Normal kidney sizes according to ultrasound. Pelvic collecting system is normal

Can kidney ultrasound be wrong? What to do if the results of a kidney ultrasound are good, but abnormalities were found in a urine test?

Are there kidney diseases that cannot be detected by ultrasound?

In what cases is it necessary to combine ultrasound of the kidneys with ultrasound of other organs?

• Ultrasound of the kidneys and heart for hypertension ( high blood pressure)
• )

Where to get an ultrasound of the kidneys?

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Urolithiasis disease ( ICD). Kidney stones on ultrasound

Urolithiasis occurs in almost 5% of the population. Among kidney diseases, it is in second place after inflammatory diseases. Urolithiasis is a multifactorial disease, with the largest component of this disease being a person's diet and daily activity.

Urolithiasis is diagnosed using various methods, among which Ultrasound is basic. On Kidney ultrasound Stones of any size and chemical composition are clearly visible. Standard x-ray techniques kidney studies ( excretory urography) are not as informative. CT scan ( CT) and magnetic resonance imaging ( MRI) provide excellent visualization of kidney stones and associated complications of urolithiasis, however, these methods are not as widely available as ultrasound.

Urolithiasis disease ( nephrolithiasis). Acute renal colic on ultrasound

Urolithiasis is a common disease. It involves the formation of stones in the urinary tract under the influence of various factors.
Stones can be found in all parts of the urinary tract, in the kidneys, ureters and bladder. There are many reasons that lead to urolithiasis and the formation of kidney stones.

The causes of kidney stones are:

• metabolic changes ( increase in the content of calcium, phosphates in the blood and primary urine);
• endocrine disorders ( hyperfunction of the parathyroid glands);
• eating disorder ( hypovitaminosis A, C);
• saturation drinking water mineral salts;
• prolonged bed rest and reduced physical activity;
• congenital narrowing of the pelvis, ureters;
• decreased tone of the smooth muscles of the pelvis ( leads to urinary retention);
• inflammatory diseases urinary tract (pyelonephritis).

Urolithiasis usually occurs unnoticed by humans. Human can long years not suspecting the presence of kidney stones. However, if stones are accidentally dislodged, a condition known as acute renal colic may occur. In this case, severe sharp pain occurs in the lumbar region, which forces the patient to call ambulance. If a stone enters a narrow area of ​​the ureter, it completely blocks the flow of urine. The pain is caused by stretching of the kidney capsule and severe spasm of the smooth muscles of the kidneys and ureters. The patient may experience nausea and vomiting. When cramping pain in the lower back occurs, the patient always undergoes an ultrasound of the kidneys as a matter of urgency.

In acute renal colic, ultrasound always shows the following signs:

• expansion of the pyelocaliceal system and ureters;
• increase in kidney size;
• hypoechogenicity of the renal parenchyma;
• the presence of a rim of hypoechogenicity around the renal capsule ( appears due to swelling of the fatty tissue around the kidneys);
• stone in the form of a hyperechoic structure.

Treatment of acute renal colic differs depending on the size of the stone. If it is small, the patient is treated with medication. In this case, the dynamics of stone movement are monitored using ultrasound. If the stone is large in size and the patient’s condition is serious, then they resort to surgery. IN Lately methods of remote stone crushing through the skin using ultrasound are successfully used.

Stones in the kidneys ( stones, sand in the kidneys) on ultrasound

Often urolithiasis disease does not appear obvious pain symptoms. In this case, it is discovered by chance when routine examinations or according to some specific symptoms. These include the presence of blood in the urine, the passage of sand or small pieces of stones during urination. The sizes of stones passed by urine range from 2 millimeters to 1 centimeter. Sometimes patients may experience dull pain before the stones pass.

Kidney stones can contain different substances:

• urates ( uric acid salts);
• oxalates;
• phosphates;
• cystine;
• protein, etc.

Ultrasound is the best method for detecting kidney stones. Alternative method diagnosis is an x-ray of the kidneys using contrast agents. However, this method takes more time and is less informative. The fact is that not all stones are radiopaque; some are not visible on x-rays. This applies to protein stones, cholesterol stones, stones consisting of urea and other types of stones.

Kidney stones can range in size from a few millimeters to very large ones, filling the entire collecting system. Such large stones are called coral-shaped stones. Dormant kidney stones often lead to complications. The most common of them is the addition of a secondary infection ( pyelonephritis). Displacement of the stone can lead to acute renal colic. Sometimes kidney stones lead to chronic renal failure and hydronephrosis. Therefore, when they are detected on an ultrasound, the doctor always prescribes treatment that promotes their destruction and removal.

Microliths in the kidneys ( microlithiasis) on ultrasound

Microlithiasis is initial manifestation urolithiasis of the kidneys. It involves the formation of stones small sizes, from 2 to 3 millimeters. They are called microliths. It is these stones that a person can observe in urine. Microliths are dangerous because they serve as the basis for the formation of large stones.

If sand appears in the urine ( small stones) doctors recommend performing an ultrasound. By using ultrasound examination Kidney stones of any size can be detected because they are highly echogenic. Microliths look like hyperechoic round or elongated formations. Sometimes they leave a hypoechoic acoustic shadow - a special kind of artifact.

Treatment of microlithiasis does not involve surgery. It consists of following a special diet, limiting the consumption of salt and foods high in calcium. You should also increase your fluid intake and increase your level of physical activity.

Uric acid diathesis ( MKD) as a factor in the formation of kidney stones

In the development of urolithiasis, hereditary characteristics of the body play a certain role. They manifest themselves in the excessive accumulation of certain substances in the body. Such conditions are called diathesis. With uric acid diathesis ( MKD) the content of uric acid in urine and blood increases. Such conditions serve as triggers for the formation of kidney stones.

Ultrasound is not suitable for diagnosing such a predisposition. Uric acid diathesis can be determined by analyzing the biochemical composition of urine and blood. To reduce the risk of kidney stones, the doctor prescribes a special diet along with drugs that regulate metabolism.

Ultrasound of the kidneys for metabolic disorders ( gout, diabetes mellitus, amyloidosis)

The kidney is an organ that removes metabolic waste from the body. However, the kidneys have limited capacity. With various metabolic disorders, the concentration of certain substances in the body increases ( glucose, uric acid). In this case, the kidneys cannot completely cope with their elimination; some of them settle in the kidneys, damaging this organ.

Metabolic disorders are common in modern world. In order to identify them in advance, preventive examinations and blood tests are carried out. Control over lifestyle and the variety of foods consumed is the basis for the treatment of metabolic disorders. Using ultrasound, it is only possible to determine the extent of kidney damage.

Gouty kidney on ultrasound

Gout is a metabolic disorder in which purines, derivatives of uric acid, accumulate in the body. Gout occurs in middle and older age, more often in women. Gout manifests itself as damage to the kidneys and joints due to uric acid deposits. Gout is diagnosed based on a blood test.

Normally, the concentration of uric acid in the blood is 0.40 mmol/l. Increased levels of uric acid are caused by excess production or insufficient excretion. 70% of uric acid is excreted by the kidneys, the rest through the intestines and skin. At high content uric acid in the blood, the kidney cannot cope with its elimination. As a result, it is deposited in the form of uric acid crystals in the kidneys. This leads to the formation of stones and inflammation of the excretory tubules of the kidneys.

The ultrasound picture of the kidneys in gout is detected even before the development clinical symptoms. It consists of pinpoint hyperechoic structures in the kidney tissue. They are the crystals of uric acid. With the development of gout, changes characteristic of chronic pyelonephritis. The kidney shrinks and its medulla becomes deformed.

