bladder, an increase in urine flow (due to the action of diuretics, contrast agents, with diabetic polyuria, hyperhydration), atony of the pelvis with acute inflammation, cystic changes in the kidney, mimicking hydronephrosis. Reasons for a false-negative diagnosis include dehydration, acute obstruction without dilatation, distal urinary tract obstruction, damage to the collecting system, and misinterpretation of a normal image. To determine the possibilities of echography, pharmacoechography with a diuretic in the visualization of the pyelocaliceal system, as well as to determine the echographic dimensions of the normal pelvis and calyces, we conducted studies in groups of healthy individuals with various drinking regimens and degrees of bladder filling. When comparing the echographic picture of the renal sinus in the B-mode and in the color Doppler mapping mode, it was found that under conditions of water deprivation (when examined on an empty stomach) and with an empty bladder, all echo-negative zones in the renal sinus corresponded to the zones of determined blood flow. Elements of the pyelocaliceal system in the form of an- or hypoechoic structures were not determined. At the same time, in the subgroup of persons under 30 years of age, the largest echo-negative structures corresponded to the venous vessels of the renal sinus and had an average diameter of 5.6 ± 1 mm, in the middle age subgroup (under 50 years) - 4.9 ± 0.4 mm, in the older age group In a subgroup of individuals, venous structures were visualized less clearly, and their average diameter was 3.8 ± 0.1 mm. The branches of the renal artery were usually defined as much smaller hypoechoic areas within the renal sinus. Almost all echo-negative zones corresponded to the zones of determined blood flow.

In a group of healthy individuals with a normal drinking regimen (1.5 liters of liquid per day) and an average bladder filling (up to 250 ml), cup structures with a diameter of no more than 5 mm were visualized in 8% of the subjects.

In the third group of healthy individuals, a pharmacoechographic test with furosemide was used as a means of visualizing the pelvicalyceal system (PCS); at the same time, the possibilities of pharmacoechography in obtaining a clear echographic picture of PCS were studied. The term "pharmacoechography" was introduced by A.V. Amosov and G.M. Imnaishvili in 1988. Pharmacoechography, according to the definition of these authors, is a study of urodynamics using diuretic medications under ultrasonic control. Before the test, the authors determine the size of the pyelocaliceal system, assess the state of the parenchyma. Then the patient is injected with 20 mg of furosemide or bufenox at a dose of 2 ml of a 0.025% solution intravenously, followed by an ultrasound examination for 30 minutes or more. The action of drugs begins after 2-3 minutes and lasts a relatively short time. The authors believe that with an undisturbed passage of urine, the clarity of the image and the size of the cups and pelvis do not change after the introduction of a diuretic. With a disturbed passage of urine, with violations of urodynamics, ultrasound begins to reveal retention changes in the pelvicalyceal system.

In later works, pharmacoechography is used as a method of diagnosis and differential diagnosis stenoses of the ureteropelvic segment to determine the degree of damage and the degree of reversibility of changes in obstructive nephropathies, for the purpose of differential diagnosis of true obstruction urinary tract in the fetus, diagnosing cysts of the renal sinus. A radio tape recorder is also used as a diuretic.

Our research proposes the use of pharmacoechography as a way to visualize the pelvicalyceal system of a normal kidney. At the same time, furosemide is administered intravenously or intramuscularly at the rate of 0.5 mg per kilogram of the patient's weight against the background of high hydration (subjects are offered a liquid intake of 0.8-1.0 liters one hour before the study). With intravenous administration of the drug, the effect occurs "at the tip of the needle." The pyelocaliceal system begins to be visualized as a hypoechoic tree-like structure that splits the central hyperechoic echo complex. In this case, the role of a kind of contrast that makes it possible to visualize PCS against the background of fatty tissue of the sinus is played by a fluid that more fully fills the cavities of the pelvicalyceal system. Pay attention to how the echographic picture of the hilum of the kidney has changed after the introduction of furosemide - three anechoic structures are already visualized in the hilum of the kidney: the renal vein, the artery, and the pelvis located behind. With the intramuscular route of administration, the average time to start visualization increases and amounts to 10.2 ± 5.3 minutes.

