Kidney ultrasound

Sonography of the kidneys can provide important anatomic information that cannot be ascertained by the usual tools of nephrologists: serum and urine chemistries and urinalysis. Performance of renal sonograms by nephrologists allows them to correlate the anatomy with the rest of the clinical workup and therefore enhances the interpretation of the ultrasound findings and the management of the patients. Specific indications are listed below.     

Chronic renal failure. Kidney ultrasound is an essential part of the workup for chronic kidney disease and performance at the bedside or in the clinic or office can provide immediate information and expedite patient care. Examples of key findings that will immediately alter the diagnostic workup include small kidneys indicative of advanced, irreversible disease, hydronephrosis indicative of urinary obstruction, or large cystic kidneys indicative of polycystic kidney disease. Accessibility of kidneys for percutaneous biopsy can also be assessed. 

Acute renal failure. Ultrasound is indicated in many patients with acute renal failure, primarily to rule out urinary obstruction, and also to diagnose underlying chronic kidney disease, both of which can easily be done at the bedside.

Cystic kidney disease. In addition to diagnosing autosomal dominant polycystic kidney disease, which is easy to recognize, ultrasound is useful in screening family members and in assessing prognosis through measurement of kidney size. The presence of multiple cysts in patients with end-stage renal disease identifies patients at greatly increased risk of renal cell carcinoma. 

Pain, hematuria. Ultrasound is a simple and inexpensive first step in the evaluation of pain and hematuria and can identify stones, neoplasms, nephritic kidneys, and culprit cysts in polycystic kidneys. 

Urinary retention. Because bladder volume can be quickly and easily measured noninvasively, ultrasound is the standard of care for diagnosing urinary retention. In many cases, the underlying cause can be identified. 

Tutorials

Literature

O’Neill,W.C.  Sonographic evaluation of renal failure.   Amer. J. Kidney Diseases 35:1021-1038, 2000.

Manley, J. and O’Neill, W.C.  How echogenic is echogenic?  Quantitative acoustics of the renal cortex.  Amer. J. Kidney Diseases 37:706-711, 2001.

O’Neill, W.C. and Baumgarten, D.A.  Ultrasonography in renal transplantation.  Amer. J. Kidney Diseases 39:663-678, 2002.

O’Neill, W.C. Sonography of the kidneys and urinary tract. Sem. Nephrol. 22:242-253, 2002.

Al-Said, J.M. and O’Neill, W.C.  Reduced kidney size in patients with simple renal cysts.  Kidney International 64: 1059-1064, 2003.

Chapman, A., Guay-Woodford, L., Grantham, J., Torres, V., Bae, K., Baumgarten, D., Kenney, P., King, B.F., Glockner, J., Wetzel, L.H., Brummer, M., O’Neill, W.C., Robbin, M., Bennett, W., Klahr, S., Hirschman, G., Kimmel, P., Thompson, P., Miller, J.  Renal structure in early autosomal dominant polycystic kidney disease (ADPKD): the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) cohort.  Kidney International 64: 1059-1064, 2003.

Moghazi, S., Jones, E., Schroepple, J., Arya, K., McClellan, W. and O’Neill, W.C. Correlation between renal histopathology and sonographic findings.  Kidney International 67:1515-1520, 2005.

O’Neill, W.C., Robbin, M.L., Bae, K.T., Grantham, J.J., Chapman, A.B., Guay-Woodford, L., Torres, V.E., King, B.F., Wetzel, L.H., Thompson, P.A., and Miller, J.P.  Sonographic Assessment of the Severity and Progression of Autosomal-Dominant Polycystic Kidney Disease: the Consortium of Renal Imaging Studies in Polycystic Kidney Disease (CRISP).  Am. J. Kidney Dis. 46:1058-1064, 2005.

O’Neill, W.C.  B-mode sonography in acute renal failure.  Nephron Clinical Practice 103:c19-c23, 2006.

Gosmanova, E.O., Baumgarten, D.A., and O'Neill, W.C.  Acute kidney injury in a patient with unilateral ureteral obstruction.  Am J of Kidney Dis 54:775-9, 2009.

Bardelli, M., Yezvlin, A., and O’Neill, W.C.  Imaging For Renovascular Disease. Seminars in Nephrology 31:272-282, 2011.

O’Neill, W.C.  Renal resistive index: a case of mistaken identity. Hypertension 64:915-917, 2014.

Bhutani, H., Smith, V., Rahbari-Oskoui, F., Mittal, A., Grantham, J.G., Torres, V.E., Mrug, M., Bae, K.T., Wu, Z., Ge, Y., Landslittel, D., Gibbs, P., O’Neill, W.C., Chapman, A.B.  A comparison of ultrasound and magnetic resonance imaging shows that kidney length predicts chronic kidney disease in autosomal dominant polycystic kidney disease. Kidney International 88:146-151, 2015.

Rahbari-Askoui, F. and O’Neill, W.C. Diagnosis and Management of Acquired Cystic Kidney Disease

and Renal Tumors in ESRD patients. Seminars in Dialysis 30:373-379, 2017.