Gout is successfully treated by taking anti-inflammatory drugs and a special diet, which reduces the formation of uric acid. If you have gout, you must follow a vegetarian diet; meat allowed is chicken, lean fish, and eggs.

Diabetes

Diabetes mellitus is an endocrine disorder in which blood sugar levels are almost constantly elevated. Diabetes mellitus is caused by absolute or relative insulin deficiency. In this case, the person is forced to take replacement medications for life.

High blood sugar levels are toxic to the blood vessels of the kidneys. Normally, urine does not contain glucose; it is completely absorbed back into the blood from primary urine. However, when the concentration of glucose in the blood is more than 9 mmol/l, it is excreted in the urine, since the kidney is not able to reabsorb such a large amount of sugar. In this case, the renal vessels are affected. Sclerosis of the vascular glomeruli occurs, and renal filtration decreases. This leads to diabetic renal failure. Clinically, kidney damage in diabetes is accompanied by edema, high blood pressure, and the presence of protein in the urine.

Diagnostics diabetes mellitus is not a problem. Patients usually know about their disease. Thanks to this they can take action preventive measures, preventing kidney damage in diabetes mellitus. On ultrasound, changes in the kidneys in diabetes mellitus have their own characteristic features. They are noticeable even before the development of symptoms associated with kidney damage.

Initial changes in the kidneys in diabetes mellitus recorded on ultrasound include:

• enlarged kidneys;
• change in the ratio of kidney sizes, their rounding ( the thickness becomes equal to the width of 6 - 7 centimeters);
• increased echogenicity of the kidneys.

Without control, diabetes eventually causes the kidneys to shrink ( nephrosclerosis). This change is typical for many kidney diseases. It occurs when kidney tissue dies and is replaced by connective tissue.

Renal amyloidosis on ultrasound

Renal amyloidosis is rare disease associated with the formation of amyloid in kidney tissue. Various diseases (chronic infections, rheumatism) provoke immune disorders, due to which cells begin to produce this protein-saccharide complex. Amyloid is deposited both in the endothelium ( inner wall) vessels and in the collecting ducts, which is why chronic renal failure develops. Amyloidosis usually appears in old age.

Amyloidosis does not have its own characteristic symptoms. Over time, the patient begins to experience swelling and high blood pressure. Protein is detected in the urine. These manifestations are symptoms of chronic renal failure.

Unfortunately, diagnosing amyloidosis is difficult. Before the development of chronic renal failure, this disease is almost impossible to detect using currently existing methods. With the help of high-quality equipment, ultrasound of the kidneys reveals some signs that require additional confirmation. IN initial stage amyloidosis, the kidney enlarges, acquiring increased echogenicity on ultrasound ( so-called large fatty kidney). IN late stage the kidney shrinks, being replaced by scar tissue. This type of kidney is called amyloid. On ultrasound, it appears as a hyperechoic formation 6–7 cm in length, with an uneven contour without a clear boundary between the cortex and medulla. Thus, the diagnosis of amyloidosis is usually delayed, so it is very important to carry out preventive kidney examinations.

Most often, patients with amyloidosis are diagnosed with chronic renal failure. Successful treatment requires establishing the correct cause of the disease, but this is only possible through a biopsy ( taking a piece of fabric) and its examination under a microscope.

Kidney tumors on ultrasound

Kidney tumors account for about three percent of neoplasms various localizations. Play a major role in the development of tumors hereditary factors, as well as contact with carcinogenic substances. These include dyes, phenols, and asbestos. A significant role Smoking, kidney injuries and excess weight play a role in the formation of tumors.

Kidney tumors are divided into two groups:

• Benign formations. These include hemangioma, angiomyolipoma, oncocytoma, adenoma and others. These tumors grow slowly, are discovered by chance, and usually do not cause renal impairment.
• Malignant tumors. Kidney cancer always develops from the epithelium. Cancer tumor grows into neighboring tissues and vessels, metastasizes and causes death.

The best way to diagnose tumors is computed tomography or magnetic resonance imaging. An accurate diagnosis is made only after a biopsy and histological examination. This diagnostic method involves examining a small area of ​​tumor tissue under a microscope, previously taken using special needles. Only under a microscope can one identify the cells that form the tumor. After establishing cellular structure tumors, you can choose the right treatment tactics.

Ultrasound is not reliable method diagnosis of kidney formations. Unfortunately, with the help of ultrasound it is possible to establish the presence of a tumor, but it is impossible to determine with certainty whether it is benign or malignant. Difficulties arise in distinguishing renal cysts from tumors. However, there are quite certain signs that are characteristic only of malignant tumors.

Kidney cancer on ultrasound

Malignant tumors make up the vast majority of kidney tumors ( 85% ). Kidney cancer develops from the epithelium renal parenchyma and is called renal cell carcinoma. To determine the treatment strategy for kidney cancer, the TNM classification is used. It describes a malignant tumor by size, extent of damage lymph nodes and the presence of metastases. Most often, kidney cancer metastasizes to the lungs, bones, and liver.

According to criterion T ( lat. tumor - tumor) malignant formations are divided into:

• T1– tumor up to 7 cm, located inside the kidney capsule;
• T2– tumor from 7 to 10 cm, limited to the renal capsule;
• T3– a tumor penetrating the adrenal gland or the veins of the kidneys;
• T4– a kidney tumor that spreads beyond the diaphragm or penetrates into neighboring organs.

According to criterion N ( lat. nodulus - node) the following types of kidney cancer are distinguished:

• N0– no damage to regional lymph nodes;
• N1– 1 lymph node is affected;
• N2– numerous lesions of the lymph nodes are observed.

According to criterion M ( lat. metastases - metastases) the following types of kidney cancer are distinguished:

• M0– no metastases;
• M1– metastases were detected in distant organs.

Ultrasound is used to diagnose malignant tumors, but small tumors may require additional testing. The connection of the tumor with the renal veins or its spread beyond the renal capsule indicates its malignancy.

Signs of malignant tumors on ultrasound may include the following:

• round or oval shape with clear, uneven boundaries;
• hyperechoic hue of the formation;
• inside the kidney there may be hypoechoic areas corresponding to areas of necrosis or cystic decay;
• deformation of the kidney contour, increase in its size;
• reduction in diameter and displacement of the pyelocaliceal system.

For malignant tumors, ultrasound with color Doppler mapping is often used. This test can detect abundant blood flow in the area of ​​the tumor. The speed of blood flow in the area of ​​tumor vessels is higher than in the unchanged renal parenchyma. Sometimes cellular thrombi can be found in the renal and inferior vena cava. They can lead to infarction or metastasis.

Benign kidney tumors on ultrasound ( hemangioma, adenoma, oncocytoma)

Benign kidney tumors are varied, but on ultrasound they look approximately the same. Some are harmless, while others can become cancerous ( for example, adenoma). Because of what they require different tactics treatment, it is very important to establish the origin of the tumor. Ultrasound examination is not suitable for this purpose, since all benign tumors on ultrasound look like hyperechoic formations with reduced blood supply. Therefore, it is better to use computed tomography or magnetic resonance imaging for differentiation.

Benign kidney tumors include the following types formations:

• adenoma;
• hemangioma;
• oncocytoma;
• angiomyolipoma and others.

A renal adenoma usually appears as a solid, dense mass inside the kidneys. Cystic form adenoma has the appearance of a honeycomb. An adenoma is almost 100% likely to degenerate into a malignant tumor, so it requires surgical removal. Lipoma occurs in the perinephric tissue as a round formation with a diameter of up to 3 cm. Lipoma consists of adipose tissue and does not contain blood vessels.
Hemangioma is a congenital defect in the formation of renal vessels; it is dangerous because when it ruptures, internal bleeding occurs. If the hemangioma is larger than 4 cm, it is removed surgically.