Summarizing all of the above about the echoanatomy of a normal kidney, we emphasize the most important points:

- a normal kidney does not necessarily have a smooth, but always clear (due to the presence of a capsule) contour;

- assessment of the position of the kidney is carried out relative to nearby organs, as well as relative to bone landmarks (mainly - the 12th rib);

- when assessing the echostructure and echogenicity of the kidney, the presence or absence of cortico-medullary differentiation, differentiation of the parenchyma and renal sinus is determined, the echogenicity and echostructure of each element of the parenchyma and renal sinus are evaluated;

- the central echo complex of the kidney section is a total reflection of the elements of the renal sinus, while the hyperechoic component of the complex is primarily due to the fatty tissue of the renal sinus; hypo- and anechoic formations in the study on an empty stomach are due to the presence of vascular elements;

Hyperechoic inclusions are usually detected during renal ultrasound. They represent a certain kind areas of tissue 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?

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 benign tumor kidneys are completely absent psammoma bodies, 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.

For the prevention of 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, there 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 the anatomical structure of the 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 dormant 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 curing 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; 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.

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.

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 unequal 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 outline.

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, the cross dystonia is located above the usual kidney, they have a more embryonic type of structure (pronounced lobulation).

The term "nephrosclerosis" refers to the replacement of the renal parenchyma with connective tissue. Renal nephrosclerosis can occur due to various diseases of the kidneys and renal vessels.

Causes of the disease

According to the mechanism of development, the following types of nephrosclerosis are distinguished:

primary (caused by a violation of the blood supply to the renal tissue with hypertension, atherosclerosis and other diseases);
secondary (developing as a result of various kidney diseases, for example, with nephritis).

Primary nephrosclerosis can occur with narrowing of the renal arteries, which is due to their atherosclerotic lesions, thrombosis or thromboembolism. Ischemia leads to the formation of infarcts and scarring in the kidneys. A similar picture is observed in hypertension, as a result of hypertensive arteriolosclerosis, with stagnation of venous blood in the kidneys, due to age-related changes in blood vessels.

A classic example of primary nephrosclerosis is a primary wrinkled kidney that develops in the late stages of hypertension. Due to circulatory failure and hypoxia, atrophic and dystrophic changes occur in the renal tissue with a gradual increase in connective tissue.

Thus, primary nephrosclerosis can be divided into the following forms:

atherosclerotic,
involutive,
hypertensive nephrosclerosis,
other forms.

Secondary nephrosclerosis, or secondary wrinkled kidney, occurs as a result of inflammatory and degenerative processes that develop directly in the kidneys:

chronic glomerulonephritis,
pyelonephritis,
nephrolithiasis,
kidney tuberculosis,
syphilis with damage to the kidney tissue,
systemic lupus erythematosus (lupus nephritis),
kidney amyloidosis,
diabetes(diabetic nephritis),
kidney injury, including repeated surgical interventions,
exposure to ionizing radiation,
severe forms of nephropathy in pregnancy.

In addition, a peculiar form of nephrosclerosis with expansion and cystic transformation of the tubules of the kidneys develops with gout and oxalaturia as a result of crystalluric interstitial nephritis, as well as with hyperparathyroidism, accompanied by increased calciuria. Radiation nephrosclerosis is usually detected many months or even years after radiation exposure. Its severity depends on the type of radiation and dose.

shriveled kidney

pathological anatomy

In the pathogenesis of nephrosclerosis, two phases are distinguished:

In the first phase, a picture is observed in the kidneys, due to a specific disease that caused the sclerotic process;
In the second phase, the features of nephrosclerosis inherent in the disease that caused it are lost.

During the second phase, the sclerotic process captures all new areas of the renal tissue until the entire kidney is largely affected. With a detailed picture of the disease, the kidneys are compacted, have an uneven surface. With arterial hypertension and glomerulonephritis, the surface of the kidney is fine-grained, and with atherosclerosis it is coarse-nodular, has cicatricial retractions of an irregular stellate shape. With pyelonephritis, nephrosclerosis affects the kidneys asymmetrically.

The morphology of the renal tissue reflects the features of the course of the sclerotic process, as well as the rate of increase in severe changes. Depending on the course, the following forms of nephrosclerosis are distinguished:

benign,
malignant.

