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Renal Tract Ultrasound

Use of renal tract ultrasound:

  • Ultrasound is a very good method for investigating a wide range of renal tract abnormalities.
  • Abnormalities that can be visualised include some structural abnormalities, size differences, hydronephrosis, renal parenchymal abnormalities, scarring, renal masses and renal cysts.
  • Use of colour Doppler scanning means the renal vessels can also be examined - a specialist procedure only.

Specific indications:

  • Renal colic: Ultrasound offers an alternative, particularly in pregnancy or repeated investigations in a young person where radiation dose is a potential concern.
  • Urinary infection: Where imaging is clinically indicated (such as in recurrent upper UTIs or adult males) Ultrasound can be useful to show renal size, scarring, collecting system dilatation, residual bladder volume and to assess for complications such as obstruction or renal / peri-renal abscesses. Ultrasound is the first line investigation for UTI in children (a micturating cystogram is probably also necessary). 
  • Haematuria: Ultrasound is the first line investigation in haematuria that relates to probable renal parenchymal disease (such as acute renal failure).
  • Renal masses: Ultrasound can assess if a solid vs cystic , the vascularity of the mass or collecting system dilatation.
  • Renal failure: Use ultrasound to exclude obstruction; assess renal size (bilateral small kidneys may suggest irreversible disease); check for calculi or polycystic kidney disease.
  • Prostatic enlargement: Ultrasound can assess the -size of the prostate and the bladder residual volume.

Advantages of renal ultrasound:

  • Painless and non-invasive. 
  • Does not involve exposure to radiation. 
  • Requires little preparation. 

Disadvantages of renal ultrasound:

  • The nature of ultrasound images means the renal tract urothelium detail is limited.
  • The image quality may be reduced by obesity, overlying bowel gas or inability of the patient to co-operate with positional and breath holding instructions.
  • If vesicoureteral reflux is the concern, it is better to perform a micturating cystourethrogram.

Patient Information

  • This examination provides images of your kidneys and bladder.

It can be used to:

  • detect a mass, cyst, kidney stone, or obstruction to the flow of urine; or
  • determine kidney size and shape.

The scan is safe and painless and no ionising radiation is involved.

How it works

A transducer passed over your kidneys emits sound waves that, like sonar, bounce off your kidney, transmitting a picture of the organ which is then displayed on a video screen.

Preparation:

  • There is no preparation necessary for this examination, although a full bladder is usually required prior to the scan.
  • Medications can be taken prior to the scan.

The procedure:

  • The procedure usually takes about 30 minutes.
  • In order to obtain quality images, a water-soluble gel is placed on your skin to act as a medium for the transducer. 
  • The transducer is a  device which is placed over the abdominal area and moved back and forth to obtain the images necessary to answer your physician's questions. 
  • Positioning may cause some minor discomfort, as may coolness of room or equipment.

Possible problems

In very obese people, the outline of the kidneys may be obscured by fatty tissue. Similar problems can be encountered by bowel gas obscuring the kidneys. 

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