Angiomyolipoma on kidney ultrasound

Angiomyolipoma is a benign kidney tumor consisting of fatty, muscle tissue and vessels in different proportions. This explains its complex name. This tumor grows slowly, a few millimeters per year. If the size of angiomyolipoma is up to 4 cm, only periodic monitoring is carried out. If it exceeds 4 cm in diameter, it must be removed surgically, as there is a risk of tumor rupture. Angiomyolipoma has characteristic signs on ultrasound that allow it to be unmistakably distinguished from other tumors.

Angiomyolipoma is a rounded hyperechoic formation. The structure of this tumor on ultrasound is homogeneous, but may include areas of necrosis in the center. On duplex ultrasound, there is usually no color signal in the center of the tumor. An X-ray examination of the kidneys reveals fatty tissue in the center of the tumor, which is characteristic of this tumor.

Interpretation of the results of ultrasound of the kidneys. Conclusion of kidney ultrasound

After undergoing a kidney ultrasound, the patient receives a form with a conclusion about the study. It does not contain a diagnosis, but only includes a description of those structures that were detected on ultrasound. An ultrasound photo may be attached to the form ( so-called sonogram), which contains the most representative image obtained during the study.

It is necessary to understand that the ultrasound report is intended for the urologist who wrote out the referral for the study. This conclusion is deciphered by himself. urologist ( sign up) . He explains to the patient the essence of the disease, prescribes treatment and monitors the dynamics of the disease. That is, the patient does not have to understand the ultrasound report, because he can get all the necessary information from the doctors.

As already noted, the ultrasound report contains a description of the structures, not a diagnosis. Medicine is a complex science, so changes may correspond various diseases. Sometimes an ultrasound reveals symptoms of several diseases, in such cases it is necessary to establish the root cause. This is done by the attending physician, since he knows complete information about the patient, starting from the patient’s lifestyle and ending with his blood and urine tests.

Conclusion form for kidney ultrasound

Many people are curious to know what the ultrasound examination report and its result may include. The conclusion is written on a document of a certain sample. It includes certain fields that the doctor or nurse fills out during the test. As a rule, filling out is carried out in parallel with the study, as it includes many quantitative and qualitative parameters.

The report form for kidney ultrasound includes the following sections:

• Passport part. It contains the patient's name, age and diagnosis at the time of appointment.
• General information about the kidney. Describes the position, mobility of the kidney during breathing, its size ( length, width thickness).
• Condition of the kidney contour and capsule. In diseases, the contour of the kidney may be uneven or unclear, and the capsule may be thickened.
• Parenchyma structure. Describes the cortex and medulla. The doctor indicates data on the echogenicity of both substances and the nature of the boundary between them. In addition, the shape and size of the pyramids are indicated.
• Renal sinus. The dimensions of the renal sinus are determined.
• Renal pelvis and calyces. The diameter of the pelvis and calyces is indicated, since their expansion usually indicates disease.
• Pathological formations. If an ultrasound reveals unusual formations in the kidney, then their size, echogenicity, and localization are described. These may be stones, cysts, tumors or foreign bodies.

The form also indicates the side on which the kidney being examined is located ( right, left). When conducting a duplex ultrasound examination of the kidneys with color circulation, an additional form is issued. It indicates the condition of the kidney vessels.

Kidney ultrasound form with color Doppler mapping ( CDC) contains the following information:

• state of the vascular pattern;
• diameter, presence of narrowing or dilatation of the renal arteries;
• diameter and features of the renal veins;
• presence of additional vessels;
• systolic and diastolic blood flow velocity of the vessels inside the kidneys ( segmental, interlobar, arcuate).

What does an enlarged and reduced kidney mean on an ultrasound?

Some signs on a kidney ultrasound can be interpreted differently. This also applies to the size of the kidneys on ultrasound. Acute kidney diseases resolve with an increase in kidney size due to inflammatory edema. In this case, there is a general decrease in the echogenicity of the parenchyma. At chronic diseases On the contrary, the kidneys become smaller due to thinning of the parenchyma.

However, the kidneys may change in size from birth. Underdevelopment is common ( hypoplasia) one of the kidneys. At the same time, she is functionally inferior. Because of this, the size of the second kidney increases to compensate for the function. This condition usually does not require treatment. Therefore, in such cases as the difference between acquired and congenital changes in kidney size, ultrasound interpretation is carried out by the attending physician, who has complete information about the patient’s symptoms.

Uneven contour of the kidneys on ultrasound ( tuberous bud)

Lumpiness of the kidney contour on ultrasound is considered a sign of chronic pyelonephritis. However, it is impossible to create a complete picture of the disease using this sign alone. The fact is that a change in the contour can be observed as residual phenomenon after acute and chronic kidney diseases. Are of great importance functionality organ. If they are normal, then there is most likely no active disease.

The contour of the kidney may change in the presence of tumors or cysts. In this case, it takes on a rounded convex shape. Tumors and cysts have their own characteristic signs. They are described as inclusions in the renal parenchyma with varying echogenicity.

Signs of diffuse changes in the kidneys. General decrease or increase in echogenicity of the renal parenchyma on ultrasound

One of the main characteristics of an ultrasound report is a description of the structure of the parenchyma. A change in its echogenicity means certain deviations at the microscopic level. On ultrasound it appears as a decrease or increase in the intensity of the color pattern. In this case, the border and thickness of the cortical and medulla may not change in some cases.

The echogenicity of the kidneys is reduced in the following diseases:

• acute renal failure ( alcohol intoxication and other conditions);
• acute pyelonephritis;
• renal vein thrombosis;
• underdevelopment ( hypoplasia) kidney.

The echogenicity of the kidneys increases under the following conditions:

• chronic pyelonephritis;
• chronic glomerulonephritis;
• diabetes;
• gout;
• amyloidosis.

As is easy to notice, when acute diseases The echogenicity of the kidneys decreases. This is explained by the fact that during acute inflammation, fluid leaves the vessels and accumulates in the intercellular space. A large amount of liquid absorbs ultrasonic waves, causing the image to become less contrast. In chronic diseases, kidney tissue is formed in excess connective tissue, making it appear lighter than a normal kidney.

Local limited changes in the kidneys on ultrasound. Hyperechoic inclusions, spots on ultrasound of the kidneys. Symptom of prominent pyramids

The most common finding on renal ultrasound is local pathological formations. They can be the most various forms, sizes and colors. Color ( echogenicity) of these formations on ultrasound indicates their density. Based on this, we can make an assumption about their composition. Due to the large number of kidney diseases in which spots or local formations are detected on ultrasound, significant medical experience is required in order to confidently understand them.