More common is benign nephrosclerosis, characterized by arteriolosclerosis and atrophy of individual groups of nephrons with glomerular hyalinosis. In this case, the connective tissue grows in the interstitium (interstitial space) and in place of atrophied areas. In the malignant form, arterioles and capillary glomeruli undergo fibrinoid necrosis, stromal edema, hemorrhages, and pronounced dystrophic changes in the tubules are observed. As a result, widespread sclerosis occurs in the kidneys. This form nephrosclerosis is characteristic of malignant arterial hypertension, eclampsia and some other diseases.

Symptoms and diagnosis of nephrosclerosis

The outcome of a long course of hypertension, as a rule, is nephrosclerosis: its symptoms usually appear in the later stages of the disease. At an early stage of nephrosclerosis, the symptoms are not very pronounced. In a laboratory study, the following changes can be detected:

polyuria,
nocturia,
the appearance of protein in the urine,
microhematuria,
decrease in the density of urine.

As a result of a decrease in the osmolarity of urine, edema occurs, which first appear on the face, and in later stages - throughout the body. In addition, in most cases it develops arterial hypertension caused by renal ischemia. It is malignant and difficult to treat. Often, renal arterial hypertension leads to the following complications:

overload of the left ventricle of the heart with coronary insufficiency,
strokes,
swelling of the papilla of the optic nerve and its atrophy up to complete blindness,
retinal disinsertion.

Ultrasound, X-ray and radionuclide studies play an important role in the diagnosis. Ultrasound of the kidneys can detect a change in their size, determine the thickness of the parenchyma and the degree of atrophy of the cortical substance. Urography allows you to determine the decrease in the volume of the affected kidney and cortical layer, sometimes calcifications are visible. The angiogram shows narrowing and deformation of small arteries, uneven surface of the kidneys. Radionuclide renography reveals a slowdown in the accumulation and excretion of the radiopharmaceutical from the kidneys. During scintigraphy, radionuclides are distributed unevenly in the kidney tissue; in severe cases, the image of the kidney may be absent.

Tip: if you find edema of unknown origin, high blood pressure with headache and visual impairment, seek immediate medical attention. Timely treatment will help to avoid such formidable complications as stroke, blindness, etc.

The end result of nephrosclerosis is severe chronic renal failure and intoxication of the body with nitrogenous slags.

General principles for the treatment of kidney nephrosclerosis

When diagnosed with kidney nephrosclerosis, treatment depends on the manifestations of the disease. If nephrosclerosis is not accompanied by obvious signs of renal failure, but is manifested by an unstable increase in blood pressure, then treatment consists in limiting the intake of salt and fluid and the use of antihypertensive drugs. In addition, diuretics, anabolic drugs, enterosorbents, vitamins are used.

In severe renal failure, antihypertensive drugs should be prescribed with great care, since a sharp decrease in blood pressure can lead to impaired renal blood flow and deterioration of the organ.

Important: with azotemia, a protein-restricted diet should be followed, this will reduce the formation of nitrogenous toxins in the body.

In malignant hypertension with rapidly developing nephrosclerosis and progressive kidney failure produce embolization of the renal arteries or nephrectomy, followed by transfer to hemodialysis. Kidney transplantation is also possible.

Pyramids of the kidneys are called certain zones through which urine enters the pelvicalyceal system after filtering fluid from the bloodstream through tubule systems. Already from the PCA, urine moves through the ureter and enters the bladder. Violations of the pyramids can be observed both in one and both kidneys, which leads to dysfunction of the organ and requires mandatory treatment. Identification of pathological changes is carried out by means of ultrasound, and only after examination and diagnosis, the doctor prescribes the necessary therapy.

What does hyperechoic pyramids mean?

Pyramids of the kidneys are called certain zones through which urine enters the pelvicalyceal system after filtering fluid from the bloodstream.

The normal healthy state of the kidneys means the correct shape, uniformity of structure, symmetrical arrangement, and at the same time, ultrasound waves are not reflected on the echogram - a study performed with a suspected disease. Pathologies change the structure, appearance of the kidneys and have special characteristics that indicate the severity of the disease and the condition of the inclusions.

For example, organs can be asymmetrically enlarged/reduced, have internal degenerative changes in parenchymal tissue - all leading to poor penetration of the ultrasonic wave. In addition, echogenicity is impaired due to the presence of stones and sand in the kidney.

