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Questions and Answers
What is a possible consequence of acute cortical necrosis?
What is a possible consequence of acute cortical necrosis?
What is a characteristic feature of medullary changes in acute conditions involving primarily the medulla?
What is a characteristic feature of medullary changes in acute conditions involving primarily the medulla?
What is a possible cause of increased medullary reflectivity?
What is a possible cause of increased medullary reflectivity?
What is a common association of renal vein thrombosis?
What is a common association of renal vein thrombosis?
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What is a rare presentation of renal vein thrombosis in adults?
What is a rare presentation of renal vein thrombosis in adults?
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What is a possible consequence of acute cortical necrosis on corticomedullary differentiation?
What is a possible consequence of acute cortical necrosis on corticomedullary differentiation?
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What is a possible cause of decreased corticomedullary differentiation?
What is a possible cause of decreased corticomedullary differentiation?
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What is a common occurrence of renal vein thrombosis in infants?
What is a common occurrence of renal vein thrombosis in infants?
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What happens to corticomedullary differentiation in the kidney after 3-4 weeks of renal vein thrombosis?
What happens to corticomedullary differentiation in the kidney after 3-4 weeks of renal vein thrombosis?
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What is the characteristic feature of the kidney in renal vein thrombosis after 1-2 months?
What is the characteristic feature of the kidney in renal vein thrombosis after 1-2 months?
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What can be demonstrated in the renal veins of some patients with renal vein thrombosis?
What can be demonstrated in the renal veins of some patients with renal vein thrombosis?
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What is the characteristic feature of the affected kidney in unilateral renal artery occlusion in the immediate acute stage?
What is the characteristic feature of the affected kidney in unilateral renal artery occlusion in the immediate acute stage?
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What can be seen in some patients with renal artery occlusion?
What can be seen in some patients with renal artery occlusion?
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What is the characteristic feature of the affected kidney in the longer term after renal artery occlusion?
What is the characteristic feature of the affected kidney in the longer term after renal artery occlusion?
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What is the role of echoenhancing agents in the diagnosis of renal artery occlusion?
What is the role of echoenhancing agents in the diagnosis of renal artery occlusion?
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What is the significance of colour or power Doppler ultrasound in the diagnosis of renal artery occlusion?
What is the significance of colour or power Doppler ultrasound in the diagnosis of renal artery occlusion?
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What is the most common underlying renal pathology that produces nephrotic syndrome, leading to renal vein thrombosis?
What is the most common underlying renal pathology that produces nephrotic syndrome, leading to renal vein thrombosis?
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Which condition is more commonly associated with renal vein thrombosis in infants?
Which condition is more commonly associated with renal vein thrombosis in infants?
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What is the characteristic sonographic appearance of the kidney in sudden complete occlusion of the main renal vein?
What is the characteristic sonographic appearance of the kidney in sudden complete occlusion of the main renal vein?
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What can be distinguished within the generally echo-poor tissue in cases of renal vein thrombosis?
What can be distinguished within the generally echo-poor tissue in cases of renal vein thrombosis?
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What is a rare presentation of left renal vein occlusion in males?
What is a rare presentation of left renal vein occlusion in males?
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What is a common complication of renal cell carcinoma?
What is a common complication of renal cell carcinoma?
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What is the typical sonographic appearance of the renal sinus in cases of renal vein thrombosis?
What is the typical sonographic appearance of the renal sinus in cases of renal vein thrombosis?
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What is the underlying pathophysiology of the sonographic appearance of the kidney in cases of renal vein thrombosis?
What is the underlying pathophysiology of the sonographic appearance of the kidney in cases of renal vein thrombosis?
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Study Notes
Renal Vein Thrombosis
- Most commonly associated with membranous nephropathy, producing the nephrotic syndrome
- Also associated with systemic lupus erythematosus, diabetes, glomerulonephritis, hypovolaemic shock, and renal transplantation
- Abnormalities of coagulation, involving clotting factors, the fibrinolytic system, and platelets, can be demonstrated
- Dehydration more commonly associated with renal vein thrombosis in infants, but may occur in adults, particularly in hot climates
- Renal cell carcinoma may invade the renal vein and produce a tumour thrombus, which can extend into the inferior vena cava (IVC) and provide a source of emboli
Ultrasound Imaging of Renal Vein Thrombosis
- Sudden complete occlusion of the main renal vein produces an enlarged, echo-poor kidney
- Changes develop over the initial 24 hours, due to swelling of the parenchyma
- Echo-free areas of haemorrhagic infarcts can be distinguished within the generally echo-poor tissue
- Renal sinus echoes may be markedly compressed by the swollen parenchyma
- After 10–14 days, the kidney starts to shrink, resulting in a small kidney with abnormally high reflectivity
- Corticomedullary differentiation is initially preserved, but is lost after 3–4 weeks as the kidney contracts
Renal Artery Occlusion
- Sudden renal infarction can occur from various causes, including atheromatous plaque haemorrhage, aortic dissection, emboli, and traumatic avulsion
- Unilateral renal artery occlusion does not produce renal failure, and without Doppler, may be difficult to detect with ultrasound
- In the immediate acute stage, the affected kidney may be normal in size and have normal reflectivity, but a small increase in size compared with the perfused contralateral kidney may be demonstrated
- In some patients, a subcapsular ‘halo’ or rim of echo-poor tissue can be seen, which is thought to correspond to oedematous perfused tissue fed by capsular collateral vessels
- In the longer term, the affected kidney slowly shrinks with smooth margins and no dilatation of the collecting system
Medullary Changes and Corticomedullary Differentiation
- Medullary pyramids may be more prominent in many cases of parenchymal disease, due to increased cortical reflectivity
- In acute conditions involving primarily the medulla, such as acute tubular necrosis, the pyramids can be enlarged due to oedema
- Increased medullary reflectivity can be detected in nephrocalcinosis of any etiology and also in some other conditions such as gout
Vascular Disorders
- Renal vein thrombosis may be seen in up to 40% of septic or dehydrated infants
- Acute presentation with renal vein thrombosis is rare in adults, but when it does occur, it is generally unilateral or restricted to one segment and clinical renal failure does not occur
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Description
This quiz covers the causes and associations of renal vein thrombosis, including membranous nephropathy, systemic lupus erythematosus, and more. Test your knowledge of ultrasound imaging in this field.
