Excretory urography (EU) or IVP US CT & radionuclide imaging

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3 Excretory urography (EU) or IVP US CT & radionuclide imaging

4 MRI arteriography studies requiring catherization or direct puncture of collecting system

5 EU & to a lesser extent CT provide both functional & anatomical informations. US & MRI provide anatomical informations. Radionuclide scanning provides functional informations only.

6 The first line No ionising radiatrion no contrast

7 IV injection of iodinated contrast media Iodine concentration is 300 mg I /Kg BW has been largely replaced by US& CT

8 Fasting for at least 6 hours Laxative taken 30 hr & 24 hr prior to the time of examination. No fluid restriction in cases of impaired renal function.

9 Plain film: full length, frontal view?calcification

10 Urinary calculi (stones are missed if no plain film is taken). Diffuse nephrocalcinosis. Localized nephrocalcinosis (TB, tumors). Prostatic calcifications.

11 Assess the renal size Assess the renal outlines

12 Assess the calices

13 Only portion of the ureter is seen Course: along the transverse processes of the lumbar vertebrae. Dilatation of the renal pelvis & ureter

14 Dilatation of the renal pelvis & ureter obstruction congenital variant vesicouretric reflux

15 Full bladder film Outline indentations

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17 CT urography More sensitive for detecting stones Allows charactarisation of renal lesions Assess surrounding structures No superimposition of structures

18 o Retrograde & antegrade pyelography o Voiding cystourethrography: o Urethrography:

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21 Most of the UT stones are radiopaque Pure uric acid & xanthine stones Radiopaque stones can be identified on plain film CT & US can identify all types of stones

22 Staghorn stone large stone filling the whole of the PCS & taking its shape PLAIN FILM

23 Urinary tract obstruction The principal feature is dilatation of PC system & ureters

24 stones Tumors blood clot strictures Congenital :PUJ obstruction, posterior urethral valve enlarged prostate compression from adjacent retroperitoneal structures or masses

25 splaying of the renal sinus fat due to pooling of urine within the dilated PCS The proximal ureter can be easily identified but the distal ureter is usually obscured by overlying bowel.

26 NORMAL US HYDRONEPHROSIS

27 Plain films may demonstrate stones Delayed nephrogram In acute obstruction, dense nephrogram In intermittent obstruction, IVU may be normal between attacks In prolonged obstruction there will be atrophy of the kidney

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30 simple renal cysts malignant tumors Multiple masses : multiple simple renal cysts, polycystic disease, lymphoma Abscess benign tumors hydatid metastasis.

31 -a rounded lucency in the nephrogram. -bulging of renal outlines -displacement of calyces -enlargement of the kidney -calcification in a small proportion of renal carcinomas or wall of a cyst

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33 determine if the mass is cystic or solid

34 further assess masses and stage renal cancer

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36 predisposing factors: Stones Reflux Obstructive lesios Diabetes mellitus

37 Most patients with Acute infections of the urinary tract do not require urgent imaging investigations. US: may show diffuse or focal swelling of kidneys, evidence of the predisposing lesion (stones, obstruction, reflux) complications (abscess, scarring)

38 Scar formation Dilatation of calyces in scarred areas. Overall reduction in renal size. Dilatation of affected collecting system due to reflux. Reflux may be demonstrated at micturating cystourethrography.

39 IVP & CT are the major imaging modalities Aim of imaging: 1-assess the renal perfusion 2-ensure that opposite kidney is normal 3-show the extent of renal parenchymal damage 4- Demonstrate injury to other abdominal organs

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42 unilateral or bilateral The upper ureter may be ectopic The dilated lower ureter may prolapse into bladder (ureterocele)

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44 usually in the lower abdomen & rotated some cases, both lie on same side of pelvis & fused. more prone to complications

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46 failure of separation of the lower poles. May be an incidental finding or associated with PUJ obstruction & stone formation

47 autosomal dominant polycystic kidney disease (adult type) autosomal recessive polycystic kidney disease (infantile type)

48 other kidney show compensatory hypertrophy. Radionuclide scanning used for diagnosis as well US & CT.

49 Absent kidney : nephrectomy, renal agenesis Non functioning kidney : Ureteric obstruction Renal artery occlusion : Acute renal vein thrombosis :

50 Nephrocalcinosis wide spread calcification in the cortex or medulla of the kidney PLAIN FILM

51 Absent kidney : nephrectomy, renal agenesis Non functioning kidney : Ureteric obstruction Renal artery occlusion : Acute renal vein thrombosis

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53 Most of tumors are TCC May obstruct the ureters US: solid mass. CT & MRI determine the extent of tumor spread outside the bladder walls

54 Usually secondary to chronic bladder outlet obstruction May be congenital Predispose to infection, stone formation & occasionally tumors may arise within them. Filled with contrast in IVP, cystourethrography & in post voiding film Readily diagnosed with US, CT & MRI.