Important! Echogenicity is the ability of wave reflection of sound from a solid or liquid substance. All organs are echogenic, which allows ultrasound. Hyperechogenicity is a reflection of increased strength, revealing inclusions in organs. Based on the monitor readings, the specialist detects the presence of an acoustic shadow, which is a determining factor in the inclusion density. Thus, if the kidneys and pyramids are healthy, the study will not show any wave deviations.

Symptoms of hyperechogenicity

Syndrome of hyperechoic kidney pyramids causes pain in the lower back of a cutting, stabbing character

The syndrome of hyperechoic kidney pyramids has a number of symptoms:

Temperature changes in the body;
Pain in the lower back of a cutting, stabbing character;
Change in color, smell of urine, blood droplets are sometimes observed;
Violation of the stool;
Nausea, vomiting.

The syndrome and symptoms indicate a clear kidney disease that needs to be treated. The selection of pyramids can be caused various diseases organs: nephritis, nephrosis, neoplasms and tumors. Additional diagnostics, examination by a doctor and laboratory tests are required to establish the underlying disease. After that, the specialist prescribes measures of therapeutic treatment.

Types of hyperechoic inclusions

All formations are divided into three types, based on what picture is visible on ultrasound

All formations are divided into three types, based on what picture is visible on ultrasound:

A large inclusion with an acoustic shadow most often indicates the presence of stones, focal inflammation, and disorders of the lymphatic system;

A large formation without a shadow can be triggered by cysts, fatty layers in the sinuses of the kidneys, tumors of a different nature, or small stones;

Small inclusions without a shadow are microcalcifications, psammoma bodies.

Possible diseases depending on the size of inclusions:

Urolithiasis or inflammation - manifested by large echogenic inclusions.

Single inclusions without a shadow indicate:

hematomas;
sclerotic changes in blood vessels;
sand and small stones;
scarring of organ tissues, for example, parenchymal tissues, where scarring occurred due to untreated diseases;
fatty seals in the sinuses of the kidneys;
cysts, tumors, neoplasms.

Important! If the monitor of the device shows obvious sparkles without a shadow, then in the kidneys there may be an accumulation of compounds (psammomic) of a protein-fatty nature, framed by calcium salts or calcifications. Miss this symptom not recommended, as this may be the beginning of the development of malignant tumors. In particular, oncological formations include calcifications in 30%, psamon bodies in 50%.

Inclusion of the echo complex of the kidneys on ultrasound is a study that allows you to identify abnormal development of all parts of the organ, the dynamics of diseases and parenchymal changes. Depending on the echogenic parameters, the characteristics of the disease are determined, therapeutic and other treatment is selected.

As for the symptoms, even knowing about the pyramids in the kidneys, what it is, what pathologies the changes in structure and echogenicity indicate, the implicitness of the signs of the disease often does not cause concern. Patients come to terms with painful sensations and delay the visit to the doctor. It is categorically not recommended to do this: if the disease has touched the pyramids, then pathological changes have gone far enough and can turn into not only purulent inflammatory processes, but also chronic diseases which will take a lot of time and money to treat.

A source

03-med.info

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:

cortical;
brain.

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).

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Syndrome of hyperechoic pyramids of the kidneys

If for a long time, then chronic renal failure, if acute, then acute renal failure. Poisoning can be the cause of both. The kidneys play an important role in the human body, and their normal functionality depends general state health. Therefore, when the first signs of malaise appear, it is recommended to immediately provide needed help kidneys.

Typical symptoms that cause kidney problems

If these symptoms appear, it is important to immediately contact your doctor, who will prescribe an immediate examination and delivery. necessary analyzes. Also, these symptoms may indicate that the patient has one kidney larger than the other, so it is necessary to undergo an additional examination, including renal clearance. In the event that, after hypothermia, a person’s kidneys began to hurt, only one conclusion can be drawn - this means that the development of the inflammatory process began earlier.

Symptoms associated with kidney disease

A person can get closed injuries of the kidneys in car accidents, when falling from a height, and even while playing sports. Each of these types of diseases has its own dangers, so in no case should you experiment on yourself and self-medicate. Often, patients who actually have a carbuncle of the kidney end up in the hospital under completely different diagnoses.