Various types of local changes on ultrasound

Ultrasonic Characterization	Color on ultrasound	Corresponding pathological formations
Anechoic inclusions		Cysts, malignant tumors ( carcinoma), renal tuberculosis, dilatation ( ectasia) pyelocalyceal system.
Hypoechoic inclusions	dark grey	For heart diseases ( for example, chronic heart failure) the heart pumps out blood with less force. Because of this, the systolic velocity of blood flow in the renal arteries falls. At the same time, kidney function decreases, therefore, the doctor makes conclusions about kidney failure. To identify the root cause of these conditions, it is necessary to perform an ultrasound of the kidneys together with an ultrasound of the heart. Ultrasound of the heart is called echocardiography. It can also be carried out using color Doppler mapping. Ultrasound of the heart gives detailed information about the valves and chambers of the heart. Hypertonic disease is an indication for examination of the kidneys and heart at the same time. Cardiologists together with nephrologists take part in the treatment of this disease. Ultrasound of the kidneys, ureters and bladder Most often, an ultrasound of the kidneys is performed in conjunction with an ultrasound of the bladder. This is done in order to examine the entire urinary system. Changes in urine can occur due to diseases of any organ that makes up the urinary system. A stone formed in the kidney can move towards the entrance to the bladder, blocking the flow of urine in this area. In all these cases, it is necessary to perform an ultrasound not only of the kidneys, but also of the ureters and bladder. Kidney disease may be caused by disease of the bladder or ureters. Very often the infection rises from the bladder to the kidneys. This is how pyelonephritis develops. Tumors, chronic bladder diseases ( cystitis) increase the risk of kidney damage and require treatment. An ultrasound of the bladder is necessarily performed when it is full. The ureters may not be visible on ultrasound, making their examination difficult. However, when there is a stone in them and they expand due to a violation of the outflow of urine, their walls become visible on an ultrasound. In case of injuries to the kidneys and bladder, ultrasound is performed as soon as possible to determine the need surgical intervention. Ultrasound of the kidneys and abdominal organs ( pancreas, spleen, adrenal glands) Ultrasound of the kidneys is very often combined with ultrasound of the abdominal organs. This is done to establish differential diagnosis or comprehensive examination patient. Despite the fact that the kidneys are located behind the peritoneum, they are very convenient to examine together with the abdominal organs due to their topographic proximity. Ultrasound examination is indispensable in distinguishing between renal and hepatic colic. Most often, an ultrasound of the kidneys and liver is performed together to detect stones that cause strong pain on the right, in upper sections abdomen and lower back. Stones can be located in the kidneys and gallbladder. Although clinical examination can reveal the location of stones, this examination is complemented by ultrasound to confidently determine the diagnosis. If there are stones in the gall bladder and severe, ongoing pain, surgery is performed to remove them. At the same time, successful use of conservative treatment is possible for the treatment of acute renal colic. Antispasmodics and local application of heat are used to remove kidney stones. Ultrasound of the kidneys and prostate gland ( prostate) Difficulty urinating can be caused not only by kidney disease, but also by diseases prostate gland.

Ultrasound examination– modern instrumental research method internal organs person. When diagnosing kidney diseases, ultrasound is the leading research procedure. Kidney ultrasound is performed as in government medical clinics, and in commercial medical institutions.

Types of examination

There are two approaches to ultrasound examination of the kidneys:

1. Ultrasound echography is based on reflection sound waves from tissues and makes it possible to identify conglomerates, neoplasms and disturbances in the topography of organs (shape, size, location).
2. Doppler ultrasound provides information about the state of blood circulation in the renal vessels.

Interpretation of ultrasound of the kidneys, adrenal glands and CLS

After the ultrasound procedure, the patient (or his relatives) is given a conclusion. The results of interpretation of kidney ultrasound are recorded in a form understandable only to specialists, as they contain a lot medical terms. The attending physician is obliged to explain to the patient what was revealed during the examination. But sometimes it is not possible to get an appointment with a nephrologist or urologist right away, and the unknown brings considerable anxiety. Let's try to figure out which parameters are considered normal during an ultrasound scan of the kidneys, and which ones renal pathologies their changes speak.

The norm for an ultrasound of the kidneys when deciphering in an adult is as follows:

1. Organ dimensions: thickness - 4-5 cm, length 10-12 cm, width 5-6 cm, thickness of the functional part of the kidneys (parenchyma) - 1.5-2.5 cm. One of the kidneys may be larger (smaller) than the second, but not more than by 2 cm.
2. The shape of each of the pair of organs is bean-shaped.
3. Location: retroperitoneal, on both sides of the spine at the level of the 12th thoracic vertebra, right kidney at the same time it is located slightly below the left one.
4. The structure of the tissue is a homogeneous, fibrous capsule ( outer shell organ) – smooth.
5. The adrenal glands have different shapes: triangular right adrenal gland and moon-shaped left adrenal gland. Moreover, fat people the adrenal glands may not be visualized.
6. Internal cavity of the kidneys ( pyelocalyceal system or chls) – normally empty, without inclusions.

What do deviations from the norm indicate?

Changes in the kidneys indicate the development the following pathologies:

Attention! Sometimes the ultrasound transcript contains the phrase “increased pneumatosis.” Excessive air may indicate increased gas formation, but most often indicates insufficient preparation of the patient for the ultrasound procedure.

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ChLS diseases

ChLS diseases - what is it? In order to understand the mechanisms of development of pathologies of this system, it is necessary to know its structure. We have already talked about calyces and pelvises above. The pelvis, into which the calyces open, is a funnel-like cavity into which the urine accumulated in the kidneys enters. This structure is covered from the inside with mucous tissue, which protects the underlying cells from the aggressive action of urine components. Under this membrane there are layers of muscles, the contractions of which ensure the transport of urine into the ureters. If any violation occurs in one part of the system, the problem affects other parts, leading to serious problems genitourinary system.

Diseases of the organs in question may be acquired or genetically determined.

Congenital diseases are defects of the ureters and the pelvis themselves, these include:

1. Hydronephrosis - when the calyces and pelvis are dilated (dilatation of the pelvis), while the kidney parenchyma is atrophied. As a rule, the defect becomes a consequence of congenital narrowing of the urinary canals; sometimes congenital cases of vesicoureteral reflux (return of urine into the bladder) occur. With it, the structures of the kidneys grow in size, increasing the organs themselves, and the expansion of the central nervous system occurs.
2. Narrowing, up to complete fusion, of the ureters, due to intrauterine developmental anomalies. Such phenomena, called strictures, can be either bilateral or develop on one side (for example, the right kidney), and are accompanied by expansions of the entire system. The ureter, like the appendix, ends blindly.
3. Doubling the number of pelvis, ureters and calyces. Usually this anomaly does not bother the patient, who may not even be aware of the developmental defect he has all his life;
4. Other structural anomalies.

Other reasons:

• kinks of the ureters;
• consequences of kidney ultrasound;
• prolonged retention of the bladder in a full state;
• children may suffer from this pathology if they urinate profusely and infrequently;
• blocking the drainage of urine by kidney stones, inflammatory discharge and other stones;
• excessive drinking;
• urinary tract infections;
• pyelonephritis;
• low tone of the kidney muscles (including due to intoxication);
• urine reflux;
• neurological phenomena;
• other systemic problems, consequences of taking medications, etc.

Disease clinic and diagnosis

An increase in renal heart rate does not have any specific symptoms, but based on a number of signs the disease can still be diagnosed quite accurately:

• the patient feels pain in the lower back, groin area;
• frequent ineffective urges to perform minor necessities;
• slow urination process;
• blood appears in the excreted urine;
• the stomach is bloated;
• the pain is often symmetrical (comes from both kidneys). If it is one-sided, then on the side of the affected organ (for example, the left kidney) it will be much stronger.

In some cases, the patient’s blood pressure rises, fever begins, and tissue swelling appears. Before starting therapeutic measures, it is necessary to conduct a full diagnosis:

• Ultrasound of the urinary organs;
• donating blood and urine samples.

This allows us to identify pathological changes in organs even in children, including the prenatal period.

Treatment

In cases of expanding inflammatory genesis, the disease is treated symptomatically, the main goal is to stop the inflammatory process.

Medicines prescribed include:

• Indomethacin;
• Diclofenac;
• Voltaren.

