Ultrasound examination allows the early detection of many kidney diseases. The changes visible in the ultrasound examination include: deposits - the so-called stones in the course of nephrolithiasis, inflammatory infiltrates, hematomas, cysts and neoplastic kidney tumors. In some cases, it is necessary to extend the diagnosis with other imaging tests (computed tomography, magnetic resonance imaging). The indications for an ultrasound of the kidneys and / or urinary system are abdominal pain, pains radiating along the lumbar spine, abnormal urine tests, hematuria or blood pressure disorders. Kidney ultrasound examination is non-invasive and completely safe for pregnant women and children.
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Kidney ultrasound - preparation
Preparation for ultrasound of the kidneys includes the following recommendations:
In the period of 2 days prior to the examination, do not eat heavy or bloating products.
On the day before the examination, you should take an agent that reduces gas accumulation in the digestive tract, eg Espumisan. Gases that accumulate in the intestines, especially in the splenic fold of the colon, can make it difficult to assess the renal parenchyma.
On the day of the examination:
be on an empty stomach or you must not eat anything for 6 hours before the test,
drink a liter of still water (4 glasses) about 1-2 hours before the test (the bladder should be full during the ultrasound).
What does an ultrasound of the kidneys look like?
During the examination, the patient lies on his back, possibly in the event of difficulty in visualizing the kidneys on his side, abdomen or standing. The doctor puts an ultrasound head emitting ultrasound waves to the patient's body, previously covering the skin with a special gel. The head is moved from the hypochondrium to the posterior region of the lower thoracic region. The test is performed on both sides - both kidneys are always assessed. During the examination, the doctor may ask you to temporarily hold the air while you breathe in - the kidneys rise when you exhale and lower when you inhale. Sometimes it is necessary to recess the head under the rib arch. If the doctor suspects that the kidney is excessively mobile, the ultrasound scan is also done while standing. When assessing the ureters and bladder, the head is placed on the side of the spine and in the lower abdomen, respectively. During the examination, the doctor may ask the patient to use the toilet - this is necessary to assess the flow of urine from the kidneys and urinary tract.
What does the doctor assess during an ultrasound of the kidneys?
During the ultrasound examination of the kidneys, the doctor assesses location, dimensions, mobility, shape of the kidneys and the width of their flesh at the thickest and thinnest part. A normal kidney is shaped like a bean. The peripheral kidney parenchyma consists of the cortical and core layers - it is visible in the ultrasound image as a hypoechoic area. The center of the kidney is occupied by the cup-pelvic system through which urine flows into the ureters, as well as blood vessels and connective tissue. In the elderly, there is also a certain amount of adipose tissue in this area.
After examining the kidneys, the doctor assesses the adrenal glands, i.e. the endocrine glands located above the kidneys, the surrounding lymph nodes and the vessels of the abdominal cavity. Additionally, the physician may decide to conduct a complete urinary evaluation (male ureters, bladder, prostate).
What does kidney ultrasound detect?
Inflamed kidneys may be characterized by blurred contours and increased echogenicity of the parenchyma in relation to the surrounding organs (liver and spleen).
The widening of the cup-pelvic system may indicate a disturbed outflow of urine from the kidney. To find the cause of the stasis, the doctor assesses the connection of the pelvis with the ureter and the bladder opening of the ureter. Stenosis of the pyeloureteral junction may be the result of dysplasia of this junction or secondary stenosis due to compression of the renal vessels. Obstructed outflow of blood from the kidney and dilatation of the pelvis may also result from anatomical abnormalities of the pelvis, urinary retention, the presence of a tumor or the presence of stone deposits in the course of kidney stones. The doctor assesses the degree of possible enlargement of the calyx-pelvic system, determines the dimensions of the changed calyxes and the thickness of the kidney parenchyma. In the case of hydronephrosis, the kidney parenchyma becomes thinned (in stagnation it remains normal).
When nephrolithiasis is diagnosed during the examination, the doctor determines the size, number and location of deposits that obstruct the outflow of urine from the kidney.
If focal lesions are found, the doctor determines their location, number, size, echogenicity and demarcation from the renal parenchyma (tumor surrounded by a capsule or not). Moreover, in a Doppler examination the doctor assesses the degree of vascularization of the lesion.
Cysts are common changes in the kidneys. Single small cysts are usually not dangerous and are only subject to periodic observation. A rare benign tumor of the kidney is angiomyolipoma (angiomyolipoma). If its dimensions do not exceed 4 cm, it is advisable to monitor the size of the tumor on ultrasound. Larger symptomatic forms of angiomyolipoma may require embolization or surgical removal.
Solid lesions present in the central part of the kidney may be associated with the presence of a tumor of the panic-pelvic system (TCC). This tumor cannot always be visualized on ultrasound. If any neoplastic lesion is suspected, the doctor also assesses the adjacent lymph nodes, the renal vein and the inferior vena cava. All solid lesions, multiple complex cysts and other changes with an ambiguous ultrasound image are an indication for computed tomography or magnetic resonance imaging.
The description of the kidney ultrasound examination ends with diagnostic conclusions and possible recommendations for performing other imaging tests or consulting a doctor of another specialty.
Source:
Tyloch JF, Woźniak MM, Wieczorek AP. Standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego – aktualizacja. Badanie nerek, moczowodów oraz pęcherza moczowego. Journal of Ultrasonography 2013; 13: 293-307
Frequently asked questions about ultrasound of the kidneys:
The most common indications for ultrasound examination of the kidneys and urinary tract are abdominal pain, pains radiating along the lumbar spine, abnormal urine test results, pain during urination, haematuria, blood pressure disorders.
Within two days before the date of the ultrasound, do not consume heavy or bloating products. On the day before the examination, you should take an agent that reduces gas accumulation in the digestive tract, eg Espumisan. The ultrasound should be performed on an empty stomach or not eaten for 6 hours before the examination. It is advisable that the bladder is full during the examination, therefore one liter of still water (4 glasses) should be drunk 1-2 hours before the ultrasound examination.
During the examination, the patient lies on his back; in cases of difficulties with visualizing the kidneys in other positions (on the side, back, standing). The doctor puts an ultrasound head emitting ultrasound waves to the body shells. The head is moved from the hypochondrium to the posterior region of the lower chest, to the side of the spine and along the lower abdomen. The image from inside the abdominal cavity appears on the monitor screen in real time. During the examination, the doctor may ask the patient to use the toilet and then re-evaluate the urinary tract. The ultrasound examination takes about 15-20 minutes and is completely painless and safe.