Types of hyperechoic inclusions and diagnosis

With this disease, pus is also released, so it is very dangerous and requires immediate hospitalization of the patient in a medical facility. It has been proven that dietary nutrition has a very beneficial effect on many kidney diseases and allows them to work in a gentle mode.

The kidneys are a paired organ and perform several functions in the human body simultaneously. Therefore, in the diagnostic ultrasound examination a mandatory examination of both kidneys is carried out. The dysfunction may begin on one side and affect the other. Hyperechoic inclusions in the kidneys can be observed both in one and in two. The location of the inclusions is the most diverse and depends on predisposing adverse factors.

website about kidney disease

Pathological processes various etiologies change the structure and appearance of the kidneys depending on the severity of the disease and the condition of the inclusions. Hyperechogenicity means a super strong reflection, indicating the presence of any inclusions in the kidneys. There are several types of echogenic inclusions, which determine pathological condition kidneys. Hyperechoic inclusions and are divided into two large groups: stones (sand) and neoplasms.

Large inclusions in the kidneys. This can also be confirmed by the presence of calcifications and psammoma bodies in the tumor, as well as sclerotic areas. The examination may reveal several various kinds echogenic inclusions. Violation of the kidneys is always accompanied by weakness and fatigue. This condition is inherent in the acute development of diseases or the phase of exacerbation of chronic pathological processes in the kidneys.

Therapeutic measures and prevention

It is necessary to assess the state of the kidney parenchyma against the background of prominent pyramids. Depending on the neglect of the condition and the type of pathological process, treatment can be therapeutic or surgical.

Pyelonephritis is an inflammatory process that occurs only in the pyelocaliceal system of the kidney, accompanied by pronounced laboratory changes. Rice. 1 Visualization of the right kidney. The sensor is located in the region of the posterior axillary line on the right.

Necessary treatment

As with a full examination of any other organs, it is necessary to examine the kidney in the second projection to study its cross section. The sensor can be installed directly under the costal arch or in the region of the last intercostal space.

Clinical manifestations

The left kidney is also located in a certain triangle, the sides of which are the spine, muscles and spleen. Sonographic characteristics of the renal capsule and parenchyma of the normal kidney are generally accepted.

A partial or complete rupture of the collecting system image at the same location indicates a doubling of the kidney with separate ureters and blood supply to each half.

Kidney dystopia is an anomaly in the development of the kidney, in which the kidney does not rise to its normal level during embryogenesis. In this case, variants of heterolateral dystopia with and without fusion of the kidneys are possible. With echographic detection of an abnormally located kidney, difficulties usually arise in the differential diagnosis of nephroptosis and dystopia. It must be remembered that the kidney with nephroptosis has a normal length ureter and vascular pedicle, located at the usual level (level L1-L2 of the lumbar vertebrae).

As for the increase in the echogenicity of the parenchyma and the protruding pyramids, here the causes of this condition may be different. In newborns, the structure and condition of the pyramids themselves and the fluids released through them are evaluated. The base of the triangle is the border between the cortex and the pyramid along the periphery of the pyramid cut. The syndrome itself is not life-threatening and is a symptom of a disease that is established after a complete comprehensive examination.

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Concepts - hyperechogenicity and acoustic shadow?

Echogenicity refers to the ability of bodies of liquid and solid consistency to beat off ultrasonic waves. All organs located inside a person are echogenic, this is what allows ultrasound procedure. Ultrasound helps to study the activity of the kidneys, determine their integrity and confirm or exclude the presence of neoplasms of a malignant or benign nature. In a healthy person, the organ is round in shape with a symmetrical location and inability to reflect sound waves. In cases of pathologies, the size of the kidneys changes, the location becomes asymmetrical and inclusions appear that can beat off sound waves.

On ultrasound, hyperechoic inclusions look like white spots.

The word "hyper" means an increased ability of echogenic tissues to reflect ultrasonic waves. During the ultrasound, the specialist sees white spots on the screen and determines whether they have an acoustic shadow, more precisely, an accumulation of ultrasonic waves that have not passed through it. Waves have a much higher density than air, so they can only pass through a dense object. Hyperechogenicity is not a separate disease, but a symptom that indicates the appearance of various kinds of pathologies inside the kidneys.