They relieve inflammation and relieve pain well.

If a patient experiences muscle spasms in the urinary system, he is additionally prescribed antispasmodics like no-shpa and the like. Patients with a bacterial disease are treated with uroseptics - special antibiotics. This group includes aminoglycosides and fluoroquinolones.

Surgical intervention is indicated if there are difficulties in the outflow of urine. Thus, blockage of the urinary tract is eliminated by crushing the nodules that blocked the ducts using shock wave or contract lithotripsy.

The most best treatment Any disease is prevention.

To minimize the risk of developing the disease, you should:

• drink the recommended amount of fluid per day (from one and a half to two liters);
• lead healthy image life;
• conduct a periodic preventive course of diuretics.

During pregnancy, refusal bad habits and a healthy lifestyle is especially important: this will help prevent the development of congenital defects in the fetus.

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Pelvis dimensions

Normally, the size of the renal pelvis does not exceed 10 mm in an adult. However, a condition such as pregnancy in women leads to their size increasing significantly. There is no need to worry about this - large pelvis sizes during pregnancy are normal.

The first trimester of pregnancy allows a change in the norm up to 18 mm. Further, as pregnancy progresses, the size can reach 27 mm.

If there is no pregnancy, but the size increases, this indicates additional kidney pathology. The size of the pelvis may change due to the following reasons:

• tumors compressing the urinary tract;
• stones in the ureters;
• kinking or torsion of the urinary tract.

In a child, the size of the renal pelvis is slightly smaller, reaching 6 mm. This is the norm and may vary slightly. The child’s parents should know that the size of the renal pelvis is a fixed value and remains the same in children before and after urination. Sometimes a variant of the norm is the size of the pelvis, reaching 7 or 8 mm. To confirm that the child’s enlarged cavity is not pathological, it is necessary to undergo an annual ultrasound examination of the kidneys.

Doctors can identify pathologies of the pyelocaliceal system in children even before the child is born. Already at 17-20 weeks of pregnancy, the doctor functional diagnostics clearly sees the urinary organs of the fetus, and can suggest one or another pathology in the kidneys of the unborn child.

Enlargement of the renal pelvis in children is called pyeloectasia.

If we analyze the health status of children born with pyeelectasis, boys are considered the leaders. They have enlarged renal pelvises 5 times more often than in newborn girls. However, there are also pitfalls here: in most cases, pyeloectsia in male children disappears without a trace by six months. But for female children, it is often evidence of another, more serious pathology.

Increased size in an adult may indicate a disease such as hydronephrosis. But we'll talk about this a little lower.

It is difficult to consider pathological processes in isolation. The renal pelvis in both an adult and a child is anatomically closely connected with the ureter, so that any disease affects both structures. Let's talk about the main pathologies.

Hydronephrosis in adults and children

Hydronephrosis, or dilation of the renal pelvis, can be either acquired or congenital.

If hydronephrosis is detected in the baby's kidneys, he will only be monitored until birth. Most often, this pathology occurs due to genetic predisposition. According to statistics, congenital hydronephrosis is present in 1.4% of newborns.

Acquired hydronephrosis may be associated with:

• with oncological pathologies;
• with vesicoureteral reflux;
• with urolithiasis.

Treatment of hydronephrosis is mainly surgical. Often performed using minimally invasive methods.

Doubling

“Double” renal pelvis is a rare and varied pathology. It happens that a person lives his whole life, having two containers for storing urine or several ureters, and does not suffer from this at all, since the basic functions of the kidney are not impaired. If segment duplication is detected in a child, this is not normal, however, treatment is not suggested. If the functions of the urinary system are not impaired, drug therapy or surgery not required.

Oncological processes

Malignant processes directly in the pyelocaliceal segment are rare. More often the tumor affects the entire kidney or bladder. If oncological tumor formed from the epithelium that lines the inner surface of the urine reservoir, they speak of adenocarcinoma.

Helps identify cancer pathology instrumental methods diagnostics The patient's general condition deteriorates sharply, hematuria, weakness, and pain of unknown origin appear in the lower back. Sudden weight loss is a clear symptom oncological diseases. If your friend or relative suddenly begins to lose weight sharply in a short period of time, possible reason may be oncology. Cancer surgeons and oncourologists treat pelvic cancer. The choice of treatment technique depends on many factors and is always strictly individual. In progress surgical operations, chemotherapy is carried out.

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Indications for ultrasound of the urinary system

Any examination, even one as safe and non-traumatic as an ultrasound examination, must be carried out according to indications. For ultrasound examination, the reasons for conducting diagnostics are:

• observation for chronic diseases of the urinary system (pyelonephritis, glamerulonephritis, cysts, etc.);
• preventive examination;
• regular headaches of a migraine nature, as well as against the background of hypertension;
• swelling lower limbs, faces;
• endocrine diseases;
• congenital pathologies of the genital organs;
• injuries and pain in the lumbar region;
• disturbance of urination (frequency, incontinence, pain during the process), suspicion of hydronephrosis;
• renal colic;
• changes in OAM data (protein, blood, mucus in urine).

Pathologies detected by ultrasound diagnostics

What does a kidney ultrasound show? The ultrasound diagnostic procedure can detect a number of changes in the urinary system from simple to very serious:

• inflammatory diseases of the urinary system (for example, nephritis);
• traumatic diseases;
• congenital anomalies;
• neoplasms;
• diseases vascular system kidneys (possibly performing ultrasound examination renal vessels);
• damage to parenchymal tissues;
• injuries;
• hydronephrosis.

Parameters assessed during ultrasound examination

During ultrasound diagnostics, the number of organs (one, two, the presence of an additional organ), mobility, location and shape, parameters and structure are assessed, the renal pelvis and ureters are studied. In the normal state of the body, the mobility of organs is not great and amounts to up to one and a half centimeters. In case of prolapse or the so-called “wandering” kidney, mobility increases.

Normal position of the kidneys- on both sides spinal column(left is higher than right). However, they can change their location and be on one side (one under the other), in the pelvic area (this prolapse of the kidneys is called nephroptosis).

Normal form for this organ - bean grain. In case of developmental anomalies, the organs can take the shape of a horseshoe, the English letters “S” and “L”, and sometimes their fusion is observed.

The normal shape of the kidneys resembles the outline of beans. However, with the development of pathologies, they can take the form of a horseshoe or the English letter “S”

One of the most important diagnostic indicators is the size of the kidneys. These parameters are different for children and adults. For children, there is a separate table with the norms of indicators and their interpretation. But no matter what the specifics of interpreting the results of kidney ultrasound in children or pregnant women may be, most diseases of the urinary system are accompanied by changes in the size of the kidneys (for example, hydronephrosis leads to an enlargement of this organ).

Normal size indicators kidneys in an adult are as follows:

• the thickness of the renal parenchyma is about 23 mm;
• length is 100-120 mm;
• the organ has a width of 40-50 mm;
• the thickness of the organ is about 45-55 mm, the thickness of the renal capsule is about 1.5 cm;
• one organ weighs 120-200 grams.

There is also a decrease in kidney parenchyma with age, after surgical interventions associated with kidney removal. The remaining organ, taking over the functions of its distant counterpart, may undergo changes in the direction of increase.

Structure a healthy kidney is not homogeneous, the contours are visualized as smooth and clear. The development of any disease affects this structure. Compaction of some structures indicates inflammation, the presence of foreign formations (conglomerates, stones) indicates the accumulation of sand and stones or the development of a tumor. Echo signs of hydronephrosis are: enlargement of the affected organ and accumulation of fluid in its cavities.

Calyces and renal pelvis normally should not be visualized. They are anechoic in nature and are detected by ultrasound diagnostics only when the pathological process develops. For example, dilation of the pelvis indicates the development of pyelonephritis, hydronephrosis and calculosis.

Ureters Normally they have a length of 25-30 cm; normally on ultrasound they have light walls with a dark cavity. In the case of pathological bends, shortening/lengthening of the ureters, the outflow of urine is disrupted and infectious processes develop. Duplication of the ureters may also occur, and the place where the ureter opens into the kidney may be blocked by a valve. In addition, there may be a stone in the ureter. All these changes will be revealed by ultrasound.

Ultrasound examination makes it possible to determine the presence of stones in the ureters so that the doctor can take timely measures to neutralize them

Interpretation of ultrasound data and doctor’s report

Interpreting kidney ultrasound is the job of a qualified specialist. However, anyone can familiarize themselves with the basic concepts that may appear in the ultrasound diagnostic doctor’s conclusion. The following results are often encountered:

• Volumetric echo-positive formations are neoplasms. In case of homogeneity we're talking about O benign education. In case of heterogeneity and uneven contour formation - we are talking about a malignant tumor.
• Cysts are located as non-echoic (anechoic) space-occupying formations. Their parameters and contents are indicated in the conclusion.
• Microliths are sand or small stones up to 3mm.
• Conglomerate (echo-shadow, hyper-echo-like formation) – stones.
• The presence of hypoechoic zones in the renal parenchyma indicates edema ( common symptom pyelonephritis).
• The presence of hyperechoic zones in the renal parenchyma is evidence of hemorrhage.
• A spongy structure may indicate congenital cystosis.
• An enlarged pelvis indicates hydronephrosis and ureteral obstruction.
• Consolidation of the mucous membrane of the renal pelvis indicates swelling of the tissue, this is another evidence of pyelonephritis.

The human kidney is a unique paired organ that continuously cleanses the blood of substances harmful to the body. human body. The size of the kidney is normal - this is one of the most important diagnostic parameters. They vary depending on age, gender and body mass index.

Anatomy of the human kidney

Let's look at the main structural elements of the kidney:

1. The kidney is covered with a thin connective tissue capsule and a serous membrane (in front).
2. The kidney parenchyma consists of the cortex and medulla. The cortex is located in a continuous layer under the renal capsule. The medulla is 10-18 conical pyramids with medullary rays located at the base, growing into cortex. The renal parenchyma is represented by epithelial tubules and renal corpuscles, which together with blood vessels form nephrons (up to 1 million in each kidney).
3. The structural unit of the kidney is the nephron.
4. The funnel-shaped cavity that receives urine from the nephron is called the pelvis.
5. The organ that receives urine from the renal pelvis and transports it to the bladder is called the ureter
6. The blood vessel that branches from the aorta and brings blood contaminated with waste products to the kidneys is called the renal artery, and the vessel that delivers filtered blood to the vena cava is called the renal vein.

Kidney size assessment

What factors influence kidney size?

Numerous studies have found that the thickness, width and length of the cortical layer, as well as the size of the kidney in men are much larger than in women. This is due to the fact that representatives of the stronger sex have body sizes that exceed those of the female body.

At the same time, the researchers found an insignificant difference between the lengths of the right and left kidney (the left kidney is on average 5% larger than the right). According to experts, the vertical growth of the right kidney is hampered by the liver.

Also affects the size of the adult kidney big influence age. The kidneys “grow” until the age of twenty to twenty-five, then they remain relatively stable throughout middle age, and after fifty years they begin to decline.

How does body mass index affect kidney size?

During the research, it was found that kidney size is closely related to body mass index (BMI). With an increase in BMI, not only the size of the kidneys increases, but also their volume, height and height.

Note: with the development of hypertension or diabetes mellitus, renal hypertrophy develops.

Normal adult kidney size

The longitudinal size of the kidney of an adult is on average 100-120 mm (more precisely, from 80 to 130 mm). As a rule, the length of the kidney corresponds to the height of three lumbar vertebrae, the width is in the range of 45-70 mm, and the thickness is 40-50 mm.

Note: no matter what size the bud is, its length to width ratio is 2:1.

In young people, the normal size of the kidney parenchyma (its thickness) ranges from 15-25 mm. With age, as a result of atherosclerotic processes or inflammation, its thinning occurs, and in people over sixty years of age, the thickness of the parenchyma often does not exceed 11 mm. To assess the structure of the kidney in clinical practice, the parenchymopyelic index is used.

I would like to note that the kidney healthy person in size does not exceed the size of his fist.

Kidney structure

Kidney size in children

It should be noted that all children develop differently, and therefore difficulties arise in determining the size of the kidneys in childhood. However, during the research, scientists were able to determine the average length of the kidneys based on age:

1. From birth to two months, the kidney size is 49 mm;
2. From three months to one year – 62 mm;
3. From one to five years – 73 mm;
4. From five to ten years – 85 mm;
5. From ten to fifteen years - 98 mm;
6. From fifteen to nineteen years - 106 mm.

To more accurately determine the size of a child’s kidney, his weight and height are taken into account.

Fun fact: Babies have kidneys that are three times larger relative to their body weight than adults.

Basic kidney functions

The main function of the kidneys is to cleanse the blood of waste and toxic substances. The most harmful waste products of the human body are urea and uric acid. The accumulation of large amounts of these substances causes the development of numerous severe pathologies, and this can also lead to death. During the filtration process, the renal parenchyma cleanses the body of waste (they are collected in the pelvis and transported to the bladder).

An interesting fact: the kidney parenchyma manages to completely cleanse the blood about fifty times per day.

The main functions of the kidneys include:

• Urine formation. Thanks to the kidneys, excess water, organic and inorganic substances, as well as nitrogen metabolism products and toxins are removed from the body;
• Maintaining a normal water-salt balance (due to fluid excreted in the urine);
• Regulation blood pressure(due to the secretion of renin, excretion of water and sodium, as well as depressor substances);
• Regulation of pH levels;
• Hormone production;
• Vitamin D production;
• Regulation of hemostasis (formation of humoral regulators of blood coagulation, as well as participation in heparin metabolism);
• Regulation of erythropoiesis;
• Metabolic function (participation in the metabolism of proteins, carbohydrates and lipids);
• Protective function (removal of foreign and toxic substances from the body).

Note: with the development of various pathological conditions renal excretion is often impaired medicines, and therefore patients may experience side effects and even poisoning.

At the moment, one of the frequently prescribed diagnostic methods that determine the condition of the kidneys is ultrasound examination. Kidney ultrasound results will help determine possible diseases organs or pathological manifestations. Using ultrasound, the following parameters are determined: quantity, location, contours, shape and size, structure of parenchymal tissue. It is determined whether there are neoplasms, stones, inflammation and swelling. Renal blood flow is visualized.

Indications for an ultrasound are: urination problems, the appearance of blood in the urine, pain in the lumbar region, existing injuries. inflammatory processes, bad urine test.

Kidney ultrasound allows you to examine the health or progress of the organ’s disease, selecting appropriate therapy based on the data obtained.

Parameters and indicators studied

• Quantity. A healthy person has two kidneys. There are cases when one is removed surgically due to certain reasons. Anomalies in the number of these organs are possible: complete absence or doubling.
• Dimensional data. Using ultrasound, the length, width and thickness of the organ are measured. Kidney size varies depending on a person's age, weight, and height.
• Localization. The retroperitoneal location of the organs is normal. The right kidney (D) is located just below the left (L). The location of the right kidney is considered normal at the level of the 12th thoracic vertebra and the 2nd lumbar vertebra, the left kidney - at the level of the 11th thoracic and 1st lumbar vertebrae.
• Shape and contours. The bean-shaped shape is considered normal. The structure of the tissue is normal - homogeneous with smooth contours.
• The structure of the renal parenchyma, that is, the tissue that fills the organ. In a healthy person, its thickness ranges from 14 to 26 mm. With age, the parenchyma becomes thinner, and for older people the norm for this indicator is 10-11 mm. An increase in this parameter indicates inflammation or swelling of the organ, a decrease indicates dystrophic changes.
• State of blood flow. When analyzing renal blood flow, a color image is used on the monitor of an ultrasound machine. Dark tones indicate that the patient's blood flow is normal (50-150 cm/sec). Bright spots indicate increased renal blood flow.

Ultrasound results in adult women and men

Diagnosis of kidney condition does not differ between people of different genders. The norms of indicators are the same for both men and women. The normal size of a woman's kidneys is different during pregnancy. The norm is considered to be lengthening of the organ up to 2 cm; slight expansion is allowed along with the pelvis and ureters. The norm for adults when decoding the results is as follows: thickness - 40-50 mm, length 100-120 mm, width 50-60 mm, thickness of the functional part - 15-25 mm. The sizes of the right and left kidneys differ, but not more than 2 cm. The normal ultrasound scan of the kidneys in an adult is determined by the height indicator. Using the table below, you can determine the normal size of the kidneys relative to a person's height.

Height	Length, mm		Width, mm		Parenchyma thickness, mm
	Left	Right	Left	Right	Left	Right
150	85	82	33	29	13	13
160	92	90	35	33	14	13
180	105	100	38	37	17	15
200	110	105	43	41	18	17

Ultrasound results in children

Kidney examinations in children using ultrasound are carried out in the same way as in adults. When prescribing an ultrasound for a baby, the likelihood of abnormalities in the development of organs is taken into account due to heredity, severe pregnancy and childbirth in the mother, resuscitation of the child at birth, and changes in urine tests. Kidney ultrasound in older children is prescribed after urine tests, if there are complaints of pain in the lumbar region or abdomen, due to injuries, or problems with urination. To decipher the results of a child’s ultrasound, a completely different table of indicator norms is used. Features of visualization of the kidney on ultrasound in newborns, since the organs are small and the development of their structure is not complete.

Age	Right			Left
	thickness, mm	length, mm	width, mm	thickness, mm	length, mm	width, mm
1-2 months	18,0-29,5	39,0-68,9	15,9-31,5	13,6-30,2	40,0-71,0	15,9-31,0
3-6 months	19,1-30,3	45,6-70,0	18,2-31,8	19,0-30,6	47,0-72,0	17,2-31,0
1-3 years	20,4-31,6	54,7-82,3	20,9-35,3	21,2-34,0	55,6-84,8	19,2-36,4
up to 7 years old	23,7-38,5	66,3-95,5	26,2-41,0	21,4-42,6	67,0-99,4	23,5-40,7

Pelvis dimensions

In an adult, the normal size of the pelvis should not be more than 10 mm. However, the exception for women is during pregnancy, when enlargement of the pelvis is normal. In the first trimester, the anterior-posterior size of the pelvis on the right is considered to be up to 18 mm, on the left - up to 15 mm, in the second trimester the anterior-posterior size of the pelvis on the right is up to 27 mm, on the left - up to 18 mm. In children, the size of the pelvis is smaller - about 6 mm.

Interpretation of ultrasound results and identification of kidney pathologies

An ultrasound machine allows you to measure various parameters of the organ being examined. But the numbers themselves don’t say anything. Only an experienced specialist, namely a urologist, can give a high-quality interpretation of the meanings. Deciphering the results of a kidney study means comparing the obtained indicators with the norms. The size of the kidney is normal if the indicators fall within the range characteristic of humans of a certain age. The patient receives a conclusion after the study. When interpreting ultrasound results, special terminology is used.

Concepts and terminology

An entry such as increased pneumatosis intestinalis indicates that the organ contains a large number of gases and the results may be distorted. This is due to incorrectness and does not mean the presence of a disease. When examining the structure of the parenchyma, the concept of echogenicity is used. The echogenicity of healthy organ tissue is homogeneous. Hypoechogenicity describes a structure that is darker than the surrounding tissue. A hyperechoic formation appears on the monitor as a white spot. Homogeneous hyperechogenicity is distinguished and heterogeneous, when there is an alternation of normal tissue and tissue with increased echogenicity.

The term nephroptosis indicates strong mobility of the organ, displacement of the kidney from its normal position to the abdomen or pelvis. With this disease, the normal outflow of urine from the renal structures is disrupted, intrarenal pressure increases, and blood circulation in the organ worsens. Nephroptosis of the right kidney is the most common. Left kidney falls much less frequently. A more rare occurrence is the prolapse of a couple of organs at once.

The term microcalculosis means the discovery of sand or small stones in the kidneys that may pass on their own. The abbreviation MKD stands for and indicates the presence of urate sand. Ultrasound clearly shows the presence of stones (urolithiasis), as well as other associated pathological manifestations (pyelonephritis, hydronephrosis).

If the ultrasound transcript contains the term space-occupying formations, this may indicate the detection of neoplasms, cysts and abscesses. A formation with clear contours or darkened areas on the kidney will also indicate the presence of cysts. An abscess on ultrasound is perceived as a round-shaped formation with low echogenicity.

It is not only one of the most accessible procedures, but is also a safe and informative technique. A renal ultrasound is required in many cases when there is a suspicion of various pathologies in women, men and children. Some situations require the appointment of such an examination in relation to the fetus - usually this is the third trimester; this approach makes it possible to identify diseases of the urinary system before the birth of the child.

One of the most important points is deciphering the ultrasound of the kidneys, since only after it an accurate diagnosis is established and competent treatment is prescribed.

What can a renal ultrasound show?

Let's talk about what ultrasound shows. There are a number of specific parameters and norms, the violation of which should raise concerns.

When performing an ultrasound, the following is considered:

• Quantity, since the kidneys are paired organs. In this case, anomalies cannot be excluded - the presence of an additional kidney, its doubling, or its complete absence may be observed. In some cases, the absence of one of the organs is the result of surgical intervention due to certain reasons.
• The dimensions of the organs, including not only the width and length, but also the thickness of the kidneys. These indicators depend on age group, to which the patient belongs, his body weight and height.
• The location of the organ is also determined using the ultrasound method. Normal indicators imply its retroperitoneal localization, with the right kidney lying slightly lower than the left. If we consider the position of the organs relative to the vertebral region, the right one is located opposite the twelfth thoracic and second lumbar vertebrae. – at the level of the first lumbar and eleventh thoracic.
• The shape of an organ is considered normal if it resembles a bean. The contours should be smooth, and the structure of the tissues should be homogeneous.
• An important indicator is the structure of the parenchyma, this is the tissue filling the organ. The norm in adult patients is thickness in the range of 14-26 mm. It should be taken into account that over time the parenchyma becomes thinner. Accordingly, for the older generation the norm is 10-11 mm. If the description includes results exceeding the indicated figures, we can talk about inflammatory processes or swelling of the kidneys. In the case when the parameters are less than normal, we are talking about dystrophic phenomena.
• When examining renal blood flow, specialists view the image in color on an ultrasound monitor. In the presence of dark tones, it can be argued that the blood flow is not impaired, amounting to 50-150 cm/sec, but if brightly illuminated areas are observed, it is enhanced.

In addition, ultrasound will show the presence of neoplasms, both benign and malignant, and the presence of stones in the kidney cavities.

Important. Conducting an ultrasound scan in adults requires preliminary preparation and adherence to certain rules; only in this case will it be possible to obtain reliable data.

Preliminary preparation and ultrasound examination

The reliability of the information depends on how correctly the preparation for the procedure and the ultrasound itself were carried out. Before an ultrasound examination, it is necessary to adhere to a diet for three days, since changing the diet will facilitate the work of the kidneys and make it as easy as possible to obtain actual results. The menu should include products that will not be difficult to process. Recommended to use:

1. Porridge on the water.
2. Lean poultry and rabbit meat, fish fillet.
3. Low-fat fermented milk products.
4. Boiled eggs.
5. Steamed, stewed, boiled vegetables.
6. Vegetable soups or with secondary broth.

When preparing meat and fish dishes, you should avoid frying and baking; preference is given to boiling and stewing. Alcohol is strictly prohibited - as are foods whose consumption provokes flatulence, as well as heavy foods, smoked foods, chocolate, pickles and preserves.

To what extent do the results of a kidney ultrasound depend on whether food was consumed immediately before the procedure? What is of great importance here is what type of research is prescribed. If the kidney test is carried out in parallel with abdominal cavity, the duration of fasting before the procedure should be at least 8-12 hours, which, if you follow a diet, guarantees complete processing of food in the gastrointestinal tract. If only the kidneys are to be examined and the ultrasound is scheduled for the afternoon, a light breakfast is allowed, but during the morning procedure you should refrain from it. Bladder fullness is of great importance for obtaining valid results.

Ultrasound of the organs of women and men is carried out with the patient lying on his side or on his back - this position of the body allows you to obtain the most accurate information. Skin covering over the organ being examined is lubricated with a special gel to avoid the appearance of air bubbles and impact hairline. An ultrasound examination lasts from 20 to 30 minutes; health status plays an important role here.

During the session, the sonologist takes measurements of the required parameters, and also describes the characteristics of the kidneys and blood vessels. Certain moments are captured in photographs. After the study is completed, all the materials received are at the disposal of the diagnostician, it is he who gives the conclusion of the ultrasound of the kidneys, without affecting the formulation of the diagnosis, since this action is within the scope of activity of the attending physician.

Interpretation of research results

Normal kidneys are an individual concept for each patient, taking into account the peculiarities of the anatomy. The standards adopted when interpreting the results of ultrasound examinations of the kidneys and established in medicine were calculated in relation to people with different body weight, height, complexion, and age. The result is templates with the help of which the assessment of the existing pathology or norm becomes simpler and more reliable. Each table includes a list of normal indicators, based on which the doctor:

• can decrypt received data;
• determines the degree of deviation;
• calculates the stage of development of the disease and the danger to the body.

Important. Even with access to such tables, patients should not interpret the results of ultrasound examinations on their own, since their conclusions may be superficial or even completely erroneous.

Here is a simple example: the size of the kidney often increases under the influence of inflammatory processes, be it pyelonephritis or other pathologies. However, similar changes will also occur in the absence of a second organ as a result of removal or anomaly.

Let's look at the table, the data of which doctors take as a sample of the norm when they decipher ultrasound of the kidneys in adult patients:

Research Options	Standard indicators
Number of kidneys.	Paired organ.
Kidney shape.	Bean-shaped.
Kidney sizes.	Length from 100 to 12 mm, width from 50 to 60 mm, thickness from 40 to 50 mm. The difference between the right and left kidneys in terms of size should not exceed 20 mm.
Localization of the organ.	The lower border is located opposite the first or second lumbar vertebra, while the right kidney lies slightly lower, taking into account the displacement under the influence of the liver.
Size (thickness) of the parenchyma.	The maximum value is 25 mm, but for most people its dimensions fall within the range of 15 to 23 mm. When a person reaches an age of over 60 years, the thickness of the parenchyma can decrease to 10 mm, which is considered normal.
Capsule.	Normally, there is a clear, even formation, its thickness is 1.5 mm.
Mobility during breathing.	The displacement of the organ during this action should not exceed 20-30 mm.
Outer border.	It is distinguished by clarity and evenness, but at the same time smoothness, there are no protrusions, the line is continuous.

Echogenicity

On ultrasound of the kidneys, in addition to the indicated parameters, echogenicity is visible. What it is? This is the name given to the ability of organs to reflect ultrasound, as a result of which their image appears on the monitor. The greater the amount of fluid contained in the organ, the darker the picture that appears on the screen. Normally, the echogenicity of the kidneys should be uniform, but a lighter image indicates increased level this indicator relative to the parenchyma. Typically, this result accompanies tissue compaction, which occurs with glomerulonephritis or sclerotic processes.

Increased echogenicity may also indicate the presence of:

1. Chronic pyelonephritis.
2. Amyloidosis.
3. Benign or cancerous tumors.
4. Affected organs in case of development of arterial hypertension.

It should be noted that ultrasound standards do not differ in men and women. The exception is the fairer sex during gestation. In this case, it is considered natural to increase the length of the organ; the size of the pelvis can normally also increase, as well as the size of the ureters.

The relationship between height and size and studies of the pyelocalyceal system

As stated above, normal sizes kidneys according to ultrasound correspond to a certain growth, as evidenced by the following table:

It is worth considering the ChLS separately. Normally, the pyelocalyceal system is not visualized during ultrasound examination. However, in the case of expansion, the calyxes together with the pelvis can be observed on the monitor, which accordingly indicates the likelihood of the formation of a pathological process. Normally, the organ pelvis should not exceed 10 mm, but there are exceptions. So, when carrying a child, their size increases - this indicator depends on the duration of pregnancy:

• First trimester. The pelvis of the right organ can reach about 18 mm, the left - not exceed 15 mm.
• Second trimester. The dimensions of the right pelvis increase to 27 mm, the left - to 18 mm.

When considering echogenicity, normal renal tissue may show areas of low density called pyramids. It happens that they are mistaken for expansion of the calyces or are regarded as an inflammatory lesion, cystic formation. The central echo complex is a total reflection of the CLS and other structures - nervous, vascular or lymphatic, which are also surrounded by fibrous and adipose tissue.

As stated, the standards assume a splitting of the CLS against the background, which is no more than 10 mm. However, in cases where ultrasound shows exclusively expansion of the mandibular joint, the transcript indicates pyelectasia, which is essentially initial stage formation of hydronephrosis. If the shape of the pelvis changes, it can be assumed that the urinary tract is blocked by a stone, the presence of adhesive process, cysts, other neoplasms.

The result of the study is a conclusion in which diagnosticians use special terminology. Thus, increased pneumatosis indicates that the kidneys contain an increased amount of gases, which can significantly distort the result - this is a common occurrence when the rules of preparation for the procedure are ignored. Nephroptosis indicates increased mobility, displacement of an organ from its natural position to the pelvic or abdominal area. When microcalculosis is mentioned, they conclude that there is sand and small stones that can leave the system on their own. MCD refers to uric acid diathesis, in which urate sand is found in the organ. Space-occupying formations are abscesses, cysts, and various tumors.

If we talk about who is usually prescribed an ultrasound, such a study is carried out with frequent lumbar pain, discomfort when emptying the bladder, swelling of the extremities, with a persistent increase in temperature, symptoms indicating inflammatory processes. Ultrasound of the kidneys is also necessary for pregnant women, since the load on the organ increases in pregnant women. The study is also carried out in cases of dysfunction of the endocrine system.